Procyclidine Hydrochloride

Indications

Procyclidine Hydrochloride is used for: Parkinsonism, Drug-induced extrapyramidal syndrome

Adult Dose

Oral Parkinsonism and drug-induced extrapyramidal syndrome Adult: As hydrochloride: Initially, 2.5 mg tid, increased gradually by 2.5-5 mg every 2-3 days if required. Maintenance: 10-30 mg/day in 3-4 divided doses. Up to 60 mg daily may be required in some cases. Parenteral Parkinsonism and drug-induced extrapyramidal syndrome Adult: Emergency cases: IV admin: 5-10 mg, higher doses may be needed; IM admin: 5-10 mg as a single dose, may repeat after 20 minutes if needed, to a max of 20 mg daily. Elderly: Lower doses are required.

Child Dose

Oral Dystonia in children Child: 7-12 yr: 1.25 mg tid; 12-18 yr: 2.5 mg tid. For emergency cases, a single dose may be given via IM or IV inj: <2 yr: 0.5-2 mg; 2-10 yr: 2-5 mg and 10-18 yr: 5-10 mg.

Renal Dose

Administration

Contra Indications

Urinary outflow obstruction, prostatic hyperthrophy, narrow-angle glaucoma, paralytic ileus and pyloric stenosis.

Precautions

Patient w/ mental disorders, CV disease (e.g. tachycardia, cardiac arrhythmias, hypertention, hypotension). Hepatic and renal impairment. Avoid abrupt withdrawal. Elderly. Pregnancy and lactation. Patient Counselling This drug may cause blurred vision, dizziness, confusion or disorientation, if affected, do not drive or operate machinery. Monitoring Parameters Monitor symptoms of extrapyramydal syndrome or Parkinson's disease, pulse, anticholinergic effects (e.g. CNS, bowel and bladder function).

Pregnancy-Lactation

Interactions

Increased plasma concentrations w/ paroxetine. Enhanced anticholinergic action w/ MAOIs and other anticholinergic drugs. Reduced therapeutic effect w/ cholinergic drugs. May antagonise the effect of parasympathomimetic agents. May reduce the absorption and therapeutic effect of sublingual or buccal nitrate tab. May reduce the efficacy of levodopa. May antagonise the GI effects of cisapride, domperidone and metoclopramide. May potentiate the vagolytic effects of quinidine. May reduce the absorption of ketoconazole.

Adverse Effects

Side effects of Procyclidine Hydrochloride : Dry mouth, mydriasis, blurred vision, lightheadedness, giddiness, disorientation, GI effects (e.g. nausea, vomiting, epigastric distress, constipation), allergic reaction (e.g. rash), muscular weakness; vertigo, confusion, hallucinations at high doses; tremor, acute suppurative parotitis.

Mechanism of Action

Procyclidine is a tertiary amine antimuscarinic which acts by blocking excess acetylcholine at cerebral synapses. It also exhibits direct antispasmodic effect on smooth muscle.