Drug information of Procyclidine

Procyclidine


A muscarinic antagonist that crosses the blood-brain barrier and is used in the treatment of drug-induced extrapyramidal disorders and in parkinsonism.

Mechanism of effect

The mechanism of action is unknown. It is thought that Procyclidine acts by blocking central cholinergic receptors, and thus balancing cholinergic and dopaminergic activity in the basal ganglia.

 Many of its effects are due to its pharmacologic similarities with atropine. Procyclidine exerts an antispasmodic effect on smooth muscle, and may produce mydriasis and reduction in salivation

Pharmacodynamic

Procyclidine has an atropine-like action on parasympathetic-innervated peripheral structures including smooth muscle. It's antispasmodic effects are thought to be related to the blockage of central cholinergic receptors M1, M2 and M4. It is used to treat symptomatic Parkinsonism and extrapyramidal dysfunction caused by antipsychotic agents.

Pharmacokinetics

Not Available

Drug indications

extrapyramidal effects

Dosage

  • Adults

Parkinsonian Syndrome

Therapy-Naive Patients

Oral

Initially, 2.5 mg 3 times daily after meals.As tolerated, gradually increase to 5 mg 3 times daily or the minimum dosage needed to control symptoms. If needed, administer an additional 5-mg dose at bedtime.

If bedtime dosage is not tolerated, total daily dosage may be administered in 3 divided doses.

Patients Transferring from Other Antiparkinsonian Therapy

Oral

Gradually substitute 2.5 mg 3 times daily for all or part of original drug. Increase procyclidine dose as needed while decreasing other drug until complete replacement achieved.

Drug-Induced Extrapyramidal Reactions

Oral

Initially, 2.5 mg 3 times daily; increase by 2.5-mg increments until symptoms controlled.

Usual dosage: 10–20 mg daily.

·         Pediatric Use

Safety and efficacy not established.

Alerts

  • Caution in tachyarrhythmias because antimuscarinics block vagal inhibition of the SA nodal pacemaker.
  • Possible decreased tone and amplitude of contractions of the ureters and bladder with resultant urinary retention;c use with caution in patients with prostatic hypertrophy.
  • Use with caution and carefully monitor hypotensive patients.
  • Possible mental confusion, disorientation, agitation, hallucinations, and psychotic-like symptoms, particularly in older patients.
  • Possible increased ocular tension.

Points of recommendation

It is best to take this medicine during or after meals to avoid side effects.

To gain the most benefit, do not miss doses.

Pregnancy level

C


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