Indications

Procyclidine is used for the adjunctive treatment of all forms of parkinsonian syndrome. It is mainly used for the symptomatic treatment of idiopathic (paralysis agitants), postencephalitic and arteriosclerotic parkinsonian. It is used to control troublesome extrapyramidal symptoms including pseudoparkinsonian, acute dystonic reactions and akathisia induced by neuroleptic drugs such as phenothiazine derivatives.

Therapeutic Class

Antiparkinson drugs

Pharmacology

Procyclidine hydrochloride is an antimuscarinic antiparkinsonian agent of relatively low toxicity. It is a synthetic tertiary amine. This drug exerts their antiparkinsonian effect by correcting the relative cholinergic excess which is thought to occur in parkinsonian as a result of dopamine deficiency. It is absorbed from G.I. tract and disappears rapidly from the tissues. After intravenous administration, it acts within 5 to 20 minutes and has a duration of effect up to 4 hours.

Dosage & Administration

Oral administration:

Adults: Procyclidine tablet is administered orally, preferably after meals.

Parkinsonism: Initially 2.5 mg 3 times a day, then 5 mg 3 times a day and occasionally 5 mg at bed time. The dosage being adjusted as tolerated or until the total daily dose reaches 20 to 30 mg divided into 3 to 4 doses.

Drug induced extrapyramidal symptom: Initially 2.5 mg 3 times a day. The dosage being increased by 2.5 mg increment per day as needed and tolerated.

Children: Safety and efficacy have not been established in the pediatric age group; therefore, the use of procyclidine hydrochloride in this age group requires that the potential benefits be weighed against the possible hazards to children.

IM or IV administration:

By intramuscular or intravenous injection, 5-10 mg, repeated if necessary after 20 minutes; maximum 20 mg daily can be given.

Interaction

The anticholinergic activity of procyclidine may be increased by agents having anticholinergic amantadine. The absorption of ketoconazole may be reduced by concomitant administration of procyclidine.

Contraindications

It should be given with caution in children and geriatric patients. It is advisable to be cautious in giving Procyclidine to patients with diarrhoea and cardiovascular disease, glaucoma, urinary retention, hepatic or renal impairment. The safety of using procyclidine during pregnancy has not been established. No data are available on the excretion of this drug in breast milk.

Side Effects

At usual dosage levels dryness of the mouth is generally the only adverse effect. Mydriasis, blurred vision and adverse G.I. effects (nausea, vomiting, epigastric distress, constipation) occur occasionally. An allergic reaction (e.g. rash) or muscular weakness may occasionally occur. High doses may cause vertigo and possibly confusion and hallucination. Adverse effect may usually be minimized by adjustment of dosage and administration after meal.

Pregnancy & Lactation

The safe use of this drug in pregnancy, lactation or in women of childbearing age requires that the potential benefits be weighed against the possible hazards to the mother and child.

Precautions & Warnings

Precaution should be taken in case of hepatic & renal impairment, children, elderly, pregnancy and lactation condition. Patients with mental disorders occasionally experience a precipitation of a psychotic episode when Procyclidine is administered for the treatment of the extrapyramidal side-effects of neuroleptic. Procyclidine should not be withdrawn abruptly as rebound Parkinsonism symptoms may occur.

Storage Conditions

Store between 15-30° C. Protect from moisture.