PROCYCLIDINE

Indications & Dose:

Parkinsonism

Extrapyramidal symptoms (but not tardive dyskinesia)

• BY MOUTH

Adult: 2.5 mg 3 times a day, then increased in steps of 2.5–5 mg daily if required; increased if necessary up to 30 mg daily in 2–4 divided doses, to be increased at 2–3 day intervals. Maximum daily dose only to be used in exceptional circumstances; maximum 60 mg per day

Elderly: Lower end of range preferable

Acute dystonia

• BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INJECTION

Adult: 5–10 mg, occasionally, more than 10 mg, dose usually effective in 5–10 minutes but may need 30 minutes for relief

Elderly: Lower end of range preferable

Contraindications:

 Narrowangle glaucoma, myasthenia gravis, GI/GU obstruction, peptic ulcer, megacolon, prostatic hypertrophy

Side Effects:

Cautions:

Precautions:

Elderly, tachycardia, liver, kidney disease, drug abuse history, dysrhythmias, hypotension, hypertension, psychiatric patients, children, tardive dyskinesia 

Interaction:

Drugs

Amantadine: Potentiates CNS side effects of amantadine

Anticholinergic  Increased anticholinergic side effects

Antipsychotic agents: Possible worsening of psychosis, increased anticholinergic side effects

Digoxin (slow dissolution tab): Increased digoxin concentration

Tacrine: Reduced therapeutic effects of both drugs 

Warnings:

Adverse Effects:

Lactations:

Pregnancy ; nursing infants may be particularly sensitive to anticholinergic effects

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Anxiety, confusion, delusions, depression, dizziness, hallucinations, headache, incoherence, irritability, memory loss, restlessness, sedation

CV: Flushing, hypotension, mild bradycardia, palpitations, postural hypotension, tachycardia

EENT: Angle-closure glaucoma, blurred vision, difficulty swallowing, dilated pupils, dry eyes, dry mouth, increased intraocular tension, mydriasis, photophobia

GI: Abdominal distress, constipation, epigastric distress, nausea, paralytic ileus, vomiting

GU: Dysuria, erectile dysfunction, hesitancy, retention

MS: Cramping, muscular weakness

SKIN: Rash, urticaria, other dermatoses

MISC: Decreased sweating, heat stroke, hyperthermia, increased temperature, numbness -of fingers

Patient And Carer Advice: