Procyclidine

Indications
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.
Elderly: Lower doses are required.
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.
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.
Contraindications
Urinary outflow obstruction, prostatic hyperthrophy, narrow-angle glaucoma, paralytic ileus and pyloric stenosis.
Warnings / Precautions
Patients with diarrhoea. May impair a patient's ability to perform skilled tasks e.g. driving. May precipitate psychotic episodes in patients with mental disorders. Thyrotoxicosis, heart failure, acute myocardial infarction, hypertension. Childn, elderly. Pregnancy and lactation. Avoid abrupt withdrawal.
Adverse Reactions
Excitability, dizziness, hallucinations (seen on abuse), dry mouth, blurred vision, constipation, urinary retention, agitation, restlessness, confusion and convulsions.
Drug Interactions
Increased plasma concentrations when used with paroxetine. May counteract the GI effects of cisapride, domperidone and metoclopramide. May also reduce gastric motility, thus affecting the absorption of other drugs.
Potentially Fatal: Additive anticholinergic effects with antihistamines, opiate antagonists, phenothiazine, tricyclic antidepressants, quinidine.
See Below for More procyclidine Drug Interactions
Mechanism of Actions
Procyclidine is a tertiary amine antimuscarinic which acts by blocking excess acetylcholine at cerebral synapses. It also exhibits direct antispasmodic effect on smooth muscle.
Absorption: Bioavailability is about 75% after an oral dose.
Distribution: About one-fifth is metabolised in the liver, mainly by P450 isoenzymes.
Excretion: Mean elimination half-life: about 12 hr (oral and IV admin). A small amount of the drug is excreted unchanged in the urine.
Storage Conditions
Oral: Store at 15-25°C. Parenteral: Store at 15-25°C.
ATC Classification
N04AA04 - procyclidine ; Belongs to the class of tertiary amines anticholinergic agents. Used in the management of Parkinson's disease.
Storage
Oral: Store at 15-25°C. Parenteral: Store at 15-25°C.
Available As
  • Procyclidine 2.5 mg
  • Procyclidine 5 mg
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