Procyclidine anticholinergic

Geriatric Considerations - Summary Procyclidine and related anticholinergics present significant risk to older adults. These drugs possess potent anticholinergic effects and can cause cognitive impairment, delirium, dry mouth, blurred vision, and increased risk of falls. The use of this drug and related compounds should be limited and when used, patients should be closely monitored. 

Anticholinergic agents benztropine mesylate biperiden hydrochloride ethopropazine hydrochloride procyclidine hydrochloride trihexyphenidyl hydrochloride... 

Centrally acting anticholinergic Benzotropine, trihexyphenidyl, procyclidine drugs... 

Anticholinerigics such as orphenadrine, procyclidine and trihexyphenidyl (benzhexol) block the effect of acetylcholine, which has the opposite effect to dopamine so ameliorating symptoms. They have limiting side-effects due to their peripheral anticholinergic effects, which are troublesome and include constipation, sedation and blurred vision, all of which can worsen the effects of Parkinson s disease. They are little used nowadays. 

May increase anticholinergic effects of procyclidine and other drugs with anticholinergic properties... 

Parkinson s medications Anticholinergic medications (e.g., benztropine, procyclidine)... 

Procyclidine is an anticholinergic drug (1). The usual oral dose, which lies between 20 and 30 mg/day, is likely to produce only mild anticholinergic adverse effects, but involuntary movements, with chewing and sucking, have been described in some patients (SEDA-1, 120). Even small doses have produced toxic confusional states when procyclidine was combined with phenothiazines for schizophrenia. Procyclidine is more hkely to produce sedation than stimulation. 

As a class, anticholinergics include the antihistamines, atropine and homatropine anti-Parkinsonian agents like benzotropine, procyclidine, and trihexyphenidyl the antimuscarinics of which atropine is the prototype and antispasmodics like dicyclomine and oxybutymin. Most antimuscarinics are amino-alcohols or their derivatives (usually esters or ethers), aminoamides, or other amines. Antimuscarinics can be divided into two groups. These are the naturally occurring alkaloids and their semisynthetic derivatives like atropine, homatropine, scopolamine, and hyoscyamine and the synthetic amine compounds such as anisotropine, dicyclomine, and ipratropium. 

Procyclidine may reduce the antipsychotic effectiveness of haloperidol and phenothiazines, possibly by direct CNS antagonism related to its anticholinergic properties. Haloperidol and phenothiazine exert their effects in part by blocking the hyperactivity of dopaminergic transmission in the mesocortical and mesolimbic systems. Concomitant use with phenothiazine derivatives, especially thioridazine having pronounced anticholinergic effects, also increases the risk of anticholinergic adverse effects. Paralytic ileus may result from concomitant use with phenothiazines or tricyclic antidepressants. Concomitant use with alcohol and other CNS depressants increases procyclidine s sedative effects. 

Clinical symptoms of overdosage with procyclidine, which result primarily from its anticholinergic effects, include central stimulation followed by depression, and such psychotic symptoms as disorientation, confusion, hallucinations, delusions, anxiety, agitation, and restlessness. Peripheral effects may include dilated, nonreactive pupils blurred vision flushed, hot, dry skin dry mucus membranes ... 

PO. Individualize dosing regimen. Levodopa T gastric deactivation of l-dopa due to i Gl motility. Benztropine, procyclidine, biperi -den, and ethopropazide are also used as anticholinergics. 

ANTIMUSCARINICS ANALGESICS - PARACETAMOL Atropine, benzatropine, orphenadrine, procyclidine and trihexyphenidyl may slow the onset of action of intermittent-dose paracetamol Anticholinergic effecis delay gastric emptying and absorption Warn patients that the action of paracetamol may be delayed. This will not be the case when paracetamol is taken regularly... 

Areca contains arecoline, an alkaloid with cholinergic activity, which could therefore oppose the antimuscarinic (anticholinergic) actions of procyclidine. As the procyclidine was being used to control the extrapyrami-dal adverse effects of the two antipsychotics, opposing its action allowed the adverse effects to re-emerge and worsen. 

Parkinsonism FGAs (NB valproate/lithium commonly cause tremor) Exclude Parkinson s disease tPD ) - Table 36.5 i Dose Change FGA to SGA Try anticholinergic, e.g. procyclidine 5 mg -review within 3 months Propranolol for lithium/valproate tremor... 

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