Procyclidine Areca

Flupenthixol and procyclidine Fluphenazine Prednisone and salbutamol Betal nut (Areca catechu) Rigidity, bradykinesia, jaw tremor Betal contains arecoline, a cholinergic alkaloid Tremor, stiffness, akithesia Inadequate control of asthma Arecoline challenge causes dose-related bronchoconstriction in patients with asthma... 

Areca nut 1 Procyclidine (used to control extrapyramidal -parkinsonian - with antipsychotic medications) Caused severe rigidity and jaw tremor. This is an established and clinically significant interaction Procyclidine is an antimuscarinic agent, i.e. antagonizes the effects of ACh in one set of ACh receptors. Thus, herbal products used culturally with effects similar to ACh, e.g. areca nut will produce enhanced effects at other -nicotinic - receptors to produce adverse effects Avoid chewing betel nut (also found in prepared pan masala )... 

The control of the extrapyramidal (parkinsonian) adverse effects of fluphenazine and flupenthixol with procyclidine was lost in two patients when they began to chew areca. 

An Indian patient receiving depot fluphenazine (50 mg every three weeks) for schizophrenia, and with mild parkinsonian tremor controlled with procyclidine 5 mg twice daily, developed marked rigidity, bradykinesia and jaw tremor when he began to chew areca. The symptoms were so severe he could barely speak. When he stopped chewing areca his stiffness and abnormal movements disappeared. Another patient receiving depot flupenthixol developed marked stiffness, tremor and akathisia, despite taking... 

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. 

---