ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Procyclidine (United States: Not available): Drug information

Procyclidine (United States: Not available): Drug information
(For additional information see "Procyclidine (United States: Not available): Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: Canada
  • PDP-Procyclidine [DSC]
Pharmacologic Category
  • Anti-Parkinson Agent, Anticholinergic;
  • Anticholinergic Agent
Dosing: Adult
Extrapyramidal symptoms

Extrapyramidal symptoms:

Note: Anticholinergic agents are not recommended for the treatment of akathisia or tardive dyskinesia (APA [Keepers 2020]; Kang 1986). Duration of therapy is based on the severity of extrapyramidal symptom reaction, pharmacologic profile of the causative agent (eg, half-life, adverse effects), and patient risk factors (Holloman 1997; Kreyenbuhl 2009). Some experts recommend attempting taper and discontinuation after several weeks to months (Desmarais 2012).

Oral: Initial: 2.5 mg 3 times daily after meals; increase in 2.5 mg daily increments until symptomatic relief; usual dose: 10 to 20 mg/day in divided doses.

Parkinsonism

Parkinsonism: Oral: Initial: 2.5 mg 3 times daily after meals; if tolerated, gradually increase to 5 mg 3 times daily after meals and 5 mg at bedtime as needed. Lower dosages may be effective in some patients; if bedtime dose is not tolerated, may omit and administer total daily dose in 3 equally divided daytime doses.

Conversion from alternative therapy: Gradually initiate procyclidine 2.5 mg 3 times daily (may be used to replace all or part of alternative therapy); titrate dosage up (procyclidine) and/or down (alternative therapy) until satisfactory effect is achieved with procyclidine monotherapy.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.

Dosing: Older Adult

Avoid use (Beers Criteria [AGS 2023]).

Adverse Reactions

The following adverse drug reactions are derived from product labeling unless otherwise specified.

Frequency not defined:

Cardiovascular: Tachycardia (Holloman 1997)

Gastrointestinal: Constipation (Holloman 1997), epigastric distress, nausea, vomiting, xerostomia (Holloman 1997)

Genitourinary: Urinary retention (Holloman 1997)

Hypersensitivity: Hypersensitivity reaction

Nervous system: Dizziness, memory impairment (Hollman 1997), myasthenia

Ophthalmic: Blurred vision (Holloman 1997), mydriasis

Contraindications

Angle-closure glaucoma

Warnings/Precautions

Concerns related to adverse effects:

• Anhidrosis/hyperthermia: Anticholinergic agents may cause anhidrosis and hyperthermia, which may be severe; use with caution in hot weather or during exercise. The risk is increased in hot environments, particularly in the elderly, patients with alcohol use disorder, patients with CNS disease, and those with prolonged outdoor exposure.

• CNS effects: May be associated with restlessness, confusion, hallucinations, or other CNS effects, particularly in the elderly and generally at higher dosages; intensification of symptoms or toxic psychosis may occur in patients with mental disorders. Dose reductions/discontinuation of therapy may be necessary. May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with tachycardia, cardiac arrhythmias, hypertension, or hypotension.

• GI obstruction: Use with caution in patients with obstructive disease of the GI.

• Hepatic impairment: Use with caution in patients with hepatic impairment.

• Prostatic hyperplasia/urinary stricture: Use with caution in patients with prostatic hyperplasia and/or urinary stricture or retention.

• Renal impairment: Use with caution in patients with renal impairment.

• Tardive dyskinesia: Not recommended for use in patients with tardive dyskinesia unless concomitant Parkinson disease or tardive dystonia exists (Kang 1986).

Special populations:

• Older adult: Frequently develop increased sensitivity and require strict dosage regulation - side effects may be more severe in older adult patients with atherosclerotic changes.

Product Availability

Not available in the US

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Elixir, Oral:

Generic: 2.5 mg/5 mL ([DSC])

Tablet, Oral:

Generic: 2.5 mg [DSC], 5 mg [DSC]

Administration: Adult

Oral: Administer after meals to minimize stomach upset and anticholinergic effects.

Use: Labeled Indications

Note: Not available in the United States.

Extrapyramidal symptoms: Management of medication-induced extrapyramidal symptoms.

Parkinsonism: Treatment of parkinsonism, including postencephalitic, arteriosclerotic, and idiopathic types.

Medication Safety Issues
Older adult: high-risk medication:

Beers Criteria: Avoid for the prevention or treatment of extrapyramidal symptoms caused by antipsychotics. In the treatment of Parkinson disease, more effective agents are available (Beers Criteria [AGS 2023]).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Risk C: Monitor therapy

Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy

Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Risk C: Monitor therapy

Betel Nut: May diminish the therapeutic effect of Procyclidine. Risk C: Monitor therapy

Botulinum Toxin-Containing Products: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy

Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Risk C: Monitor therapy

Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Risk C: Monitor therapy

Chlorprothixene: Anticholinergic Agents may enhance the anticholinergic effect of Chlorprothixene. Risk C: Monitor therapy

Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Risk X: Avoid combination

CloZAPine: Anticholinergic Agents may enhance the constipating effect of CloZAPine. Management: Consider alternatives to this combination whenever possible. If combined, monitor closely for signs and symptoms of gastrointestinal hypomotility and consider prophylactic laxative treatment. Risk D: Consider therapy modification

Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Risk X: Avoid combination

Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Risk C: Monitor therapy

Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor therapy

Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Risk X: Avoid combination

Glycopyrronium (Topical): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Risk C: Monitor therapy

Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Risk X: Avoid combination

Lisuride: Procyclidine may enhance the adverse/toxic effect of Lisuride. Risk X: Avoid combination

Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy

Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Risk C: Monitor therapy

Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Risk C: Monitor therapy

Opioid Agonists: Anticholinergic Agents may enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. Risk C: Monitor therapy

Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

PARoxetine: May increase the serum concentration of Procyclidine. Risk C: Monitor therapy

Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid combination

Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium citrate. Risk X: Avoid combination

Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Risk X: Avoid combination

Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Risk C: Monitor therapy

Revefenacin: Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. Risk X: Avoid combination

Rivastigmine: Anticholinergic Agents may diminish the therapeutic effect of Rivastigmine. Rivastigmine may diminish the therapeutic effect of Anticholinergic Agents. Management: Use of rivastigmine with an anticholinergic agent is not recommended unless clinically necessary. If the combination is necessary, monitor for reduced anticholinergic effects. Risk D: Consider therapy modification

Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Risk D: Consider therapy modification

Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Risk X: Avoid combination

Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Risk C: Monitor therapy

Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

Pregnancy Considerations

Safe use during pregnancy has not been established.

Breastfeeding Considerations

It is not known if procyclidine is present in breast milk.

Dietary Considerations

Should be taken after meals to minimize stomach upset and anticholinergic effects.

Monitoring Parameters

Heart rate, anticholinergic effects (ie, CNS, bowel and bladder function).

Mechanism of Action

Thought to act by blocking excess acetylcholine at cerebral synapses; many of its effects are due to its pharmacologic similarities with atropine; it exerts an antispasmodic effect on smooth muscle, is a potent mydriatic; inhibits salivation

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: 45 to 60 minutes (Whiteman 1985)

Duration: Significant autonomic effects have been observed up to 12 hours (Whiteman 1985)

Distribution: Vd: 1 L/kg (Whiteman 1985)

Metabolism: Hydroxylation of the alicyclic groups (Brocks 1999)

Bioavailability: ~75% (Whiteman 1985)

Half-life elimination: ~12.6 hours (Whiteman 1985)

Time to peak: ~1.1 hour (Whiteman 1985)

Excretion: Urine (predominantly as metabolites) (Whiteman 1985)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Kemadrin;
  • (AT) Austria: Kemadrin;
  • (AU) Australia: Kemadrin;
  • (BD) Bangladesh: Kdrine | Kemadrin | Opsodrin | Parkaid | Perkinil;
  • (BE) Belgium: Kemadrin;
  • (CH) Switzerland: Kemadrin;
  • (CZ) Czech Republic: Kemadrin;
  • (DE) Germany: Osnervan;
  • (ES) Spain: Kemadren;
  • (FI) Finland: Kemadrin;
  • (FR) France: Kemadrine;
  • (GB) United Kingdom: Arpicolin | Kemadrin | Muscinil | Procyclidine | Procyclidine aps | Procyclidine berk | Procyclidine cox | Procyclidine dc | Procyclidine kent | Procyclidine opus;
  • (HU) Hungary: Kemadrin;
  • (IE) Ireland: Arpicolin | Kemadrin | Procyclidine;
  • (IL) Israel: Kemadrin;
  • (IN) India: Aldine | Axeps | Cyclid | Dine | Kemadrin | Lepark | Modin | Parklid | Pcdine | Procydin | Prolid | Trodin;
  • (IT) Italy: Kemadrin;
  • (JO) Jordan: Kemadrin;
  • (JP) Japan: Kemadrin;
  • (KR) Korea, Republic of: Paroma | Pharma procyclidine | Proimer | Youngproma;
  • (KW) Kuwait: Kemadrin;
  • (LB) Lebanon: Kemadrin;
  • (LT) Lithuania: Kemadrin;
  • (LU) Luxembourg: Kemadrin;
  • (LV) Latvia: Kemadrin;
  • (MY) Malaysia: Kemadrin;
  • (NL) Netherlands: Kemadrin;
  • (NZ) New Zealand: Kemadrin;
  • (PK) Pakistan: Cyclidine | Epsent | Kemadrin | Kempro | Oclidin | Procholidin | Procye | Prosyclidine | Zyclidine;
  • (PR) Puerto Rico: Kemadrin;
  • (QA) Qatar: Kemadrin;
  • (SA) Saudi Arabia: Kemadrin;
  • (SE) Sweden: Kemadrin;
  • (SI) Slovenia: Kemadrin;
  • (SK) Slovakia: Kemadrin;
  • (TN) Tunisia: Kemadrine;
  • (UY) Uruguay: Kemadrin
  1. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372 [PubMed 37139824]
  2. Brocks DR. Anticholinergic drugs used in Parkinson’s disease: an overlooked class of drugs from a pharmacokinetic perspective. J Pharm Pharm Sci. 1999;2(2):39-46. [PubMed 10952768]
  3. Desmarais JE, Beauclair L, Margolese HC. Anticholinergics in the era of atypical antipsychotics: short-term or long-term treatment? J Psychopharmacol. 2012;26(9):1167-74. doi: 10.1177/0269881112447988 [PubMed 22651987]
  4. Holloman LC, Marder SR. Management of acute extrapyramidal effects induced by antipsychotic drugs. Am J Health Syst Pharm. 1997;54(21):2461-2477. doi: 10.1093/ajhp/54.21.2461 [PubMed 9359953]
  5. Kang UJ, Burke RE, Fahn S. Natural history and treatment of tardive dystonia. Mov Disord. 1986;1(3):193-208. doi:10.1002/mds.870010305 [PubMed 8369593]
  6. Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. 2020;177(9):868-872. doi:10.1176/appi.ajp.2020.177901 [PubMed 32867516]
  7. Kreyenbuhl J, Buchanan RW, Dickerson FB, Dixon LB; Schizophrenia Patient Outcomes Research Team (PORT). The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2009. Schizophr Bull. 2010;36(1):94-103. doi: 10.1093/schbul/sbp130 [PubMed 19955388]
  8. Procyclidine [product monograph]. Montreal, Quebec, Canada: Pendopharm, Division of Pharmascience Inc; February 2014
  9. Whiteman PD, Fowle AS, Hamilton MJ, et al. Pharmacokinetics and pharmacodynamics of procyclidine in man. Eur J Clin Pharmacol. 1985;28(1):73-78. [PubMed 3987788]
Topic 15559 Version 188.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟