Procyclidine (Kemadrin) is an anticholinergic drug that is used in the treatment of:

• Parkinsonism, including:

  • postencephalitic,

  • arteriosclerotic, and

  • idiopathic types.

• Extrapyramidal side effects induced by phenothiazines such as:

  • Dystonia,

  • Dyskinesia,

  • Akathisia, and

  • Parkinsonism.

Procyclidine dose in Adults

Procyclidine dose in the treatment of Parkinson disease:

• 2.5 mg orally thrice daily after meals.
• After each meal, the amount is progressively increased to 5 mg, and if necessary, 5 mg is also given at bedtime.
• The bedtime dose may be omitted in some patients who are intolerant.

Conversion from alternative therapy:

• Give a lesser dose, 2.5 mg three times per day, and gradually increase it based on the response and side effects.

Extrapyramidal side effects:

• 2.5 mg three times a day orally after meals.
• The dose is increased in increments of 2.5 mg daily (until improvement is noted) to the usual dose of 10 - 20 mg daily.

Procyclidine dose in Children

Pediatric patients have not yet been studied for safety and effectiveness.

Pregnancy Risk Category: C

• Its use in pregnancy is not well documented.

Use of procyclidine while breastfeeding

• It is unknown if the drug will be excreted into breastmilk.

Procyclidine dose in Kidney Disease:

It should be used with caution in renal impairment. However, the manufacturer has not recommended any adjustment in the dose in patients with renal disease.

Procyclidine dose in Liver Disease:

You should use caution if you have liver disease. The manufacturer has not advised any adjustments in the dose for patients with liver disease

Procyclidine side effects:

• Central Nervous System:

  • Dizziness

• Dermatologic:

  • Skin Rash

• Gastrointestinal:

  • Constipation
  • Epigastric Distress
  • Nausea
  • Vomiting
  • Xerostomia

• Hypersensitivity:

  • Hypersensitivity Reaction

• Neuromuscular & Skeletal:

  • Weakness

• Ophthalmic:

  • Blurred Vision
  • Mydriasis

Contraindication to Procyclidine (Kemadrin) Include:

• Angle-closure Glaucoma

Warnings and precautions

• Hyperthermia/ anhidrosis:

  • Anhidrosis and hyperthermia are side effects of anticholinergic medications that can sometimes be severe, especially during hot weather.
  • In such cases, treatment must be stopped.
  • Hyperthermia is a serious condition that can affect the elderly, CNS patients, and people who have been exposed to hot environments for a long time.

• CNS effects

  • Use of procyclidine may cause confusion, restlessness and hallucinations.
  • This is more evident in patients with neurological disorders or older people who are taking higher doses.
  • CNS depression may also be caused by it. It should be used with caution by patients who are required to remain alert for mental tasks.
  • A physician should be notified if there are any neuropsychiatric symptoms.

• Cardiovascular disease

  • Patients suffering from cardiac disease (tachycardias, arrhythmias, hypertension or hypotension) should be cautious.

• Obstructive GI:

  • Patients suffering from obstructive gastropathy should be cautious.

• Hepatic impairment

  • Patients with hepatic impairment need to be cautious.

• Prostatic hyperplasia/Urinary stricture:

  • It is possible to have urinary retention, especially among the elderly, people with BPH, or those who have had a history urinary stricture, or those with a history urinary retention.

• Renal impairment

  • It should be used with caution by patients with impaired renal function.

Procyclidine (United States: Not available): Drug Interaction

Monitor:

• Extrapyramidal symptoms, Parkinson's disease.
• Pulse
• Anticholinergic effects such as CNS, bladder and bowel function

How to administer Procyclidine (Kemadrin)?

It should be taken after a meal to minimize the anticholinergic side effects and maximize the gastrointestinal tolerance.

Mechanism of action of Procyclidine (Kemadrin):

• It is an anticholinergic drug, which acts by blocking the cerebral acetylcholine receptors.
• It reduces salivation and acts on the smooth muscles to prevent spasm. It can also cause mydriasis.

The onset of action is 45 - 60 minutes.

The duration of action lasts for up to 12 hours.

Distribution: V : 1 L/kg.

Metabolism: It is metabolized by hydroxylation of the alicyclic groups.

Bioavailability is about 75%

Half-life elimination: about 12.6 hours

Time to reach peak plasma concentration is about 1.1 hours

Excretion: is via Urine (predominantly as metabolites)

International Brands of Procyclidine:

• PDP-Procyclidine
• Akinetic
• Cyclid
• Emadrin
• Kemadrin
• Osnervan
• Picidin
• Proimer
• Youngproma

Procyclidine Brands in Pakistan: