PROCYCLIDINE HYDROCHLORIDE

PROCYCLIDINE HYDROCHLORIDe
(proe-sye'kli-deen)
Kemadrin, Procyclid

Classifications: anticholinergic; antimuscarinic; antispasmodic; antiparkinson agent;
Therapeutic: antiparkinson
Prototype: Atropine
Pregnancy Category: C

Availability

5 mg tablets

Action

Centrally acting synthetic anticholinergic agent with actions similar to those of atropine. Selectively blocks muscarinic responses to acetylcholine (ACh), whether excitatory or inhibitory.

Therapeutic Effect

Diminishes the characteristic tremor of parkinsonism.

Uses

To relieve symptoms of parkinsonism syndrome (postencephalitic, arteriosclerotic, and idiopathic), and drug-induced extrapyramidal symptoms.

Contraindications

Angle-closure glaucoma; pregnancy (category C), lactation. Safe use in children not established.

Cautious Use

Hypotension; mental disorders; tachycardia; prostatic hypertrophy.

Route & Dosage

Parkinsonism Symptoms
Adult: PO 2.5 mg t.i.d. p.c., may be gradually increased to 5 mg t.i.d. if tolerated with an additional 5 mg h.s. (max: 45–60 mg/d)
Geriatric: PO Start with 2.5 mg 1–2 times/d

Administration

Oral

Minimize adverse effects by administration of drug during or after meals.
Store at 15°–30° C (59°–86° F) in tightly closed containers unless otherwise directed.

Adverse Effects (≥1%)

Body as a Whole: Flushing of skin, decreased sweating, headache, lightheadedness, dizziness, feeling of muscle weakness. Special Senses: Blurred vision, mydriasis, photophobia. CV: Palpitation, tachycardia, hypotension. GI: Dry mouth, nausea, vomiting, epigastric distress, constipation, paralytic ileus, acute suppurative parotitis. Urogenital: Urinary retention. Skin: Skin eruptions (occasionally). CNS: Mental confusion, psychotic-like symptoms.

Interactions

Drug: Additive adverse effects with anticholinergic agents. Herbal: Betel nut may induce extrapyramidal symptoms.

Pharmacokinetics

Onset: 35–40 min. Duration: 4–6 h.

Nursing Implications

Assessment & Drug Effects

Monitor heart rate and rhythm and BP. Report palpitations, tachycardia, paradoxical bradycardia, or decreasing BP. Dosage adjustment or discontinuation of drug may be indicated.
Monitor therapeutic effectiveness. Generally more effective in controlling rigidity than tremors. Tremors may temporarily appear to be exaggerated as rigidity is relieved, especially in patients with severe spasticity.
Observe for and report symptoms of mental confusion, disorientation, agitation, and psychotic-like symptoms, particularly in older adult patients who have low BP, to physician.
Check for constipation and abdominal distention and provide information for preventing constipation.

Patient & Family Education

Void before taking drug if urinary hesitancy or retention is a problem.
Avoid potentially hazardous activities until response to drug is known because drug may cause blurred vision and dizziness.
Relieve dry mouth by rinsing frequently with water, chewing sugarless gum or sucking hard candy, or increasing noncaloric fluid intake. If these measures fail, a saliva substitute, available OTC, may help (e.g., Orex, Xero-Lube).
Avoid alcohol and do not to take other CNS depressants unless otherwise advised by physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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