PROPANTHELINE BROMIDE

PROPANTHELINE BROMIDe
(proe-pan'the-leen)
Pro-Banthine, Propanthel 
Classifications: anticholinergic; antimuscarinic agent; antispasmodic;
Therapeutic: antispasmodic

Prototype: Atropine
Pregnancy Category: C

Availability

7.5 mg, 15 mg tablets

Action

Similar to atropine in peripheral effects. Has potent antimuscarinic activity and ganglionic blocking action.

Therapeutic Effect

Decreases motility (smooth muscle tone) in the GI, biliary, and urinary tracts. Results in antispasmodic action.

Uses

Adjunct in treatment of peptic ulcer, irritable bowel syndrome, pancreatitis, ureteral and urinary bladder spasm. Also used prior to radiologic diagnostic procedures to reduce duodenal motility.

Contraindications

Pregnancy (category C); narrow-angle glaucoma; tachycardia, MI; paralytic ileus, GI obstructive disease; myasthenia gravis. Safety in children is not established.

Cautious Use

CAD, CHF, cardiac arrhythmias; liver disease, ulcerative colitis, hiatus hernia, esophagitis; kidney disease; prostatic hypertrophy; glaucoma; debilitated patients; hyperthyroidism; autonomic neuropathy; brain damage; Down's syndrome; spastic disorders; lactation.

Route & Dosage

Irritable Bowel Syndrome
Adult: PO 15 mg 30 min a.c. and 30 mg h.s. (max: 120 mg/d)
Geriatric: PO 7.5 mg 2–3 times/d a.c. (max: 90 mg/d)

Administration

Oral
  • Give 30–60 min before meals and at bedtime. Advise not to chew tablet; drug is bitter.
  • Give at least 1 h before or 1 h after an antacid (or antidiarrheal agent).
  • Store dry powder and tablets at 15°–30° C (59°–86° F); protect from freezing and moisture.

Adverse Effects (≥1%)

GI: Constipation, dry mouth. Special Senses: Blurred vision, mydriasis, increased intraocular pressure. CNS: Drowsiness. Urogenital: Decreased sexual activity, difficult urination.

Interactions

Drug: Decreased absorption of ketoconazole; oral potassium may increase risk of GI ulcers. Food: Food significantly decreases absorption.

Pharmacokinetics

Absorption: Incompletely from GI tract. Onset: 30–45 min. Duration: 4–6 h. Metabolism: 50% in GI tract before absorption; 50% in liver. Elimination: Primarily in urine; some in bile. Half-Life: 9 h.

Nursing Implications

Assessment & Drug Effects

  • Assess bowel sounds, especially in presence of ulcerative colitis, since paralytic ileus may develop, predisposing to toxic megacolon.
  • Be aware that older adult or debilitated patients may respond to a usual dose with agitation, excitement, confusion, drowsiness. Stop drug and report to physician if these symptoms are observed.
  • Check BP, heart sounds and rhythm periodically in patients with cardiac disease.

Patient & Family Education

  • Void just prior to each dose to minimize risk of urinary hesitancy or retention. Record daily urinary volume and report problems to physician.
  • Relieve dry mouth by rinsing with water frequently, chewing sugar-free gum or sucking hard candy.
  • Maintain adequate fluid and high-fiber food intake to prevent constipation.
  • Make all position changes slowly and lie down immediately if faintness, weakness, or palpitations occur. Report symptoms to physician.
  • Do not drive or engage in potentially hazardous activities until response to drug is known.

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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