Procyclidine Hydrochloride

Extranil is used for the adjunctive treatment of all forms of parkinsonian syndrome. It is mainly used for the symptomatic treatment of idiopathic (paralysis agitants), postencephalitic and arteriosclerotic parkinsonian. It is used to control troublesome extrapyramidal symptoms including pseudoparkinsonian, acute dystonic reactions and akathisia induced by neuroleptic drugs such as phenothiazine derivatives.

Procyclidine hydrochloride is an antimuscarinic antiparkinsonian agent of relatively low toxicity. It is a synthetic tertiary amine. This drug exerts their antiparkinsonian effect by correcting the relative cholinergic excess which is thought to occur in parkinsonian as a result of dopamine deficiency. It is absorbed from G.I. tract and disappears rapidly from the tissues. After intravenous administration, it acts within 5 to 20 minutes and has a duration of effect up to 4 hours.

Tablet : This is administered orally, preferably after meals.

Parkinsonism: Initially 2.5 mg 3 times a day, then 5 mg 3 times a day and occasionally 5 mg at bedtime. The dosage being adjusted as tolerated or until the total daily dose reaches 20 to 30 mg divided into 3 to 4 doses.

Drug induced extrapyramidal symptom: Initially 2.5 mg 3 times a day. The dosage being increased by 2.5 mg increment per day as needed and tolerated.

Injection : 5-10 mg, repeated if necessary after 20 minutes; maximum 20 mg daily can be given.

The anticholinergic activity of procyclidine may be increased by agents having anticholinergic amantadine. The absorption of ketoconazole may be reduced by concomitant administration of procyclidine.

It should be given with caution in children and geriatric patients. It is advisable to be cautious in giving Procyclidine to patients with diarrhoea and cardiovascular disease, glaucoma, urinary retention, hepatic or renal impairment. The safety of using procyclidine during pregnancy has not been established. No data are available on the excretion of this drug in breast milk.

At usual dosage levels dryness of the mouth is generally the only adverse effect. Mydriasis, blurred vision and adverse G.I. effects (nausea, vomiting, epigastric distress, constipation) occur occasionally. An allergic reaction (e.g. rash) or muscular weakness may occasionally occur. High doses may cause vertigo and possibly confusion and hallucination. Adverse effect may usually be minimized by adjustment of dosage and administration after meal.

The safe use of this drug in pregnancy, lactation or in women of childbearing age requires that the potential benefits be weighed against the possible hazards to the mother and child.

Precaution should be taken in case of hepatic & renal impairment, children, elderly, pregnancy and lactation condition. Patients with mental disorders occasionally experience a precipitation of a psychotic episode when Extranil is administered for the treatment of the extrapyramidal side-effects of neuroleptic. Extranil should not be withdrawn abruptly as rebound Parkinsonism symptoms may occur.

Protect from light and moisture, store below 25°C. Keep out of the reach of children.