Kemadrin

Generic Name: Procyclidine Hydrochloride
Class: Anticholinergic Agents
VA Class: AU350
CAS Number: 1508-76-5

Introduction

Antimuscarinic antiparkinsonian agent.b

Uses for Kemadrin

Parkinsonian Syndrome

Adjunctive treatment of all forms of parkinsonian syndrome.a

May be used as monotherapy for mild to moderate symptoms or in combination with other antiparkinsonian agents for severe symptoms.a

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Relieves muscle rigidity better than it does tremor; however, tremor, fatigue, weakness, and sluggishness frequently are relieved.a b

Drug-Induced Extrapyramidal Reactions

Control of extrapyramidal reactions induced by antipsychotic agents (e.g., phenothiazines).a b

Kemadrin Dosage and Administration

Administration

Administer orally, preferably after meals.a b

Dosage

Available as procyclidine hydrochloride; dosage expressed in terms of the salt.a

Adjust dosage carefully according to individual requirements and response.a b

Adults

Parkinsonian Syndrome

Younger and postencephalitic patients require and tolerate a higher dosage than geriatric patients or those with arteriosclerosis.a b

Therapy-Naive Patients
Oral

Initially, 2.5 mg 3 times daily after meals.a As tolerated, gradually increase to 5 mg 3 times daily or the minimum dosage needed to control symptoms.a If needed, administer an additional 5-mg dose at bedtime.a b

If bedtime dosage is not tolerated, total daily dosage may be administered in 3 divided doses.b

Patients Transferring from Other Antiparkinsonian Therapy
Oral

Gradually substitute 2.5 mg 3 times daily for all or part of original drug.a Increase procyclidine dose as needed while decreasing other drug until complete replacement achieved. a

Drug-Induced Extrapyramidal Reactions
Oral

Initially, 2.5 mg 3 times daily; increase by 2.5-mg increments until symptoms controlled.a b

Usual dosage: 10–20 mg daily.a a

Special Populations

No special population dosage recommendations at this time.a

Cautions for Kemadrin

Contraindications

  • Angle-closure glaucoma.a c

  • Known hypersensitivity to procyclidine or any ingredient in the formulation.c

Warnings/Precautions

Warnings

Pregnancy

Safe use during pregnancy has not been established.a b

General Precautions

Cardiovascular Effects

Caution in tachyarrhythmias because antimuscarinics block vagal inhibition of the SA nodal pacemaker.a c

GU Effects

Possible decreased tone and amplitude of contractions of the ureters and bladder with resultant urinary retention;c use with caution in patients with prostatic hypertrophy.a c

Hypotension

Use with caution and carefully monitor hypotensive patients.a

CNS Effects

Possible mental confusion, disorientation, agitation, hallucinations, and psychotic-like symptoms, particularly in older patients.a

Ophthalmic Effects

Possible increased ocular tension.c

Contraindicated in patients with angle-closure glaucoma; however, can be administered safely to patients with open-angle glaucoma.a c

Specific Populations

Pregnancy

Category C.d (See Warnings under Cautions.)

Pediatric Use

Safety and efficacy not established.a b

Geriatric Use

Possible increased incidence of adverse CNS effects compared with younger adults.a (See CNS Effects under Cautions.)

Common Adverse Effects

Dry mouth, blurred vision, nausea, vomiting, epigastric distress, constipation, lightheadedness, muscular weakness.a

Interactions for Kemadrin

Specific Drugs

Drug

Interaction

Comments

Anticholinergic agents

Increased risk of adverse anticholinergic effectsc

Antipsychotic agents (phenothiazines)

Risk of intensification of mental symptoms or precipitation of toxic psychosis, especially when increasing procyclidine dosagea (see CNS Effects under Cautions)

Monitor closelya

Stability

Storage

Oral

Tablets

15–25°C.a

Actions

  • Exhibits atropine-like action and exerts antispasmodic effects on parasympathetic-innervated peripheral structures including smooth muscle.a b

  • Competitively inhibits acetylcholine or other cholinergic stimuli at autonomic effectors innervated by postganglionic nerves.c

  • Antagonizes certain muscarinic effects; may produce mydriasis and reduction in salivation.a

Advice to Patients

  • Potential for drug to impair mental alertness or physical coordination; use caution when driving or operating machinery until effects on individual are known.a

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as concomitant illnesses.a

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Procyclidine Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

5 mg

Kemadrin (scored)

Monarch

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions October 1, 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

a. Monarch Pharmaceuticals, Inc. Kemadrin (procyclidine hydrochloride) tablets prescribing information. Bristol, TN; 2003 Jun.

b. AHFS drug information 2006. McEvoy GK, ed. Procyclidine. Bethesda, MD: American Society of Health-System Pharmacists; 2006:1255-6.

c. AHFS drug information 2006. McEvoy GK, ed. Antimuscarinics/Antispasmodics General Statement. Bethesda, MD: American Society of Health-System Pharmacists; 2006:1257-64].

d. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation, 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:1349.

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