Propantheline Bromide

Pronunciation: pro-PAN-thuh-leen BROE-mide
Class: Quaternary anticholinergic

Trade Names

Propantheline Bromide
- Tablets 15 mg

Propanthel (Canada)

Pharmacology

Exerts anticholinergic effects, resulting in GI smooth muscle relaxation and diminished volume and acidity of GI secretions. Also inhibits the action of acetylcholine at the post ganglionic nerve endings of the parasympathetic nervous system.

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Pharmacokinetics

Absorption

Poor GI absorption, only 10% to 25% of oral dose is absorbed. T max is approximately 1 h.

Metabolism

Extensively metabolized by hydrolysis to inactive metabolites.

Elimination

Renal (70%, mostly as metabolites and 3% as propantheline). Half-life is 1.6 h.

Indications and Usage

Adjunctive therapy in treatment of peptic ulcer.

Contraindications

Glaucoma; obstructive uropathy (eg, bladder neck obstruction due to prostatic hypertrophy); obstructive disease of GI tract (eg, pyloroduodenal stenosis, achalasia, paralytic ileus, etc.); intestinal atony of elderly or debilitated patient; severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; unstable cardiovascular status in acute hemorrhage; myasthenia gravis.

Dosage and Administration

Peptic Ulcer
Adults

PO 15 mg 30 min before meals and 30 mg at bedtime.

General Advice

  • Do not crush or allow patient to chew tablets.
  • Administer antacids 1 h before or after propantheline.

Storage/Stability

Store between 68° and 77°F.

Drug Interactions

Antacids

Decreased absorption of propantheline if given together.

Corticosteroids

Increased intraocular pressure may result with coadministration.

Drugs with anticholinergic effects (eg, antihistamines, belladonna alkaloids, meperidine, Type 1 antiarrhythmics [eg, disopyramide, procainamide, quinidine], tricyclic antidepressants)

Additive peripheral anticholinergic adverse reactions.

Digoxin, slow dissolving

Concurrent use may cause increased digoxin levels. Avoid this interaction by only using digoxin tablets that rapidly dissolve by USP standards.

Phenothiazines

May decrease antipsychotic effectiveness of phenothiazines; may produce additive anticholinergic effects.

Adverse Reactions

Cardiovascular

Palpitations; tachycardia.

CNS

Headache; flushing; nervousness; drowsiness; weakness; dizziness; confusion; insomnia.

Dermatologic

Severe allergic reactions including anaphylaxis, urticaria, and dermal manifestations.

EENT

Blurred vision; mydriasis; cycloplegia; increased IOP; altered taste perception.

GI

Dry mouth; nausea; vomiting; constipation; bloated feeling.

Genitourinary

Urinary hesitancy and retention; impotence.

Miscellaneous

Suppression of lactation; decreased sweating.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Elderly

For elderly or debilitated patients, drug may cause excitement, agitation, drowsiness, and other untoward manifestations, even in small doses. Use with caution.

Special Risk Patients

Use drug with caution in patients with autonomic neuropathy, hepatic or renal disease, hyperthyroidism, cardiac tachyarrhythmias, heart disease, hypertension, and hiatal hernia associated with reflux esophagitis.

Diarrhea

May be symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. Treatment of diarrhea with drug is inappropriate and possibly harmful.

Gastric ulcer

May delay gastric emptying rate and complicate therapy.

Heat prostration

Can occur in presence of high environmental temperature.

Large doses

Large doses may suppress intestinal motility to the point of precluding paralytic ileus and may precipitate or aggravate toxic megacolon.

Overdosage

Symptoms

Dry mouth, thirst, vomiting, nausea, abdominal distention, paralytic ileus, difficulty swallowing, muscular weakness, paralysis, CNS stimulation (restlessness, anxiety), delirium (disorientation, hallucinations), drowsiness, stupor, fever, dizziness, headache, seizures, ataxia, coma, circulatory failure, rapid pulse and respiration, vasodilation, tachycardia with weak pulse, hypertension, hypotension, respiratory depression, palpitations, urinary urgency with difficulty in micturition, blurred vision, photophobia, dilated pupils, leukocytosis, flushed hot dry skin, rash.

Patient Information

  • Advise patient to take drug 30 min before meals and at bedtime unless directed otherwise by health care provider.
  • Instruct patient not to chew or crush tablets.
  • Warn patient that drug increases risk of heat prostration and caution patient to avoid becoming overheated by exercise or high environmental temperatures.
  • Instruct patient to report the following symptoms to health care provider: drowsiness, dizziness, urinary hesitancy and retention, blurred vision, diarrhea or constipation, skin rash, flushing, or eye pain.
  • Tell patient to take sips of water frequently, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs.
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.

Copyright © 2009 Wolters Kluwer Health.

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