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(pro-SIGH-klih-deen)
Kemadrin,  PMS-Procyclidine, Procyclid
Class: Antiparkinson/Anticholinergic

 Action Has atropine-like action and exerts antispasmodic effect on smooth muscle. Is potent mydriatic and inhibits salivation and normally has no sympathetic ganglion-blocking activity.

 Indications Treatment of parkinsonism, including postencephalitic, arteriosclerotic and idiopathic types. Usually more efficacious in relief of rigidity than of tremor and can be used alone in mild to moderate cases. Also can be given to treat drug-induced extrapyramidal symptoms of phenothiazine or rauwolfia therapy and to control sialorrhea associated with neuroleptic medication.

 Contraindications Angleclosure glaucoma; pyloric and duodenal obstruction; stenosing peptic ulcers; prostatic hypertrophy; bladder neck obstruction; achalasia; myasthenia gravis; megacolon.

 Route/Dosage

Parkinsonism (No Prior Therapy)

ADULTS: PO 2.5 mg tid after meals initially. If well tolerated, dose may be gradually increased to 5 mg tid. Bedtime dose can be added if necessary.

Transferring from Prior Therapy

Substitute 2.5 mg tid for all or part of original agent. Increase prn while other drug is lowered or omitted. Individualize (maximum dose 60 mg/day).

Drug-Induced Extrapyramidal Symptoms

ADULTS: Begin with 2.5 mg tid; increase by 2.5 mg increments until symptoms are relieved. Usually 10 to 20 mg daily is adequate.

 Interactions

Haloperidol: Schizophrenic symptoms may worsen, haloperidol levels may decrease and tardive dyskinesia may develop. Phenothiazines: Actions of phenothiazines may be decreased. Anticholinergic side effects may increase.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Tachycardia; palpitations; orthostatic hypotension. CNS: Disorientation; confusion; memory loss; hallucinations; agitation; nervousness; depression; drowsiness; giddiness; lightheadedness. DERM: Rash; urticaria; decreased sweating. EENT: Mydriasis; blurred vision. GI: Dry mouth; nausea; vomiting; epigastric distress; constipation; paralytic ileus. GU: Urinary retention; urinary hesitancy. OTHER: Muscle weakness; acute suppurative parotitis; hyperthermia; heat stroke.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly: More susceptible to adverse effects. Occasionally may exhibit confusion, disorientation, agitation, hallucinations and psychotic-like symptoms. Special-risk patients: Use caution in concurrent illness in which anticholinergic effects may be undesirable (ie, tachycardia, urinary retention, marked prostatic hypertrophy). Closely observe hypotensive patients. Anticholinergic effects: Administration of other drugs with anticholinergic effects will increase incidence and severity of these effects. CNS: Psychotic episode may be precipitated in treating drug-induced extrapyramidal side effects of phenothiazines or rauwolfia derivatives. Heat illness: Give with caution during hot weather. Ophthalmic: Incipient narrow-angle glaucoma may be precipitated.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Give with food if GI upset is experienced.
  • Give before meals if excessive drying of mouth occurs.
  • Offer water or ice chips to aid patient comfort.
  • Give with caution during hot weather (anhidrosis and hyperthermia may occur).
  • Store at room temperature in tightly closed containers.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Observe hypotensive patients closely.
  • Inform physician of dizziness, orthostatic hypotension, tachycardia or mild bradycardia, dry mouth, constipation, blurred vision, disorientation, confusion, urinary retention or hesitancy, or other side effects.
  • Observe elderly patients for signs of mental confusion and disorientation.
OVERDOSAGE: SIGNS & SYMPTOMS
  Circulatory collapse, respiratory depression or arrest, CNS depression preceded or followed by stimulation, psychosis, stupor, coma, seizures, fever, hot/dry/flushed skin, dry mucous membranes, paralytic ileus

 Patient/Family Education

  • Advise patient to use caution in hot weather as drug increases susceptibility to heat stroke.
  • Instruct patient to report the following symptoms to physician immediately: Pounding heartbeat, eye pain, confusion or skin rash. Also tell patient to report bothersome side effects including blurred vision, urinary retention or hesitancy, nausea, vomiting, constipation, dizziness, drowsiness or dry mouth, nose, or throat.
  • Tell patient to take sips of water frequently, suck on ice chips or sugarless hard candy or chew sugarless gum if dry mouth occurs.
  • Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
  • Advise patient that drug may cause drowsiness or dizziness and to use caution while driving or performing tasks requiring mental alertness.
  • Instruct patient not to take any otc medications without consulting physician.

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