▶Rare or very rarePsychotic disorder
lPREGNANCYUse only if potential benefit outweighs risk.
lBREAST FEEDINGNo information available.
lHEPATIC IMPAIRMENTUse with caution.
lRENAL IMPAIRMENTUse with caution.
lTREATMENT CESSATIONAvoid abrupt withdrawal in
patients taking long-term treatment.
lPATIENT AND CARER ADVICE
Driving and skilled tasksMay affect performance of skilled
tasks (e.g. driving).
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Solution for injection
▶Procyclidine hydrochloride (Non-proprietary)
Procyclidine hydrochloride 5 mg per 1 mlProcyclidine 10 mg/ 2 ml
solution for injection ampoules| 5 ampouleP£ 60. 00 – £ 78. 75 DT =
£ 72. 50
Oral solution
▶Procyclidine hydrochloride (Non-proprietary)
Procyclidine hydrochloride 500 microgram per 1 mlProcyclidine
2. 5 mg/ 5 ml oral solution sugar free sugar-free| 150 mlP£ 8. 22 –
£ 10. 49 DT = £ 10. 49
Procyclidine hydrochloride 1 mg per 1 mlProcyclidine 5 mg/ 5 ml
oral solution sugar free sugar-free| 150 mlP£ 14. 54 – £ 18. 54 DT =
£ 18. 54
Tablet
▶Procyclidine hydrochloride (Non-proprietary)
Procyclidine hydrochloride 5 mgProcyclidine 5 mg tablets|
28 tabletP£ 12. 65 DT = £ 5. 91 | 100 tabletP£ 8. 94 – £ 21. 11 |
500 tabletP£ 44. 63 – £ 105. 54
▶Kemadrin(Aspen Pharma Trading Ltd)
Procyclidine hydrochloride 5 mgKemadrin 5 mg tablets|
100 tabletP£ 4. 72 | 500 tabletP£ 23. 62
Trihexyphenidyl hydrochloride
(Benzhexol hydrochloride)
lDRUG ACTIONTrihexyphenidyl exerts its effects by
reducing the effects of the relative central cholinergic
excess that occurs as a result of dopamine deficiency.
lINDICATIONS AND DOSE
Dystonia
▶BY MOUTH
▶Child 3 months–17 years:Initially 1 – 2 mg daily in
1 – 2 divided doses, then increased in steps of 1 mg
every 3 – 7 days, dose to be adjusted according to
response and side-effects; maximum 2 mg/kg per daylUNLICENSED USENot licensed for use in children.
lCONTRA-INDICATIONSGastro-intestinal obstruction.
myasthenia gravis
lCAUTIONSCardiovascular disease.hypertension.liable to
abuse.psychotic disorders.pyrexia.those susceptible to
angle-closure glaucoma
lINTERACTIONS→Appendix 1 : trihexyphenidyl
lSIDE-EFFECTSAnxiety.bronchial secretion decreased.
confusion.constipation.delusions.dizziness.dry mouth
.dysphagia.euphoric mood.fever.flushing.
hallucination.insomnia.memory loss.myasthenia gravis
aggravated.mydriasis.nausea.skin reactions.
tachycardia.thirst.urinary disorders.vision disorders.
vomiting
lPREGNANCYUse only if potential benefit outweighs risk.
lBREAST FEEDINGAvoid.
lHEPATIC IMPAIRMENTUse with caution.
lRENAL IMPAIRMENTUse with caution.
lTREATMENT CESSATIONAvoid abrupt withdrawal in
patients taking long-term treatment.
lDIRECTIONS FOR ADMINISTRATIONTablets should be
taken with or after food.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Trihexyphenidyl hydrochloride for
dystoniawww.medicinesforchildren.org.uk/trihexyphenidyl-
hydrochloride-for-dystonia
Driving and skilled tasksMay affect performance of skilled
tasks (e.g. driving).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Oral solution
EXCIPIENTS:May contain Propylene glycol
▶Trihexyphenidyl hydrochloride (Non-proprietary)
Trihexyphenidyl hydrochloride 1 mg per 1 mlTrihexyphenidyl
5 mg/ 5 ml oral solution| 200 mlP£ 22. 00 DT = £ 22. 00
Tablet
▶Trihexyphenidyl hydrochloride (Non-proprietary)
Trihexyphenidyl hydrochloride 2 mgTrihexyphenidyl 2 mg tablets
| 84 tabletP£ 4. 20 DT = £ 3. 28
Trihexyphenidyl hydrochloride 5 mgTrihexyphenidyl 5 mg tablets
| 84 tabletP£ 17. 91 DT = £ 17. 91DOPAMINERGIC DRUGS›DOPAMINE
PRECURSORSCo-careldopa 01-May-2018
lINDICATIONS AND DOSE
Dopamine-sensitive dystonias including Segawa syndrome
and dystonias related to cerebral palsy (dose expressed
as levodopa)
▶BY MOUTH
▶Child 3 months–17 years:Initially 250 micrograms/kg
2 – 3 times a day, dose to be increased according to
response every 2 – 3 days, increased if necessary up to
1 mg/kg 3 times a day, preparation containing 1 : 4 ratio
of carbidopa:levodopa is to be used
Treatment of defects in tetrahydrobiopterin synthesis and
dihydrobiopterin reductase deficiency (dose expressed
as levodopa)
▶BY MOUTH
▶Neonate:Initially 250 – 500 micrograms/kg 4 times a day,
dose to be increased every 4 – 5 days according to
response, a preparation containing 1 : 4 carbidopa:
levodopa to be administered; maintenance 2. 5 – 3 mg/kg
4 times a day, at higher doses consider preparation
containing 1 : 10 carbidopa:levodopa, review regularly
(every 3 – 6 months).▶Child:Initially 250 – 500 micrograms/kg 4 times a day,
dose to be increased every 4 – 5 days according to
response, a preparation containing 1 : 4 carbidopa:
levodopa to be administered; maintenance
2. 5 – 3 mg/kg 4 times a day, at higher doses consider
preparation containing 1 : 10 carbidopa:levodopa,
review regularly (every 3 – 6 months in early childhood)
DOSE EQUIVALENCE AND CONVERSION
▶The proportions are expressed in the form x/y where x
and y are the strengths in milligrams of carbidopa and
levodopa respectively.
▶ 2 tabletsSinemet® 12. 5 mg/ 50 mg is equivalent to
1 tabletSinemet®Plus 25 mg/ 100 mg.lUNLICENSED USENot licensed for use in children.
lCAUTIONSCardiovascular disease.diabetes mellitus.
history of myocardial infarction with residual arrhythmia.
history of peptic ulcer.history of skin melanoma (risk ofBNFC 2018 – 2019 Dystonias and other involuntary movements 257
Nervous system4