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Procyclidine

Procyclidine ("pro-sigh-clid-ene") is used to help with movement-related side effects caused by some antipsychotics

This page will give you general information about propranolol. It is not medical advice. Always talk to your doctor about your situation and whether this medication is for you.

What's it for?

Procyclidine is used to help with movement-related side effects caused by some antipsychotics.

It is most helpful with movement problems such as stiffness in the arms and legs, and tremors (shakes). It is not so good with akathisia (a side effect that makes you more restless).

Procyclidine should not be taken to help with the later-developing movement condition tardive dyskinesia. In fact, it can make tardive dyskinesia worse.

It can also be used as an early treatment for Parkinson's.

The medicines orphenadrine and trihexphenidyl are very similar to procyclidine but not as common.

Name: procyclidine ("pro-sigh-clid-ene")

Other names: Kemadrin ("kem-a-drin")

Medication type: anticholinergic

What can it be used for?
Procyclidine is used to help with movement-related side effects caused by some antipsychotic medications.

It can also be used as an early treatment for Parkinson's.

The medicines orphenadrine and trihexphenidyl are very similar to procyclidine but not as common.

Ways to take it:
Tablets: 5mg. The tablets may not be suitable for you if you have problems eating some sugars or dairy (milk-based) foods, as they contain lactose.

Liquid: 2.5mg per 5ml; 5mg per 5ml. The oral solution has a type of sugar called maltitol in it, so if you have trouble digesting some sugars like fructose, please let your doctor or pharmacist know. It should not affect your blood sugars if you are diabetic.

Injection: 10mg per 2ml. The injection is only used in emergencies. It will be given by a nurse or doctor should you need it.

How it works

What does procyclidine do?

There is a naturally-occurring chemical messenger ('neurotransmitter') in the brain called acetylcholine. Acetylcholine is involved in thinking, emotions, behaviour and perception. It is also linked with movement and muscle activity.

In the brain, acetylcholine sits in balance with dopamine, another neurotransmitter. Picture the two neurotransmitters sitting in balance either side of a see-saw.

When you take antipsychotic medication, it reduces the activity of dopamine. This upsets the balance between acetylcholine and dopamine, which leads to movement problems.

If we think about the see-saw, the dopamine has now become light and the acetylcholine has become heavy.

Procyclidine helps re-balance the see-saw. It does this by reducing the activity of acetylcholine.

Procyclidine reduces acetylcholine activity by blocking acetylcholine target sites (receptors). Drugs that block target acetylcholine receptors are called anticholinergics or anti-muscarinics.

How long does procyclidine take to start working?

You should see positive results right from the first week.

However, getting the right dose may take a little longer. The aim is to get the movement symptoms under control without giving you extra side effects from the procyclidine.

You should stay in touch with your doctor to see how it goes over the first few weeks. They may do some tests to check your symptoms.

How long will I need to take procyclidine for?

You and your doctor should talk about how long you will need to take procyclidine.

It is likely that your doctor will tell you to continue taking procyclidine alongside your current antipsychotic for as long as it is helpful.

If you change the antipsychotic that you take, your procyclidine should be reviewed as well.

Your doctor needs to know if...

You should tell your doctor or pharmacist before you start taking procyclidine if you have, or have a history of these conditions:

  • Parkinson's
  • prostate problems
  • paralytic ileus (a blocked intestine)
  • epilepsy or seizures (fits)
  • narrow-angle glaucoma (increased pressure in the eye)
  • respiratory (lung) disease

Taking procyclidine

How can procyclidine be taken?

Procyclidine can be taken as tablets, an oral solution or given by injection in an emergency.

The tablets contain lactose, so they may not be suitable for you if you have problems eating some sugars or dairy (milk-based) foods.

The oral solution has a type of sugar called maltitol in it. Please let your doctor or pharmacist know if you have trouble digesting some sugars like fructose. This should not affect your blood sugars if you are diabetic.

The injection is for emergency use and would be given to you by a doctor or nurse if you develop a sudden movement problem where your muscles lock or freeze.

You should only take procyclidine as agreed with your doctor

You will get the best effect from procyclidine if you take it as advised by your doctor.

Make sure that you know your dose. If it is not written on the label, check with your pharmacist or doctor.

Your dose will be adjusted to give you the best control of movement difficulties with as few side effects as possible.

You may need to take your procyclidine more than once a day.

It is usually recommended that you avoid taking it before bedtime, as it may keep you awake.

However, it is important to choose a time of day that you can remember easily to take it, which could be a mealtime, or when you brush your teeth.

It is best if you take it after food.

If you take the tablets, swallow them whole with a drink of water - if you chew them, they taste bitter.

The injection is for emergency use and would be given to you by a doctor or nurse if you develop a sudden movement problem where your muscles lock or freeze.

What if I miss a dose?

If you remember during the day, take it as soon as possible.

If you forget to take it by bedtime, just start again the next day.

If it is less than eight hours before your next dose of procyclidine, then do not take the missed dose as taking the doses too close together could cause more side effects.

What will happen if I forget to take my procyclidine?

If you forget to take your tablets for a while, your movement-related side effects may come back. You should talk to your doctor if this happens.

Do not take a double dose.

Stopping the use of procyclidine

When you stop taking procyclidine, the balance of chemicals in the brain changes.

Stopping this medication suddenly, or reducing the dose too much at once, may cause the acetylcholine receptors to go into overdrive. This may cause withdrawal effects, such as:

  • nausea and vomiting
  • diarrhoea
  • muscle cramps
  • excess saliva and tears

If you want to stop taking procyclidine, it is better to do so under a doctor's supervision. They will help you reduce your dose gradually over a few weeks. You will probably go for checks with your doctor after you stop procyclidine to check that you still feel better.

The information on this page was reviewed by the College of Mental Health Pharmacy in March 2020.

CMHP
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