Procyclidine

Medication name

Procyclidine ("pro-sigh-clid-ene")
Brand name

Kemadrin ("kem-a-drin")
Medication type

Anticholinergic

Tablets: 5mg strength

Liquid: 2.5mg per 5ml, 5mg per 5ml

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

If you are 18 or over, the doctor can prescribe procyclidine for you as a licensed medicine for the treatment of extrapyramidal symptoms (movement disorders) caused by antipsychotic medicines.

If you are under 18, a specialist doctor may still consider this as a treatment option.

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

About procyclidine

There is a naturally occurring chemical messenger (or '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 chemical messenger. 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 may lead 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 and everyday life

You should get a beneficial effect soon after taking the first dose. It may take a few days of taking it regularly to get the maximum benefit from your medicine.

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.

Procyclidine itself is unlikely to affect your weight, but it is often taken with antipsychotic medications which may cause weight gain.

A common side effect of procyclidine is a dry mouth. Over a long time, this can increase your risk of developing tooth decay or gum disease. Make sure you brush your teeth well and have regular dental check-ups. Speak to your dentist, doctor or pharmacist about things you can do to help.

You may want to let your family and friends know you are taking procyclidine so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

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

Alcohol

It may be possible to drink some alcohol in moderation while taking procyclidine but having the two together might make you very sleepy and unsteady on your feet. If you drink a lot of alcohol, these effects will be more serious.

During the first few weeks of treatment, it might be best to stop drinking alcohol until you see how the medicine affects you.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

Cannabis and procyclidine taken together increases your heart rate and may also make any drowsiness worse.

Amfetamine and procyclidine taken together increases your heart rate.

Methadone can make the more common side effects of procyclidine (such as dry mouth, blurred vision and constipation) worse.

If you are taking procyclidine to help treat the side effects of an antipsychotic medication, it is important to look up how your antipsychotic medication interacts with other drugs.

There are many other street drugs, but we don’t know what effect taking them with procyclidine will have, so it’s best to be cautious. There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Procyclidine on its own can, in large doses, cause a high and make psychosis symptoms worse. Do not share your procyclidine with anyone else.

Get more advice on our drugs and alcohol guide.

Procyclidine does not mix well with some other medicines, including herbal medicines. It may affect how they work or could cause more side effects.

Always tell your doctor if you are taking other medication before you start taking procyclidine.

Tell your pharmacist you are taking procyclidine if you buy medicines for common illnesses, including things you put on your skin.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with procyclidine. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

The tablets may not be suitable for you if you have problems eating some sugars or dairy foods, as they contain lactose.

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.

Let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

If you need to avoid animal products, please note that non-active ingredients used in the production of medicines may sometimes be of animal origin. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

Taking procyclidine may make you feel tired or dizzy when you start taking it. It will also slow down your reaction time, even if you don’t feel tired. This could affect you if you drive a car, ride a bike, or do anything that needs a lot of focus.

It might be best to stop doing these things for the first few days until you know how it affects you.

Most people drive as normal while taking procyclidine. If you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

Pregnancy

There is little research into the effects on procyclidine while you are pregnant. It is also important to look at the information available for the antipsychotic medication you are taking and understand its impact on your developing baby.

If you become pregnant while you are on procyclidine, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing procyclidine and help you to make a decision that is best for you and your baby.

They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking procyclidine during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Untreated illnesses can also be harmful to you and your developing baby, so decisions about stopping or avoiding medication when you are pregnant need to be discussed carefully with your doctor. If you and your doctor agree that it is best for you to continue taking procyclidine while pregnant, you should tell your midwife. If you are planning to get pregnant, it is recommended that you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with procyclidine.

Breastfeeding

There is no specific information about whether procyclidine is passed on to the baby through breastmilk, but since this is the case with most other drugs, it is likely that it is also the case with procyclidine.

It is also important to read the information you have for the antipsychotic medication you are taking.

If your baby was born early, then breastfeeding while you are taking procyclidine may not be recommended. Talk to your midwife and doctor about feeding options.

If you breastfeed while taking procyclidine, seek urgent medical advice if your baby becomes restless, very sleepy or develops feeding problems.

Sex

Procyclidine does not have any side effects which might affect your sex life.

As it is taken to treat the side effects of an antipsychotic medication, you should look at the information available for this medicine and see if there are any side effects which may effect your sex life.
If you do experience any side effects that you think could be caused by your medication, speak to your doctor.

Fertility

There is no evidence to suggest that procyclidine will affect your fertility. Talk to your doctor about your procyclidine or the antipsychotic medication you are taking if you are trying to get pregnant or planning a family.

Procyclidine is not a banned substance in sport.

Most people play sports as normal while taking procyclidine , but if procyclidine affects your concentration, eyesight or co-ordination, then you may want to see if those side effects go away before playing sports that need a lot of focus. If you have any concerns, discuss this with your doctor.

Ideally, it is best not to take procyclidine for the first time just before your exams, as it may affect your concentration.

Procyclidine is usually taken to help with the movement disorders caused by antipsychotics, so speak to your doctor if you have any worries about taking it.

It’s not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking procyclidine.

You should talk to your doctor about any future exams if you are starting procyclidine. You might decide together to delay starting until you have done them.

If they are more than a month away, however, you might find that it is better to start procyclidine to improve your ability to study and wellbeing.

Most people take exams as normal while taking procyclidine, but if you have any concerns, discuss this with your doctor.

Information and safety considerations

Your doctor will consider any other medical conditions or symptoms you have before recommending a medicine for you.

Your medicine will come with a ‘patient information leaflet’. It’s important that you read this information. Speak to your pharmacist if:

you’re not given a leaflet
you don’t understand the information
you need it in a different format or language
you’re concerned about something you’ve read

The information leaflet also includes a list of warnings and precautions to consider before you take the medicine. If you think that any of these apply to you and are concerned that your doctor is not already aware of them, check with your doctor or pharmacist before you start to take your medication (or as soon as possible if you are already taking it).

Uses, warnings, safety and side effects

Taking procyclidine

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.

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

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.

This medicine may be given as an injection. This is only ever for short-term 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.

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

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 four hours before your next dose of procyclidine, do not take the missed dose as taking the doses too close together could cause more side effects. Do not try and catch up by taking a double dose.

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.

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 or worsening in movement disorders
excess saliva and tears
feeling jittery or anxious
trouble getting to sleep or having nightmares

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.

Warnings and safety

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

allergic reaction (difficulty breathing, swelling of your face or throat, itching skin lumps)
any combination of fever, faster breathing, sweating, muscle stiffness and drowsiness or sleepiness
very slow heart rate followed by rapid beating of the heart
agitation/aggressiveness
speech problems
difficulty peeing
blurred vision and dilated (wide) pupils
reduced level of consciousness or coma
confusion
seizures or fits
a combination of fever, faster breathing, sweating, muscle stiffness and drowsiness or sleepiness, slower breathing, aspiration (breathing in vomit, mucus or blood), high blood pressure and unusual heart rhythms

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Serious side effects

Stop taking procyclidine and go to a hospital straight away if you get any of the following symptoms:

allergic reaction (including difficulty breathing, swelling of your face or throat, itching skin lumps)
any combination of fever, faster breathing, sweating, muscle stiffness and drowsiness or sleepiness

Seek urgent advice from an optician if you develop any of the following:

eye pain (this may be severe and sometimes accompanied by feeling sick or being sick)
headache
tenderness around the eyes
blurred vision and seeing rings around lights

These symptoms could be caused by the pressure in your eyes being too high. An optician can check this and send you to hospital for treatment if needed.

Contact your doctor immediately but don't stop taking procyclidine, if you get any of the following symptoms:

increased feelings of anxiety, agitation or nervousness
feeling confused or having problems with your memory
seeing or hearing things that are not real
dizziness
your heart beating much faster than usual

A possible but rare side effect of antipsychotic medications is repeating movements of the tongue, mouth and face. This is called tardive dyskinesia and is more common with older antipsychotic medications. The first sign might be experiencing movements of your tongue that you cannot control, which may be quite regular and rhythmic. The problem with tardive dyskinesia is that it might not stop, even if you stop taking your medicine. It is not helped by procyclidine – in fact, procyclidine may make it worse. If you notice tardive dyskinesia early and act on it with your doctor, the problem should not get worse, so go and see your doctor straight away if you get any symptoms.

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects and your health

Side effects are more common when you first start taking procyclidine. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor or pharmacist about them.

Common side effects (affecting up to one in ten people) include:

constipation
dry mouth
blurred vision
difficulty peeing

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.