Drug-induced parkinsonism
Treatment with antimuscarinics
For the control of extrapyramidal symptoms (but not tardive dyskinesia).
Procyclidine
Procyclidine 5mg tablets
2.5mg 3 times a day, then increased in steps of 2.5-5mg daily if required; increased if necessary up to 30mg daily in 2-4 divided doses, to be increased at 2-3 day intervals. Maximum daily dose only to be used in exceptional circumstances; maximum 60mg per day. Lower end of range preferable in elderly patients.
Procyclidine 5mg/5ml oral solution sugar free
2.5mg 3 times a day, then increased in steps of 2.5-5mg daily if required; increased if necessary up to 30mg daily in 2-4 divided doses, to be increased at 2-3 day intervals. Maximum daily dose only to be used in exceptional circumstances; maximum 60mg per day. Lower end of range preferable in elderly patients.
Prescribing Notes:
- Procyclidine is mainly used for the control of drug induced parkinsonism symptoms induced by antipsychotic drugs.
- Procyclidine is rarely used in the treatment and symptomatic relief of Parkinson’s disease.
- Intramuscular procyclidine is also used for acute dystonia and oculogyric crisis.
- Antimuscarinics may occasionally be useful in patients with tremor which is unresponsive to other drugs, on the advice of a specialist.
- Antimuscarinics may cause cognitive impairment and urinary retention. They should be avoided in older patients.
- Abrupt withdrawal of antimuscarinics should be avoided.
History Notes
27/10/2022
East Region Formulary content agreed.