4.9.2 Antimuscarinic drugs used in parkinsonism
| Choice | Drug | Dosage |
|---|
| 1st choice | Procyclidine tablets 5mg | Dose:
See BNF - seek specialist advice |
| Or | |
| Trihexyphenidyl hydrochloride tablets 2mg, 5mg | Dose:
See BNF - seek specialist advice |
| | |
Prescribing Notes
- Antimuscarinics are sometimes used as a first line therapy in young onset Parkinson’s Disease under specialist supervision, but not generally recommended in older patients – see cautions.
- Antimuscarinics may occasionally be useful in patients with tremor which is unresponsive to other drugs, on the advice of a specialist.
- Procyclidine is mainly used in the management of drug-induced parkinsonism.
- Tardive dyskinesia is not improved by antimuscarinic drugs and may be made worse.
Cautions
- Antimuscarinics may cause cognitive impairment and urinary retention. They should be avoided in older patients.
- Antimuscarinics are not generally recommended for use in Parkinson’s Disease because of toxicity in the elderly and the risk of aggravating dementia.
- Abrupt withdrawal of antimuscarinics should be avoided.
