4.9.2 Antimuscarinic drugs used in parkinsonism

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