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Home Formulary 4.0 Central Nervous System 4.9 Drugs used in parkinsonism and related disorders 4.9.2 Antimuscarinic drugs used in parkinsonism

4.9.2 Antimuscarinic drugs used in parkinsonism

ChoiceDrugDosage
1st choiceProcyclidine tablets 5mgDose:
See BNF - seek specialist advice
Or
Trihexyphenidyl hydrochloride tablets 2mg, 5mgDose:
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.

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