II. Indications
- Drug-Induced Extrapyramidal Side Effects
- Parkinsonism
III. Contraindications
- Narrow Angle Glaucoma
- Acute Bowel Obstruction
- Megacolon
- Elderly (relative)
- On Beer's List, due to risk of Delirium, pscyhosis, Fall Risk
IV. Mechanism
- Centrally acting Muscarinic Antagonist
- Decreases imbalance of Acetylcholine to Dopamine ratio within corpus striatum (Basal Ganglia)
V. Dosing: Parkinsonism
- Start: 0.5 to 1 mg/day orally, IM or IV divided once at bedtime to four times daily
- Increase by 0.5 mg/day each week as needed
- Maximum: 6 mg/day
VI. Dosing: Extrapyramidal Side Effects
- Acute Dystonic Reaction
- Administer 1 to 2 mg orally, IM or IV
- Chronic
- Start 1 to 4 mg orally, IM or IV once to twice daily
- Consider taper off after 1-2 weeks
VII. Adverse Effects
- See Anticholinergic Symptoms
- Avoid in pregnancy (may be Teratogenic)
- Unknown safety in Lactation
- Withdrawal symptoms with severe increase in Parkinsonism symptoms
- Titrate medication off without abruptly stopping
VIII. Resources
IX. References
- (2021) Med Lett Drugs Ther 63(1618): 25-32
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 46-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
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