PK-MERZ Merz

[Croma Medic]

Contents: Amantadine Sulfate

Indications: Treatment of symptoms of Parkinson’s disease. Eg: rigidity, tremor,

hypokinesia or akinesia

Dosage: 1 tab daily for the first 4-7 days, increased by the same amount once
a week until a maintenance dose of 1-3 tab/s bid. Max 600mg/day.

Administration: After meals.

Contraindications: Severe non-compensated myocardial insufficiency, other

myocardial disorders, heart conduction defects, slow heartbeat,
unusual ECG, features, a blood relative with congenital QT
syndrome, history of serious cardiac dysrythmias, reduction in the
levels of K and Mg in the blood. Pregnancy and lactation.

Special precaution: ECG should be recorded 1 & 3 week/s after treatment. Patients with
prostatic hypertrophy, glaucoma, renal dysfunction, pre-existing
convulsive disorders, patient with cardiac pacemakers, limited renal
function, and organic brain syndrome.

Adverse reaction: Sleep disturbances, restlessness, agitation & urinary retention.

Drug interactions: Drugs that prolong QT interval eg: quinidine, disopyramide,

procainamide, amiodarone, sotalol, antipsychotics, antidepressants,
macrolide antibiotics, sparfloxacin, other antiparkinsonian drugs,
anticholinergics, indirectly centrally acting sympathommetics;
alcohol; memantine.
Benztropine  
[Cogentin]

Indications: The symptomatic treatment of all etiologic groups of parkinsonism

and drug induced extrapyramidal reactions (except tardive
dyskinesia).

Contraindications: Narrow angle glaucoma. Because of its atropine like side effects,
this drug is contraindicated in children less than 3 years of age, and
should be used with caution in older children.

Special precaution: Since benztropine mesylate has cumulative action, continued

supervision is advisable.

Patients with a tendency to tachycardia and patients with prostatic

hypertrophy should be closely observed during treatment.

The occurrence of glaucoma is possible. Although the drug does not

appear to have any adverse effect on simple glaucoma, it should not
be used in narrow angle glaucoma (see Contraindications).

Tardive dyskinesia may appear in some patients on long-term

therapy with phenothiazines and related agents, or may occur after
therapy with these drugs has been discontinued. Antiparkinsonism
agents usually do not alleviate the symptoms of tardive dyskinesia,
and in some instances may aggravate or unmask such symptoms.
Benztropine mesylate is not recommended in tardive dyskinesia.

Benztropine mesylate may produce anhidrosis. Therefore, it should

be given with caution during hot weather, especially to the old, the
chronically ill, the alcoholic, those with CNS disease and those who
do manual labor in a hot environment. Anhidrosis may be
anticipated to occur more readily when some disturbance of
sweating already exists. If there is evidence of anhidrosis, dosage
 should be decreased so that the ability to maintain body heat
equilibrium by perspiration is not impaired. Severe anhidrosis and
fatal hyperthermia have occurred.

Occupational Hazards: Benztropine mesylate may impair mental and/or physical

abilities required for performance of hazardous tasks such as
operating machinery or driving a motor vehicle.

Pregnancy: The safe use of this drug in pregnancy has not been established.

Adverse Effects: CNS: Nervousness, impaired memory, numbness of fingers,

listlessness, depression. Mental confusion, excitement and visual
hallucinations with high doses.

Gastrointestinal: Dry mouth, constipation, nausea, vomiting, rarely

paralytic ileus.

Ophthalmic: Blurred vision, mydriasis.

Endocrine: Hyperthermia, anidrosis, heat stroke.

Genitourinary: Urinary retention and/or dysuria.

Skeletomuscular: Weakness and inability to move particular muscle

groups.

Hypersensitivity: Skin rash may occur occasionally.

Cardiovascular: Tachycardia.
Dosage:

Benztropine mesylate should be used orally in all cases when patients are able to take
oral medication. In other cases, where more rapid response is desired, benztropine
mesylate may be administered i.v. or i.m.

Since there is no significant difference in onset of effect after i.v. and i.m. injection,
usually there is no need to give benztropine i.v. It is quickly effective after either route,
with improvement sometimes noticeable a few minutes after injection. In emergency
situations, 1 to 2 mg of benztropine mesylate parenterally normally will provide quick
relief. If the parkinsonian effect begins to return, the dose can be repeated.

Because benztropine has cumulative action, therapy should be initiated with a low dose
which is increased gradually at 5 or 6 day intervals to the smallest amount necessary for
optimal relief. The initial dose should be 0.5 mg daily. Increases should be made in
increments of 0.5 mg to a maximum of 6 mg or until optimal results are obtained without
excessive adverse effects.

Arteriosclerotic, idiopathic and postencephalitic parkinsonism:

The usual daily dose is 1 to 2 mg with a range of 0.5 to 6 mg orally or parenterally. As
with any agent used in treatment of parkinsonism, dosage must be individualized;
consider the patient's age and weight, and the type of parkinsonism being treated.

Elderly and debilitated patients:

Exercise particular caution in increasing dosage. Generally, older patients, thin patients
and those with arteriosclerotic parkinsonism cannot tolerate large doses. Most patients
with postencephalitic parkinsonism need fairly large doses and tolerate them well.
Patients with dementia or a tendency to mental confusion are usually poor candidates for
therapy.

In arteriosclerotic and idiopathic parkinsonism, therapy may be initiated with a single

daily dose of 0.5 to 1 mg at bedtime. In some patients, this will be adequate; in others 4
to 6 mg a day may be required.

In postencephalitic parkinsonism, therapy may be initiated with 2 mg a day in 1 or more

doses. In highly sensitive patients, therapy may be initiated with 0.5 mg at bedtime, and
increased as necessary.
Some patients experience greatest relief by taking the entire daily dose at bedtime;
others react more favorably to divided doses 2 to 4 times a day.

Therapy with other agents should not be terminated abruptly when therapy with
benztropine mesylate is initiated, but may be reduced or discontinued gradually.
Benztropine mesylate may be administered concomitantly with levodopa or a
levodopa/carbidopa combination, in which case the dose of each may need adjustment.

Drug-induced extrapyramidal symptoms:

In treating extrapyramidal disorders due to phenothiazine derivatives or reserpine, the
recommended dosage is 1 to 4 mg once or twice a day orally or parenterally. Dosage
must be individualized according to the needs of the patient.

In acute dystonic reactions, 2 mg of benztropine mesylate given i.m./i.v. quickly relieves

the condition. After that, 1 to 2 mg given orally twice a day, usually prevents recurrence.

When extrapyramidal disorders develop soon after initiation of treatment with

phenothiazine derivatives or reserpine, they are likely to be transient. One to 2 mg given
orally 2 or 3 times a day usually provides relief within 1 or 2 days. After 1 or 2 weeks,
benztropine mesylate should be withdrawn to determine the continued need for it. If
parkinsonism recurs, benztropine mesylate can be reinstituted.

Benztropine mesylate should not be used beyond the period necessary to counteract the
extrapyramidal manifestations. Although medication with the drug causing parkinsonism
can frequently be continued without change of dosage when adjunctive therapy with
benztropine is used, a reduction in dosage of the psychotropic drug might be indicated.

Patients must be closely observed for severe reactions and benztropine mesylate
discontinued temporarily if they appear.
AKINETON Abbott
[Zuellig]

Contents: Biperiden

Indications: Tab Adjunct therapy of all forms of parkinsonism (post-encephalatic,

arteriosclerotic & idiopathic). Amp Symptomatic treatment of
parkinsonism including alleviation of the extrapyramidal syndrome
induced by drugs.

Dosage: Tab Adult Parkinsonism initially 1mg bid, increased by 2mg/day.

Max: 16mg daily. Drug induced movement disorders 1-4mg once-
qid. Children 3-15 y/o. 1-2mg once-tid.

Administration: After meals.

Contraindications: Untreated narrow-angle glaucoma, intestinal stenoses or

obstruction, mega colon, prostatic hypertrophy, life-threatening
tachycardia.

Special precaution: Avoid abrupt discontinuation, increased sensitivity to side effects,

esp. elderly; enhanced risk of cerebral seizures in predisposed
persons, abuse, impaired ability to drive or operate machinery.

Adverse reaction: Fatigue, dizziness, drowsiness, dry-mouth, rarely, swelling of

salivary glands, accommodation difficulties, mydriasis &
photophobia, hypohydrosis, constipation, gastric symptoms,
nausea, tachycardia, very rarely bradycardia, esp. at higher doses,
restlessness, agitation, anxiety confusion, euphoria, impairment of
memory, delirium, hallucinations, nervousness, headache,
insomnia, dyskinesia, ataxia, muscle twitching, speech impairment.
 Drug interactions: Enhanced ant cholinergic effects in combination w/ other
psychotropic drugs, antihistamines, antiparkinsonism drugs,
antispasmodics, quinidine & pethidine.

Diazepam
 
Brand name: T-Quil, Valium

Anxiolytic - Sedative - Muscle Relaxant

Diazepam is a benzodiazepine with CNS depressant properties and a somewhat flatter

dose-response slope than the sedative-hypnotic drugs. In laboratory animals, it
produces, in varying doses, taming, disinhibitory, sedative, anticonvulsant, muscle
relaxant, ataxic and hypnotic effects.

Diazepam is relatively devoid of autonomic effects and does not significantly reduce
locomotor activity at low doses, or depress amphetamine-induced excitation. In high
doses, it activates the drug metabolizing enzymes in the liver. Diazepam also possesses
dependence liability and may produce withdrawal symptoms, but has a wide margin of
safety against poisoning.

Metabolism studies in animals and man have indicated that oral diazepam is rapidly
absorbed from the gastrointestinal tract. Peak blood levels are reached within 1-2 hours
after administration. The acute half-life is 6-8 hours with a slower decline thereafter,
possibly due to tissue storage.

In humans, comparable blood levels of diazepam were obtained in maternal and cord
blood indicating placental transfer of the drug. Diazepam may appear in human breast
milk.

With the parenteral form, peak blood levels are reached within 15 minutes after i.v.
administration and are of the same magnitude as after oral administration. The
respective half-life is approximately 2-3 hours.

The distribution and fate of tritium-labeled diazepam in man has indicated that the drug
has a rapid and extensive uptake by tissues. Although the radioactivity in the blood
appears to represent mainly the intact drug, diazepam was shown to be excreted
exclusively in the form of its metabolites. The two major metabolites are oxazepam
glucuronide and N-desmethylated diazepam.

Indications: The short-term symptomatic management of mild to moderate

degrees of anxiety in conditions dominated by tension, excitation,
agitation, fear or aggressiveness, such as may occur in
psychoneurosis, anxiety reactions due to stress conditions and
anxiety states with somatic expression.

In acute alcoholic withdrawal, diazepam may be useful in the

symptomatic relief of acute agitation, tremor and impending acute
delirium tremens.

As an adjunct for the relief of skeletal muscle spasm due to reflex

spasm to local pathology, such as inflammation of the muscle and
joints or secondary to trauma; spasticity caused by upper motor
neuron disorders, such as cerebral palsy and paraplegia; athetosis
and the rare stiff man syndrome.

Contraindications: Myasthenia gravis, known hypersensitivity to benzodiazepines. Not

recommended for children under 6 months of age.

Pregnancy: Several studies have suggested an increased risk of congenital

malformations associated with the use of diazepam,
chlordiazepoxide and meprobamate during the first trimester of
pregnancy. Therefore, the administration of diazepam is rarely
justified in women of childbearing potential. If the drug is prescribed
for a woman of childbearing potential, she should be warned to
contact her physician regarding discontinuation of the drug if she
intends to become or suspects that she is pregnant.

Precautions:

Geriatrics:
Elderly and debilitated patients or those with organic brain disorders have been found to
be prone to CNS depression following even low doses. For these patients it is
recommended that the dosage be limited to the smallest effective amount to preclude
development of ataxia, oversedation or other possible adverse effects.

Use in emotional disorders:

Diazepam is not recommended in the treatment of psychotic or severely depressed
patients. Precautions are indicated for severely depressed patients or those who show
evidence of impending depression, particularly the recognition that suicidal tendencies
may be present and protective measures may be necessary. Since excitement and other
paradoxical reactions may result from the use of the drug in psychotic patients, it should
not be used in ambulatory patients suspected of having psychotic tendencies.

Use in epileptic patients:

Since diazepam may exacerbate grand mal seizures in some patients, caution is required
when it is used in epileptic patients. An adjustment may be necessary in their
anticonvulsive medication. Abrupt withdrawal of diazepam in these patients should also
be avoided.

Potentiation of drug effects:

Patients should be advised to abstain from alcohol and other CNS depressant drugs
during treatment with diazepam. Phenothiazines, barbiturates, MAO inhibitors and other
psychoactive drugs may potentiate the action of the drug and should not usually be
given concurrently.

Drug dependence:
Abrupt cessation of large doses of diazepam after prolonged periods may precipitate
acute withdrawal symptoms and, in these cases, the drug should be discontinued
gradually. Caution should be exercised when it is considered necessary to administer
diazepam to addiction prone individuals.

Adverse Effects: The most common adverse effects reported are drowsiness and
ataxia. Other reactions noted less frequently are fatigue, dizziness,
nausea, blurred vision, diplopia, vertigo, headache, slurred speech,
tremors, hypoactivity, dysarthria, euphoria, impairment of memory,
confusion, depression, incontinence or urinary retention,
constipation, skin rash, generalized exfoliative dermatitis,
hypotension, changes in libido.
 The more serious adverse reactions occasionally reported are
leukopenia, jaundice, hypersensitivity and paradoxical reactions.

Paradoxical reactions such as hyperexcited states, anxiety,

excitement, hallucinations, increased muscle spasticity, insomnia,
rage, as well as sleep disturbances and stimulation, have been
reported; should these occur, the drug should be discontinued.

Dosage:

Adults:
Symptomatic relief of anxiety and tension in psychoneurosis and anxiety reactions: 2 to
10 mg, 2 to 4 times daily depending upon severity of symptoms.

Symptomatic relief in acute alcohol withdrawal: 10 mg, 3 or 4 times during the first 24
hours, reducing to 5 mg, 3 or 4 times daily as needed.

Adjunctively for relief of skeletal muscle spasms: 2 to 10 mg, 3 to 4 times daily.

Elderly and debilitated patients, or in the presence of debilitating disease:

2 mg, 1 or 2 times daily initially; increase gradually as needed and tolerated.

Children (Because of varied responses, initiate therapy with lowest dose and increase as
required. Not for use in children under 6 months):
1 to 2.5 mg, 3 or 4 times daily initially; increase gradually as needed and tolerated.

Do not prescribe or administer diazepam for periods in excess of 6 weeks, unless a

definite need for utilizing this medication has been established by a follow-up medical
examination.
Benadryl Anti-histamine
[Zuellig]

Contents: Diphenhydramine HCI

Indications: Hay fever, urticaria, vasomotor rhinitis, angioneurotic edema, drug

sensitization, serum & penicillin reaction, contact dermatitis, atopic
eczema, other allergic dermatoses, pruritus food sensitivity,
parkinsonism, motion sickness.

Dosage: Cap: 25-50mg tid-qid, Syr: 12.5-25mg qid, Inj: 10-50mg IV or IM if

required but not to exceed 400mg over a 24 hours period.

Administration: Before or after meals.

Contraindications: Premature & newborn infants, asthma attack & lactation.

Special precautions: Narrow-angle glaucoma, stenosing peptic ulcer, pyloroduodenal

obstruction, symptoms of prostatic, hypertrophy or bladder-neck
obstruction. History of bronchial asthma, increased intraocular
pressure, hyperthyroidism, CV disease or hypertension, pregnancy.
Avoid operating vehicles or machineries.

Adverse reaction: CV & CNS effects, blood disorders, GI disturbances, antimuscarinic

effects, allergic reactions.

Drug interactions: Alcohol, CNS depressants, MAOIs.

Apo-Lorazepam (CAN), Ativan, Novo-Lorazem (CAN), Nu-Loraz (CAN)

Drug classes: Benzodiazepine, Anxiolytic, Sedative-hypnotic

Therapeutic actions:

Exact mechanisms are not understood; acts mainly at subcortical levels of the CNS,
leaving the cortex relatively unaffected. Main sites of action may be the limbic system
and reticular formation; benzodiazepines potentiate the effects of GABA, an inhibitory
neurotransmitter; anxiolytic effects occur at doses well below those needed to cause
sedation and ataxia.

Indications:

 Oral: Management of anxiety disorders or for short-term relief of symptoms

of anxiety or anxiety associated with depression; insomnia due to anxiety of
transient situational stress
 Parenteral: Preanesthetic medication in adults to produce sedation,
relieve anxiety, and decrease recall of events related to surgery; treatment of status
epilepticus
 Unlabeled parenteral use: Management of chemotherapy-induced nausea and
vomiting, acute alcohol withdrawal

Contraindications and cautions:

 Contraindicated with hypersensitivity to benzodiazepines, propylene glycol,

polyethylene glycol or benzyl alcohol (parenteral lorazepam); psychoses; acute
narrow-angle glaucoma; shock; coma; acute alcoholic intoxication with depression
of vital signs; pregnancy (crosses placenta; risk of congenital malformations and
neonatal withdrawal syndrome); labor and delivery (“floppy infant” syndrome);
lactation.
 Use cautiously with impaired hepatic or renal function.

Available forms:

Injection—2, 4 mg/mL; oral solution—2 mg/mL; tablets—0.5, 1, 2 mg

Dosages:

Oral

Usual dose is 2–6 mg/day; range 1–10 mg/day given in divided doses with largest
dose hs.

 Insomnia due to transient stress: 2–4 mg given hs.

IM

0.05 mg/kg up to a maximum of 4 mg administered at least 2 hr before operative

procedure.

IV

Initial dose is 2 mg total or 0.044 mg/kg, whichever is smaller. Do not exceed this dose in
patients older than 50 yr. Doses as high as 0.05 mg/kg up to a total of 4 mg may be given
15–20 min before the procedure to those benefited by a greater lack of recall. Continuous
infusion 0.5–1 mg/hr titrated, based on patient response.

PEDIATRIC PATIENTS

Drug should not be used in children < 12 yr.

GERIATRIC PATIENTS OR PATIENTS WITH HEPATIC DISEASE

Initially, 1–2 mg/day in divided doses. Adjust as needed and tolerated.

Pharmacokinetics

Route Onset Peak Duration

Oral Intermediat 1 hr 12–24 hr
e
IM 15–30 min 60–90 min 12–24 hr
IV 1–5 min 10–15 min 12–24 hr
Metabolism: Hepatic; T1/2: 10–20 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

IV facts

Preparation: Dilute lorazepam immediately before IV use. For direct IV injection or

injection into IV line, dilute with an equal volume of compatible solution (sterile water for
injection, sodium chloride injection, or 5% dextrose injection); do not use if solution is
discolored or contains a precipitate. Protect from light.

Infusion: Direct inject slowly, or infuse at maximum rate of 2 mg/min.

Y-site incompatibilities: Do not mix with foscarnet, ondansetron.

Adverse effects

 CNS: Transient, mild drowsiness initially; sedation, depression, lethargy,

apathy, fatigue, light-headedness, disorientation, anger, hostility,episodes of mania
and hypomania, restlessness, confusion, crying, delirium, headache, slurred
speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria,
nervousness, difficulty concentrating, vivid dreams, psychomotor
retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions
during first 2 wk of treatment
 CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension,
palpitations, edema
 Dermatologic: Urticaria, pruritus, rash, dermatitis
 EENT: Visual and auditory disturbances, diplopia, nystagmus, depressed
hearing, nasal congestion
 GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting,
difficulty in swallowing, gastric disorders, hepatic dysfunction
 GU: Incontinence, urinary retention, changes in libido, menstrual irregularities
 Hematologic: Elevations of blood enzymes: LDH, alkaline phosphatase, AST,
ALT; blood dyscrasias—agranulocytosis, leukopenia
 Other: Hiccups, fever, diaphoresis, paresthesias, muscular
disturbances, gynecomastia. Drug dependence with withdrawal syndrome when
drug is discontinued; more common with abrupt discontinuation of higher dosage
used for > 4 mo
Duranol OEP Phils
[Zuellig]

Contents: Propanolol HCI

Indications: HTN, angina, cardiac arrhythmias, anxiety & thyrotoxiccosis

symptoms; prophylaxis of re-infarct in heart attack victims;
migraine prevention.

Dosage: Adult: 40-120mg/daily

Administration: Take consistently either always w/ or w/o meals. Swallow whole,

do not chew or crush.

Contraindications: Heart failure, bradycardia, heart block of any degree,

bronchospasm, metabolic acidosis, diabetic ketoacidosis & after
prolonged fasting.

Special precautions: Poor cardiac reserve, conduction abnormalities; DM; anaesth;

withdrawal and pregnancy.

Adverse reaction: Cold extrimities, GI & sleep disturbances, lassitude. Rarely,

paresthesias, thrombocytopenia, purpura, bronchospasm, skin
rash.

Drug interactions: Increased risk of myocardial depression when combined with

verapamil, dilitiazen & class 1 antiarrhythmics. May reduce
requirement for hypoglycemic therapy.
Trihexyphenidyl
 
Artane

Pharmacology:

Antiparkinsonian

Trihexyphenidyl is an anticholinergic antiparkinsonian agent. It produces an atropine-like

blocking action of parasympathetic-innervated peripheral structures, including smooth
muscle. It also exhibits a direct spasmolytic action and weak mydriatic, anti-sialogogue
and cardiovagal blocking effects. In small doses, trihexyphenidyl depresses the CNS but
larger doses cause cerebral excitement resembling the signs of atropine toxicity.

Pharmacokinetics:
Trihexyphenidyl is rapidly absorbed from the gastrointestinal tract. After oral
administration, the onset of action occurs within 1 hour, peak effects last 2 to 3 hours
and the duration of action is 6 to 12 hours. It is excreted in the urine, probably as
unchanged drug.

Indications

The treatment of all forms of Parkinsonism (postencephalitic, arteriosclerotic, and

idiopathic) as well as in the prevention or control of extrapyramidal disorders due to CNS
drugs such as reserpine and the phenothiazines. These disorders are similar to those
encountered in Parkinson's disease and include: tremor, rigidity, and increased
salivation, akathisia manifested by extreme restlessness, and dyskinesias characterized
by spastic contractions and involuntary movements.
Precautions

Closely observe patients with cardiac, liver, kidney or hypertensive disorders. Patients
undergoing prolonged therapy should be subjected to careful periodic review to avoid
untoward reactions. Trihexyphenidyl should be used with caution in patients with
glaucoma, obstructive disease of the gastrointestinal or genitourinary tracts, and in
elderly males with possible prostatic hypertrophy. Trihexyphenidyl may cause
anhidrosis. Caution should be exercised during hot weather especially if given with other
anticholinergic drugs. Incipient glaucoma may be precipitated by trihexyphenidyl.

Pregnancy, Lactation and Children:

Safe use in children, pregnant or lactating women has not been established.

Geriatrics:
Geriatric patients, particularly over the age of 60, frequently develop increased sensitivity
to parasympatholytic drugs and hence, require strict dosage regulation.

Adverse Effects

Dryness of mouth, blurred vision, dizziness, mild nausea or nervousness will be

experienced by 30 to 50% of all patients. Isolated instances of suppurative parotitis
secondary to excessive dryness of the mouth, skin rashes, dilatation of the colon,
paralytic ileus, and certain psychiatric manifestations such as delusions and
hallucinations, plus one doubtful case of paranoia have been rarely reported with
trihexyphenidyl. Older patients, particularly those with underlying cognitive impairment
are especially prone to reactions of mental confusion, agitation, disturbed behavior, or
nausea and vomiting. Such patients should be allowed to develop a tolerance through
the initial administration of a small dose and gradual increase in dose until an effective
level is reached. If a severe reaction should occur, administration of the drug should be
discontinued for a few days and then resumed at a lower dosage. Psychiatric
disturbances can result from indiscriminate use (leading to overdosage) to sustain
continued euphoria.
Withdrawal symptoms may occur in patients receiving large doses.

Potential untoward effects associated with the use of any atropine like drugs include
constipation, drowsiness, urinary hesitancy or retention, tachycardia, postural
hypotension, dilatation of the pupil, increased intraocular tension, weakness, vomiting,
and headache.

Dosage

Should be individualized. The initial dosage should be low and then increased gradually,
especially in patients over 60 years of age.

Parkinsonism:
1 mg orally the first day; increased by 2 mg daily at intervals of 3 to 5 days, up to 6 to 10
mg daily. Best tolerated in divided dose at mealtime.

Drug-induced Parkinsonism:
The size and frequency of doses of trihexyphenidyl needed to control drug induced
extrapyramidal reactions, attributable especially to reserpine and phenothiazine
derivatives, must be determined empirically. The total daily dosage usually ranges
between 5 and 15 mg although, in some cases, these reactions have been satisfactorily
controlled on a little as 1 mg daily. It may be advisable to commence therapy with a
single 1 mg dose. If the extrapyramidal manifestations are not controlled in a few hours,
the subsequent doses may be progressively increased until satisfactory control is
achieved. Satisfactory control may sometimes be more rapidly achieved by temporarily
reducing the dosage of the antipsychotic or instituting trihexyphenidyl therapy and then
adjusting dosage of both drugs until the desired antipsychotic effect is retained without
onset of the extrapyramidal reactions.

It is sometimes possible to maintain the patient on a reduced trihexyphenidyl dosage

after the reactions have remained under control for several days. Instances have been
reported in which these reactions have remained in remission for long periods after
therapy was discontinued.