Kemadrin: Effective Control of Parkinsonian Tremor and Rigidity
| Product dosage: 5mg | |||
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Synonyms | |||
Kemadrin (procyclidine hydrochloride) is a well-established anticholinergic agent indicated for the management of parkinsonian symptoms, including tremor, rigidity, and sialorrhea. As a centrally acting muscarinic antagonist, it functions by restoring the neurotransmitter balance between acetylcholine and dopamine in the basal ganglia. This medication is particularly valuable in the symptomatic treatment of drug-induced extrapyramidal symptoms and as an adjunctive therapy in Parkinson’s disease. Its targeted mechanism offers a specialized approach to improving motor function and quality of life for affected individuals.
Features
- Active ingredient: Procyclidine hydrochloride
- Available in 5 mg tablet formulation
- Selective central anticholinergic activity
- Rapid absorption with peak plasma concentrations within 1-2 hours
- Hepatic metabolism via cytochrome P450 system
- Renal elimination pathway
- Well-characterized pharmacokinetic profile
Benefits
- Reduces muscular rigidity and improves mobility in parkinsonian syndromes
- Diminishes tremor amplitude and frequency for enhanced motor control
- Decreases excessive salivation (sialorrhea) associated with neurological disorders
- Improves overall functional capacity and activities of daily living
- Provides symptomatic relief from drug-induced extrapyramidal effects
- Offers flexible dosing regimen adaptable to individual patient needs
Common use
Kemadrin is primarily prescribed for the symptomatic management of all forms of parkinsonism, including post-encephalitic, arteriosclerotic, and idiopathic Parkinson’s disease. It demonstrates particular efficacy in addressing the triad of rigidity, tremor, and sialorrhea. Additionally, it is extensively used in psychiatric practice to counteract extrapyramidal symptoms induced by neuroleptic medications, such as dystonic reactions, drug-induced parkinsonism, and akathisia. The medication may also be employed off-label for the treatment of certain forms of dystonia and as an adjunct in management of excessive sweating related to neurological conditions.
Dosage and direction
Initial dosage for adults typically begins with 2.5 mg administered three times daily, preferably after meals to minimize gastrointestinal discomfort. Dosage may be gradually increased by 2.5 mg increments every 2-3 days until optimal therapeutic effect is achieved, with most patients responding to 15-30 mg daily in divided doses. The maximum recommended daily dosage is 60 mg. For elderly patients or those with hepatic impairment, initiation at lower doses (1.25-2.5 mg once or twice daily) is advised with careful titration. Tablets should be swallowed whole with water and not crushed or chewed. Consistent timing of administration maintains stable plasma concentrations.
Precautions
Patients should be monitored for signs of anticholinergic toxicity, particularly in hot environments due to reduced sweating capacity. Use with caution in individuals with cardiovascular disorders, especially those with tachycardia, hypertension, or cardiac arrhythmias. Hepatic function should be assessed periodically during long-term therapy. Kemadrin may cause drowsiness or blurred vision; patients should avoid operating machinery until response is determined. Abrupt discontinuation should be avoided as it may precipitate withdrawal symptoms or exacerbation of parkinsonian features. Special caution is required in patients with prostatic hypertrophy, gastrointestinal obstruction, or angle-closure glaucoma.
Contraindications
Kemadrin is contraindicated in patients with known hypersensitivity to procyclidine hydrochloride or any component of the formulation. Absolute contraindications include narrow-angle glaucoma, myasthenia gravis, obstructive gastrointestinal diseases (such as paralytic ileus, intestinal atony), severe ulcerative colitis, and toxic megacolon. It should not be used in patients with significant bladder neck obstruction or prostatic hypertrophy causing urinary retention. Concurrent use with other potent anticholinergic agents is generally contraindicated due to additive effects.
Possible side effect
Common adverse reactions include dry mouth (approximately 40% of patients), blurred vision (25-30%), constipation (20-25%), and urinary hesitation (15-20%). Central nervous system effects such as dizziness, drowsiness, or nervousness occur in 10-15% of patients. Less frequently, tachycardia, palpitations, nausea, vomiting, or rash may develop. Rare but serious side effects include acute angle-closure glaucoma, neuroleptic malignant syndrome, paralytic ileus, and severe confusion or hallucinations in elderly patients. Psychiatric manifestations including agitation, euphoria, or memory disturbances have been reported in approximately 5% of cases.
Drug interaction
Concurrent administration with other anticholinergic drugs (including tricyclic antidepressants, antihistamines, and phenothiazines) may result in additive anticholinergic effects and increased toxicity. Kemadrin may decrease the gastrointestinal absorption of levodopa and other drugs. Alcohol and other CNS depressants may enhance sedative effects. MAO inhibitors may potentiate anticholinergic side effects. The medication may interfere with the therapeutic effects of cholinergic agents used for myasthenia gravis. Ketoconazole and other CYP3A4 inhibitors may increase procyclidine concentrations, while enzyme inducers like carbamazepine may reduce its efficacy.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Consistent timing is important for maintaining therapeutic drug levels, but occasional missed doses are unlikely to cause significant clinical deterioration. If multiple doses are missed, medical advice should be sought regarding dose re-titration.
Overdose
Symptoms of overdose include severe anticholinergic effects: hyperthermia, tachycardia, dilated pupils, blurred vision, dry skin and mucous membranes, hallucinations, seizures, respiratory depression, and cardiovascular collapse. Management involves immediate gastric lavage if ingestion was recent, followed by activated charcoal. Physostigmine may be administered as an antidote under careful monitoring. Supportive measures include temperature control, intravenous fluids, and management of arrhythmias. Dialysis is not effective due to extensive tissue binding. Patients require intensive monitoring for at least 24 hours due to potential for delayed symptoms.
Storage
Store at controlled room temperature (15-30°C) in the original container, protected from light and moisture. Keep tightly closed and away from excessive heat or humidity. Do not store in bathroom cabinets or near kitchen sinks where moisture levels fluctuate. Keep out of reach of children and pets. Do not use if tablets show signs of discoloration, cracking, or if the expiration date has passed. Proper disposal of unused medication should follow local regulations for pharmaceutical waste.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Individual response to medication may vary based on genetic factors, concomitant conditions, and other medications. Kemadrin should only be used under the supervision of a qualified healthcare professional who can assess the risk-benefit ratio for each patient. The prescribing physician should be consulted for specific dosage recommendations and management of adverse effects. This monograph does not include all possible uses, directions, precautions, or interactions.
Reviews
Clinical studies demonstrate that approximately 70% of patients with drug-induced extrapyramidal symptoms show significant improvement within 2-3 days of initiating therapy. In parkinsonian patients, long-term studies indicate sustained efficacy in reducing tremor and rigidity scores by 40-60% compared to baseline. Patient-reported outcomes suggest improved quality of life measures related to mobility and daily activities. Some reports note that younger patients tend to tolerate higher doses better than elderly individuals, who may experience more cognitive side effects. Overall satisfaction rates among prescribing neurologists remain high due to predictable pharmacokinetics and manageable side effect profile when properly titrated.