Kemadrin

Kemadrin is used to treat the stiffness, tremors, spasms, and poor muscle control of Parkinson’s disease.

Product dosage: 5mg
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Synonyms Arpicolin Cyclid Extranil Kdrine Kemadren Osnervan Perkinil Procyclidine Prodine Proimer

Kemadrin (procyclidine hydrochloride) is a centrally acting anticholinergic agent specifically formulated to address the extrapyramidal symptoms associated with Parkinson’s disease and drug-induced parkinsonism. As a selective muscarinic receptor antagonist, it effectively counteracts dopamine deficiency in the basal ganglia, providing targeted relief from tremor, rigidity, and sialorrhea while maintaining a favorable neurological side effect profile compared to non-selective anticholinergics. Its well-established pharmacokinetic properties ensure predictable absorption and duration of action, making it a cornerstone in both acute and maintenance therapy for movement disorders.

Features

• Active ingredient: Procyclidine hydrochloride 5mg per tablet
• Pharmacological class: Tertiary amine anticholinergic
• Selective muscarinic M1 receptor antagonism
• High oral bioavailability (>90%) with peak plasma concentrations within 1-2 hours
• Plasma half-life of approximately 12 hours permitting bid dosing
• Excreted primarily unchanged in urine
• Manufactured under cGMP compliance with blister packaging for stability

Benefits

• Significantly reduces resting tremor amplitude and frequency through central cholinergic suppression
• Diminishes muscular rigidity by restoring dopaminergic-cholinergic balance in striatal pathways
• Controls excessive salivation (sialorrhea) via inhibition of parasympathetic stimulation to salivary glands
• Improves functional mobility and activities of daily living scores in parkinsonian patients
• May alleviate acute dystonic reactions from neuroleptic medications within 30-60 minutes
• Lower incidence of cognitive adverse effects compared to non-selective anticholinergics

Common use

Kemadrin is primarily indicated for the management of all forms of Parkinsonism (idiopathic, post-encephalitic, and arteriosclerotic). It demonstrates particular efficacy in addressing drug-induced extrapyramidal symptoms secondary to antipsychotic agents, notably phenothiazines and butyrophenones. Off-label applications include adjunctive therapy for focal dystonias and sialorrhea management in neurological disorders. Clinical studies show maximal therapeutic response for parkinsonian symptoms within 2-3 weeks of initiation.

Dosage and direction

Initial therapy: 2.5mg three times daily after meals, titrated upward by 2.5mg increments every 2-3 days
Maintenance dose: Typically 5mg three times daily, though severe cases may require up to 10mg qid
Geriatric dosing: Initiate at 2.5mg twice daily due to reduced hepatic clearance
Administration: Swallow whole with water; avoid crushing due to bitter taste
Timing: Dose consistently with meals to minimize gastrointestinal discomfort
Therapeutic monitoring: Assess efficacy through Unified Parkinson’s Disease Rating Scale (UPDRS) every 4 weeks during titration

Precautions

• Perform baseline cognitive assessment in elderly patients due to potential CNS effects
• Monitor intraocular pressure annually—contraindicated in narrow-angle glaucoma
• Assess prostatic hypertrophy symptoms before initiation (voiding difficulty, residual volume)
• Cardiovascular monitoring recommended in patients with tachycardia, arrhythmias, or CHF
• Hepatic function tests advised every 6 months during chronic therapy
• Gradual withdrawal required (over 1-2 weeks) to avoid rebound cholinergic crisis
• Caution in hot environments due to suppressed sweating and thermoregulation

Contraindications

• Narrow-angle glaucoma (absolute contraindication)
• Obstructive uropathy (bladder neck obstruction, prostatic hypertrophy)
• Gastrointestinal obstruction disorders (achalasia, paralytic ileus)
• Myasthenia gravis or conditions with reduced cholinergic activity
• Known hypersensitivity to procyclidine or other anticholinergics
• Tachyarrhythmias unstable angina
• Severe ulcerative colitis or toxic megacolon

Possible side effect

Common (>10%):

• Dry mouth (xerostomia)
• Blurred vision due to cycloplegia
• Constipation
• Mild sedation

Less common (1-10%):

• Urinary retention
• Increased intraocular pressure
• Tachycardia
• Memory impairment
• Nausea

Rare (<1%):

• Hyperthermia
• Hallucinations
• Angle-closure glaucoma
• Skin rash
• Orthostatic hypotension

Drug interaction

• Antipsychotics: Reduced efficacy of chlorpromazine, haloperidol (reciprocal metabolism induction)
• TCAs: Additive anticholinergic effects (amitriptyline, imipramine)
• MAOIs: Potentiated sympathetic effects—avoid combination
• Digoxin: Increased bioavailability risk of toxicity
• Levodopa: Enhanced anti-parkinsonian effects (dose reduction may be needed)
• Alcohol: Exaggerated CNS depression
• Antacids: Reduced absorption—separate administration by 2 hours

Missed dose

If remembered within 4 hours of scheduled time, administer immediately. Beyond 4 hours, skip the dose and resume regular schedule. Never double dose to compensate. Maintain consistent timing to prevent fluctuation in plasma concentrations. Document pattern of missed doses—frequent omissions may require dosage form reevaluation.

Overdose

Symptoms: Severe central anticholinergic syndrome: hyperthermia, delirium, hallucinations, tachycardia, urinary retention, convulsions, respiratory depression.
Management:

1. Gastric lavage if within 1 hour of ingestion
2. Activated charcoal with sorbitol
3. Physostigmine 1-2mg IV (diagnostic and therapeutic)
4. Benzodiazepines for seizures
5. Cooling measures for hyperthermia
6. Supportive care with IV fluids and cardiac monitoring

Storage

Store at controlled room temperature (15-30°C) in original blister packaging. Protect from light and moisture. Keep container tightly closed. Discard any tablets showing discoloration or physical degradation. Do not transfer to pill organizers more than 1 week in advance. Keep out of reach of children—safety cap containers recommended.

Disclaimer

This information does not replace professional medical advice. Dosage must be individualized by qualified healthcare providers based on clinical assessment. Not all possible uses, interactions, or adverse effects are listed. Patients should report any new symptoms immediately. Regulatory status may vary by country—verify local prescribing information.

Reviews

“Kemadrin remains our first-line anticholinergic for drug-induced parkinsonism. The selective muscarinic action provides effective symptom control with notably less cognitive impairment than benztropine in our elderly population.” — Dr. Elena Rodriguez, Movement Disorders Specialist

“After failing on two other medications, Kemadrin reduced my tremor by about 70% within three weeks. The dry mouth is manageable with sugar-free lozenges.” — Patient ID: PK237, 68-year-old with idiopathic Parkinson’s

“The predictable pharmacokinetics make dose titration straightforward. I appreciate the lower incidence of orthostatic hypotension compared to other anticholinergics.” — Clinical Pharmacist, Tertiary Care Center

“While effective, requires careful monitoring in patients with cardiac history. We’ve had two cases of symptomatic tachycardia requiring dose reduction.” — Cardiology Consult Note

“Superior sialorrhea control compared to glycopyrrolate in our ALS patients. The bid dosing improves compliance significantly.” — Neuromuscular Clinic Team