Artane: Restore Motor Control in Parkinsonism and Dystonia
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Synonyms
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Artane (trihexyphenidyl hydrochloride) is a centrally acting anticholinergic agent indicated for the treatment of parkinsonism and drug-induced extrapyramidal symptoms. It functions as a selective muscarinic antagonist, effectively counteracting the relative cholinergic excess that characterizes these movement disorders. By modulating neurotransmitter activity in the basal ganglia, Artane helps alleviate tremor, rigidity, and sialorrhea, thereby significantly improving functional mobility and quality of life for affected patients. Its well-established efficacy profile makes it a cornerstone in the management of these neurological conditions.
Features
- Active ingredient: Trihexyphenidyl Hydrochloride
- Available in 2 mg and 5 mg tablet formulations
- Also available as a 2 mg/5 mL elixir for flexible dosing
- Rapid gastrointestinal absorption with onset of action within approximately one hour
- Demonstrated high affinity for central muscarinic M1 receptors
- Long history of clinical use with extensive safety data
Benefits
- Effectively reduces the characteristic tremor and muscular rigidity associated with parkinsonism.
- Mitigates acute dystonic reactions and other extrapyramidal symptoms induced by antipsychotic medications.
- Decreases excessive salivation (sialorrhea), a common and troublesome symptom in Parkinson’s disease.
- Improves overall functional capacity, allowing for greater independence in daily activities.
- Provides adjunctive therapy that can help reduce the required dosage of levodopa in Parkinson’s disease management.
- Enhances quality of life by addressing both motor and non-motor symptoms of cholinergic imbalance.
Common use
Artane is primarily prescribed for the management of all forms of parkinsonism, including post-encephalitic, arteriosclerotic, and idiopathic Parkinson’s disease. It is particularly valuable as adjunctive therapy when patients experience diminishing responses to levodopa. Additionally, Artane is widely used to prevent or treat extrapyramidal disorders that may develop during treatment with neuroleptic drugs, such as phenothiazines and butyrophenones. Off-label uses include the treatment of focal dystonias, such as writer’s cramp, and sometimes as prophylaxis for migraine headaches.
Dosage and direction
Dosage must be individualized based on therapeutic response and emergence of side effects. For parkinsonism: Initiate with 1 mg on first day, increase by 2 mg increments at intervals of 3-5 days until total daily dose of 6-10 mg is reached, usually given in 3-4 divided doses. Some patients may require up to 15 mg daily. For drug-induced extrapyramidal symptoms: Begin with 1 mg daily, then increase as needed to total daily dose of 5-15 mg, typically administered in divided doses. The elixir formulation allows for more precise titration in patients requiring fractional dosing. Always administer with or after meals to minimize gastrointestinal discomfort.
Precautions
Exercise caution in patients with cardiovascular disorders, as tachycardia may occur. Use with careful monitoring in individuals with hepatic or renal impairment due to altered metabolism and excretion. Patients with prostatic hypertrophy may experience urinary retention. Those with glaucoma, particularly angle-closure glaucoma, require close ophthalmologic supervision. Caution is advised in patients with gastrointestinal obstructive disorders. Elderly patients may be more susceptible to confusion, agitation, or other central anticholinergic effects. Artane may impair mental and/or physical abilities required for performance of hazardous tasks; patients should be cautioned accordingly.
Contraindications
Artane is contraindicated in patients with known hypersensitivity to trihexyphenidyl hydrochloride or any component of the formulation. It should not be used in patients with narrow-angle glaucoma, regardless of therapy. Contraindicated in patients with obstructive diseases of the gastrointestinal tract (such as achalasia, paralytic ileus, or pyloroduodenal stenosis). Should not be administered to patients with significant bladder neck obstruction or prostatic hypertrophy leading to urinary retention. Use is contraindicated in myasthenia gravis due to its anticholinergic effects.
Possible side effect
Common side effects include dry mouth, blurred vision, dizziness, nausea, and nervousness. Constipation and urinary hesitancy or retention may occur. Some patients experience mild confusion or excitement, particularly elderly individuals. Less frequently, tachycardia, palpitations, dilated pupils, increased intraocular pressure, and vomiting may develop. Rare but serious side effects include severe allergic reactions, neuroleptic malignant syndrome, and paradoxical worsening of parkinsonian symptoms. Psychiatric disturbances such as hallucinations or delusions have been reported, especially at higher doses.
Drug interaction
Artane may interact significantly with other anticholinergic drugs, resulting in additive effects and increased side effects. Concurrent use with amantadine may enhance anticholinergic side effects. It may decrease the efficacy of neuroleptic drugs while potentially increasing their blood levels. MAO inhibitors may intensify anticholinergic effects. Artane may alter the absorption of other drugs from the gastrointestinal tract. Concomitant use with alcohol or other CNS depressants may enhance sedative effects. It may antagonize the effects of cholinergic agents such as bethanechol.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Consistent dosing is important for maintaining therapeutic effect, but occasional missed doses are unlikely to cause significant clinical deterioration. Patients should be instructed to maintain a regular dosing schedule and use reminder systems if necessary.
Overdose
Overdosage with Artane produces typical central anticholinergic effects including dilated pupils, blurred vision, hot dry skin, dryness of mucous membranes, difficulty swallowing, tachycardia, hyperthermia, urinary retention, and decreased gastrointestinal motility. CNS effects may include confusion, agitation, hallucinations, and delirium. Severe overdose may lead to convulsions, coma, respiratory depression, and circulatory collapse. Treatment is primarily symptomatic and supportive. Physostigmine may be considered in severe cases but should be administered with caution due to risk of precipitating seizures or bradycardia.
Storage
Store at controlled room temperature between 20°C to 25°C (68°F to 77°F). Excursions permitted between 15°C to 30°C (59°F to 86°F). Protect from light and moisture. Keep in original container with lid tightly closed. Keep out of reach of children and pets. Do not use if the seal is broken or if tablets appear discolored or deteriorated. The elixir formulation should be protected from freezing. Properly discard any unused medication after the expiration date or when no longer needed.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting, changing, or stopping any medication. The prescribing physician should be familiar with the complete prescribing information and monitor patients appropriately. Individual responses to medication may vary, and not all side effects or interactions are listed here. Proper diagnosis and treatment selection should be made by a healthcare provider familiar with the patient’s complete medical history.
Reviews
Clinical studies and decades of use demonstrate Artane’s efficacy in managing parkinsonian symptoms and drug-induced extrapyramidal effects. Neurologists frequently report satisfactory control of tremor and rigidity, particularly in patients who cannot tolerate or have contraindications to other antiparkinsonian agents. Many patients describe significant improvement in daily functioning and reduction in embarrassing symptoms like drooling. Some note that side effects, particularly dry mouth and blurred vision, can be bothersome but often diminish with continued use or dose adjustment. The elixir formulation receives particular praise for its utility in titration and use in patients with swallowing difficulties. Overall, Artane remains a valuable therapeutic option in movement disorder management.