Kemadrin: Effective Control of Parkinsonian Tremor and Rigidity
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Synonyms | |||
Kemadrin (procyclidine hydrochloride) is a well-established anticholinergic agent specifically formulated for the management of symptoms associated with Parkinson’s disease and drug-induced extrapyramidal symptoms. As a centrally acting muscarinic antagonist, it works by restoring the balance between acetylcholine and dopamine in the basal ganglia, providing targeted relief from motor disturbances. Its clinical profile demonstrates particular efficacy in reducing tremor, rigidity, and sialorrhea while maintaining a predictable pharmacokinetic profile. This medication represents an important therapeutic option within the neurological treatment arsenal, particularly for patients who may not tolerate or require alternative dopaminergic therapies.
Features
- Contains procyclidine hydrochloride as the active pharmaceutical ingredient
- Available in 5mg tablet formulation for precise dosing
- Exhibits selective central anticholinergic activity with minimal peripheral effects
- Features rapid absorption with peak plasma concentrations within 1-2 hours
- Demonstrates linear pharmacokinetics across therapeutic dose ranges
- Maintains plasma half-life of approximately 12-14 hours in adults
- Shows minimal protein binding characteristics
- Undergoes hepatic metabolism primarily via CYP450 enzymes
- Provides predictable elimination through renal excretion
Benefits
- Significantly reduces Parkinsonian tremor amplitude and frequency through central cholinergic blockade
- Improves muscular rigidity and enhances overall mobility by modulating basal ganglia circuitry
- Decreases excessive salivation (sialorrhea) commonly associated with Parkinsonian conditions
- Provides adjunctive symptomatic relief when used alongside dopaminergic therapies
- Offers flexible dosing regimen adaptable to individual patient response and tolerance
- Maintains therapeutic effect with twice-daily dosing in most patients due to favorable half-life
Common use
Kemadrin is primarily indicated for the treatment of all forms of Parkinsonism, including post-encephalitic, arteriosclerotic, and idiopathic varieties. It demonstrates particular effectiveness in managing the triad of tremor, rigidity, and excessive salivation characteristic of these conditions. Additionally, it is extensively used to counteract extrapyramidal symptoms induced by neuroleptic medications, including dystonic reactions, akathisia, and drug-induced Parkinsonism. Off-label applications include adjunctive management of dystonia and certain forms of essential tremor when first-line therapies prove insufficient or poorly tolerated.
Dosage and direction
Initial dosing for Parkinsonism typically begins at 2.5mg administered three times daily, preferably after meals to minimize gastrointestinal discomfort. This may be gradually increased by 2.5-5mg increments every 2-3 days until optimal therapeutic effect is achieved, with most patients responding to maintenance doses between 10-20mg daily divided into three or four administrations. The maximum recommended daily dose is 30mg for Parkinsonism management. For drug-induced extrapyramidal symptoms, lower initial doses of 2.5mg two or three times daily usually suffice, with adjustment based on symptom response. Elderly patients or those with hepatic impairment should initiate therapy at reduced doses of 2.5mg once or twice daily, with careful titration based on tolerance and response. Tablets should be swallowed whole with water and not crushed or chewed.
Precautions
Patients should be cautioned regarding potential blurred vision and advised against operating machinery or driving until individual response is determined. Regular monitoring of intraocular pressure is recommended in patients with predisposition to glaucoma. Those with prostatic hypertrophy require careful observation for urinary retention. Hepatic and renal function should be assessed periodically during long-term therapy. Elderly patients may experience increased sensitivity to anticholinergic effects and require closer monitoring for cognitive changes. Dehydration risk increases due to reduced sweating capacity, particularly in warm environments. Abrupt discontinuation should be avoided to prevent rebound cholinergic effects. Dental hygiene should be maintained vigilantly due to reduced salivary flow.
Contraindications
Kemadrin is contraindicated in patients with known hypersensitivity to procyclidine hydrochloride or any component of the formulation. Absolute contraindications include narrow-angle glaucoma, gastrointestinal obstructive conditions such as paralytic ileus, pyloric stenosis, or megacolon. Severe ulcerative colitis or toxic megacolon present additional absolute contraindications. Myasthenia gravis patients should not receive this medication due to potential exacerbation of weakness. Obstructive uropathy, including prostatic hypertrophy with significant residual urine, represents another absolute contraindication. Relative contraindications include tachycardia, hypertension, hepatic impairment, and renal insufficiency requiring careful risk-benefit assessment.
Possible side effect
Common adverse effects (occurring in >5% of patients) include dry mouth, blurred vision, constipation, and mild drowsiness. Moderate frequency effects (1-5% incidence) comprise urinary hesitation or retention, increased intraocular pressure, tachycardia, and nausea. Less common reactions (<1%) include confusion, hallucinations, memory impairment, skin rash, and orthostatic hypotension. Rare but serious adverse effects requiring immediate medical attention include acute narrow-angle glaucoma, severe gastrointestinal obstruction, neuroleptic malignant syndrome-like presentations, and anaphylactic reactions. Peripheral anticholinergic effects typically dose-dependent and often diminish with continued therapy or dose adjustment.
Drug interaction
Concurrent administration with other anticholinergic agents may produce additive effects and increase adverse reaction risk. Alcohol and CNS depressants may potentiate sedative effects. Absorption may be impaired when administered with antacids or antidiarrheal preparations. Kemadrin may reduce gastrointestinal motility and affect absorption of other medications. MAO inhibitors may intensify anticholinergic side effects. Antipsychotic medications may see reduced efficacy due to opposing mechanisms of action. Amantadine coadministration may increase confusion and hallucination risk. Digoxin absorption may be increased due to reduced gastrointestinal motility. CYP3A4 inhibitors may increase procyclidine plasma concentrations.
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 such cases, the missed dose should be skipped and the regular dosing schedule resumed. Doubling of doses to compensate for missed administration is not recommended due to potential increased adverse effects. Patients should maintain a consistent dosing schedule and consider using reminder systems if missed doses occur frequently. Extended missed doses may result in return of Parkinsonian symptoms, requiring gradual retitration rather than immediate full dose resumption.
Overdose
Symptoms of overdose include severe central anticholinergic effects: agitation, confusion, hallucinations, seizures, and coma. Peripheral manifestations include hyperthermia, flushed dry skin, dilated pupils, tachycardia, hypertension, urinary retention, and reduced gastrointestinal motility. Management involves immediate gastric lavage if presentation is early, followed by activated charcoal administration. Supportive care includes temperature control, maintenance of airway, and cardiovascular monitoring. Physostigmine may be considered in severe cases with life-threatening symptoms under careful monitoring due to risk of cholinergic crisis. Dialysis is not effective due to extensive tissue distribution.
Storage
Store at controlled room temperature between 15-30°C (59-86°F) in original container. Protect from light and moisture. Keep tightly closed and ensure container is properly sealed after each use. Do not store in bathroom or other areas with high humidity. Keep out of reach of children and pets. Do not use beyond expiration date printed on packaging. Discard any tablets showing signs of discoloration, cracking, or physical deterioration. Do not transfer to alternative containers as this may affect stability and identification.
Disclaimer
This information provides a comprehensive overview of Kemadrin but does not replace professional medical advice. Healthcare providers should be consulted for individual dosage determinations and treatment decisions. Patients should not alter dosing regimens without medical supervision. The prescribing physician should be informed of all concomitant medications and medical conditions. This medication should only be used for approved indications under appropriate medical supervision.
Reviews
Clinical studies demonstrate Kemadrin’s efficacy in reducing Parkinsonian tremor severity by approximately 60-70% in responsive patients. Rigidity improvement typically shows 50-60% reduction based on standardized assessment scales. Patient-reported outcomes indicate significant improvement in activities of daily living and quality of life measures. Long-term follow-up studies show maintained efficacy over 12-24 month periods with appropriate dose adjustment. Comparative analyses suggest similar efficacy to benztropine with potentially better tolerance profile in elderly populations. Specialist neurologists frequently note its particular value in managing sialorrhea and drug-induced dystonic reactions where other agents may prove less effective.