Trihexyphenidyl hydrochloride (artane) can be used for a long time?

Trihexyphenidyl hydrochloride (Benzhexol dihy - drochloride Antan,, Artane) is one of the commonly used drugs in psychiatric department. It

Content

Trihexyphenidyl hydrochloride (Benzhexol dihy - drochloride Antan,, Artane) is one of the commonly used drugs in psychiatric department. It is mainly used to relieve extrapyramidal symptoms caused by antipsychotic drugs (tremor, sit INS, muscle tension and so on). The use of the drug in the current psychiatric clinic is seen in most patients who are taking antipsychotic drugs. From 60s onwards, domestic and foreign scholars on the prevention of trihexyphenidyl medication and long-term joint use have researched the issue, many scholars in the aspects of preventive medication should not reach a consensus.

First, introduction of trihexyphenidyl efficacy, dosage and adverse reaction:

This product is the central anticholinergic drugs against Parkinson's disease, the role of selective blockade of the striatum of cholinergic

Through the pathway, and the peripheral role is small, which is beneficial to restore the brain dopamine and acetyl Parkinson's disease

Balance of choline improves symptoms in patients with Parkinson's disease.

[pharmacokinetics]

After oral absorption quickly and completely, through the blood-brain barrier, oral 1 hours onset, the role of continuous 6~12

Hour. Take 56% of the amount of urine, renal function when the excretion of slow down, there is accumulation, and from

Milk secretion.

[indications]

Parkinson's disease, Parkinson's syndrome. Can also be used for drug-induced extrapyramidal disorders.

The function of the central nervous system has a blocking effect on the cholinergic receptor in the striatum, and the peripheral anticholinergic effect is weak, which is about 1 / 10 to 1 / 3 of atropine. Clinical use: parkinsonism, encephalitis or arteriosclerosis caused by paralysis agitans, to improve the effective to alleviate the salivation rigidity, bradykinesia, poor effect, improve the tremor significantly but the total curative effect, less levodopa, amantadine. Mainly used for mild and intolerant of levodopa in patients. Often combined with levodopa. Extrapyramidal reactions in the drug reserpine and phenothiazine (caused by delayed ataxia except). Hepatolenticular degeneration.

[usage]

Oral Parkinson's disease, syndrome, began the first day of 1~2mg, every 3~5 days after the increase of 2mg,

To the best curative effect and no side effects, generally not more than 10 mg a day, divided 3~4 times, must be taken for a long time. After a day of 20mg. Drug induced extrapyramidal disorders, the first day of 2~4mg, taking 2~3 times, after the apparent need and tolerance gradually increased to 5~10 mg. Elderly patients should be reduced as appropriate.

[adverse reaction]

Common dry mouth, blurred vision, occasionally tachycardia, nausea, vomiting, urinary retention, constipation etc..

Long term use can appear lethargy, depression, memory loss, hallucinations, consciousness turbidity.

[taboo]

Glaucoma, urinary retention, prostatic hypertrophy.

[pregnant and lactating women]

Caution.

[drug for children]

Caution.

[elderly patients medication]

Long term application of glaucoma in elderly patients. With arteriosclerosis, the amount of commonly used against Parkinson

The disease is prone to mental disorder, disorientation, anxiety, hallucinations and psychotic symptoms. Should be used with caution.

Drug interaction

1, this product and ethanol or other central nervous system depressants, can make the central inhibition.

2, this product with amantadine and anticholinergics, monoamine oxidase inhibitors, and procarbazine in Jilin

It can enhance the anti cholinergic effect and can cause paralytic ileus.

3, this product and monoamine oxidase inhibitor, can lead to high blood pressure.

4, this product with antacids or adsorption of antidiarrheal agents in combination, can weaken the effect of the product.

5, this product with chlorpromazine, which can increase the metabolic rate, plasma concentration decreased.

6, this product can be used in combination with cardiac glycosides to prolong the retention time of the gastrointestinal tract, increase absorption, and be easy to use

Poisoning.

Drug overdose

Toxic symptoms: Super dose, visible mydriasis, increased intraocular pressure, palpitations, tachycardia, urination

The difficulty, weakness, headache, flushing, fever or abdominal distension. Sometimes accompanied by confusion, delirium, delusion, illusion

Symptoms of toxic psychosis. Severe coma, convulsions, circulatory failure.

Treatment of vomiting or gastric lavage, take measures to increase the excretion, and according to the condition of the corresponding symptomatic treatment and support

Holding therapy.

Two, in the clinical use of some harm

Trihexyphenidyl for central anticholinergic drugs for Parkinson disease, anticholinergic side effects (anti-cholinergic effects) can be divided into central and peripheral two categories: central role, including cognitive decline, hallucinations and delirium; peripheral effects exist in many systems, such as dry mouth, tachycardia, blurred vision. Dysuria, constipation and so on; and it can cause a series of complications, such as urinary retention, paralytic ileus, narrow angle glaucoma increased.

1, let's talk about the effects of trihexyphenidyl on cognitive function: a cognitive decline in recent years; the cognitive process of fine worked activities include extensive cognitive function, and generally decline, mainly referring to the intelligent memory attention disorder; cognitive dysfunction can be found in many cases: mental illness itself has cognitive function disorder last, the cognitive function of psychotropic drugs can be found that loss, decline in drug-induced cognitive function, and the main function of anti Ch drugs; drug also sedative drowsiness effects also have certain effect; in addition to the obvious effect of anti Ch drugs, BDZs (especially three midazolam) can also lead to cognitive decline.

Cognitive dysfunction symptoms, clinical manifestations, aprosexia concentrate difficult, short-term memory loss and disorientation, confusion or even delirium.

2, withdrawal of trihexyphenidyl anticholinergic drugs:

In clinical practice, some doctors will stop once trihexyphenidyl. But the anticholinergic (trihexyphenidyl) all of a sudden stop, there will be a cholinergic rebound phenomenon, nausea, vomiting, loss of appetite, malaise and diarrhea, runny nose, sweat, anxiety, excitement, insomnia. Can dyskinesia (akinesia, akathisia, Ba Jinsen's disease), some physicians may misidentification induced by antipsychotics.

Long term and artane may lead to abuse (1994, Fang Yiru): "withdrawal" to psychiatric symptoms, including depression, anxiety, hostility and psychoticism; and somatic symptoms is mainly caused by the less, artane psychological dependence, for patients with a doctor's prescription, often resorted to various rescue clinicians mistaken for psychiatric symptoms or have severe extrapyramidal reactions, which may lead to iatrogenic further abuse.

3. Antipsychotic drug combination may reduce the blood concentration of antipsychotic drugs. It is reported that the combination of artane can reduce the blood concentration of chlorpromazine, anticholinergic drugs can reduce the gastrointestinal function, altered drug absorption. In addition, artane induced hepatic enzyme to chlorpromazine increase metabolism, blood drug concentration decreased, the impact of drug efficacy.

4, pay attention to the clinical drug merger will lead to the following body disease:

Severe narrow angle glaucoma

Retention of urine

Intestinal paralysis, fecal impaction

gastritis

Older patients have greater impact, before the use of detailed medical history:

Ask if you have gastrointestinal disease?

Bladder neck obstruction?

Glaucoma?

Heart disease?

Cognitive function?

Therefore, artane in clinical long-term joint use should be careful, try not to use or not use long-term anticholinergic drugs, even if you want to use, should also be gradually removed in three months.

 

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