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Kemadrin tablets and injection contain the active ingredient procyclidine hydrochloride, which is a type of medicine called an anticholinergic. (NB. Procyclidine is also available without a brand name, ie as the generic medicine.) Anticholinergic medicines (sometimes also called antimuscarinics) work by preventing the activity of a neurotransmitter called acetylcholine.

Kemadrin tablets and injection contain the active ingredient procyclidine hydrochloride, which is a type of medicine called an anticholinergic. (NB. Procyclidine is also available without a brand name, ie as the generic medicine.) Anticholinergic medicines (sometimes also called antimuscarinics) work by preventing the activity of a neurotransmitter called acetylcholine.

Neurotransmitters are chemical compounds that are found in the brain and nerves. They act as chemical messengers between the nerve cells. There are many different neurotransmitters in the body and these have various different functions. Several diseases and conditions involve either overactivity or underactivity of certain neurotransmitters.

In Parkinson’s disease, there is a deficiency of a neurotransmitter called dopamine in the brain. Normally there is a balance between the activity of dopamine and the activity of acetylcholine in the brain. However, in Parkinson's disease, the deficiency of dopamine causes overactivity of acetylcholine. This causes some of the symptoms of the disease.

Procyclidine works by blocking the receptors that acetylcholine acts on. This reduces the activity of the acetylcholine, and helps restore the balance of acetylcholine and dopamine in the brain. In this way, procyclidine helps control some of the symptoms of Parkinson's disease. It is most effective at reducing the tremor and rigidity associated with the disease, but it has little effect on the slow movements (bradykinesia).

By contrast, some psychiatric illnesses, for example schizophrenia, are associated with overactivity of dopamine in the brain. Antipsychotic medicines that are used to treat these diseases work by decreasing the activity of dopamine in the brain. However, because they decrease dopamine they can produce side effects that resemble the symptoms of Parkinson's disease. These side effects are known as extrapyramidal side effects, and include abnormal face and body movements, restlessness and tremor. Procyclidine can be used to treat this type of side effect.

Warning!

This medicine may cause various side effects, such as blurred vision, dizziness or confusion, that may reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.
You should not suddenly stop taking this medicine, unless your doctor tells you otherwise, as this could cause your symptoms to come back.
This medicine can normally be used effectively and uneventfully in combination with antipsychotic medicines, to treat the extrapyramidal side effects of the antipsychotic. However, on rare occasions, it may worsen the abnormal body movements. Tell your doctor if you get any new or worsening involuntary movements of your tongue, face, arms or legs after you start taking this medicine.
The combination of procyclidine and an antipsychotic medicine may on rare occasions increase the risk of getting heat stroke in hot and humid conditions. This is because antipsychotic medicines can sometimes interfere with the body's ability to control body temperature, and both medicines may reduce sweating.

Use with caution in

Elderly people.
Decreased kidney function.
Decreased liver function.
People at risk of glaucoma.
People at risk of obstruction of the stomach or intestines, eg due to severe constipation.
Men with difficulty passing urine (urinary retention) due to an enlarged prostate gland (prostatic hypertrophy).
People taking antipsychotic medicines who are suffering from or are predisposed to tardive dyskinesias (rhythmical involuntary movements of the tongue, face, mouth and jaw, which may sometimes be accompanied by involuntary movements of the arms and legs).

Not to be used in

Closed angle glaucoma.
Obstruction of the stomach or intestines.
Untreated difficulty in passing urine (urinary retention).
This medicine is not recommended for children.
Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (Kemadrin tablets contain lactose).

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

The safety of this medicine in pregnancy has not been established. It should therefore be used with caution during pregnancy, and only if the benefits to the mother outweigh any risks to the foetus. Seek medical advice from your doctor.
It is not known if this medicine passes into breast milk. It's safety for use during breastfeeding has not been established. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

Dry mouth.
Blurred vision.
Constipation.
Difficulty in passing urine (urinary retention).
Nausea and vomiting.
Inflammation of the gums (gingivitis).
Nervousness.
Rash.
Dizziness.
Confusion.
Impaired memory or concentration.
Disorientation.
Agitation.
Anxiety.
False perceptions of things that are not really there (hallucinations).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

Many groups of medicines have anticholinergic effects. If this medicine is taken in combination with any of these, there there is an increased likelihood of anticholinergic side effects, such as blurred vision, dry mouth, constipation and difficulty passing urine. Other medicines with anticholinergic effects include the following:

amantadine
antihistamines, eg brompheniramine, chlorphenamine
antispasmodics, eg hyoscine
antipsychotics, eg chlorpromazine, clozapine
certain antisickness medicines, eg promethazine, prochlorperazine, meclozine, cyclizine
certain medicines for abnormal heartbeats (antiarrhythmics), eg disopyramide, propafenone
MAOI antidepressants, eg phenelzine
medicines for urinary incontinence, eg oxybutynin, flavoxate, tolterodine, propiverine, trospium
memantine
muscle relaxants, eg baclofen
nefopam
other anticholinergics, eg trihexyphenidyl, orphenadrine
tricyclic or related antidepressants, eg amitriptyline, maprotiline.

This medicine has an opposite effect to cholinergic medicines, which work by increasing the activity of acetylcholine. If this medicine is used in combination with medicines that have cholinergic effects, the medicines may oppose each others effects, making one or both less effective. Medicines with cholinergic effects include the following:

medicines for myaesthenia gravis, eg neostigmine, edrophonium, distigmine, pyridostigmine
medicines for Alzheimer's disease, eg galantamine, donepezil, rivastigmine
tacrine.

Procyclidine can reduce the motility of the gut and may therefore reduce the absorption of certain other medicines taken by mouth, for example levodopa (L-dopa) for Parkinson's disease and the antifungal medicine ketoconazole. If you are taking levodopa and start taking this medicine as well, let your doctor know if your levodopa seems to be less effective.

Procyclidine may reduce the effects of the following medicines on the gut:

cisapride
domperidone
metoclopramide.

The antidepressant paroxetine may increase the blood level of procyclidine and this could increase the chance of side effects. If you start taking paroxetine with procyclidine and you get new or increased side effects, such as blurred vision, dry mouth, constipation or difficulty passing urine, you should let your doctor know. Your dose of procyclidine may need to be reduced.

If you experience a dry mouth as a side effect of this medicine you may find that medicines that are designed to dissolve and be absorbed from under the tongue, eg sublingual glyceryl trinitrate (GTN) tablets, become less effective. This is because the tablets do not dissolve properly in a dry mouth. To resolve this, drink a mouthful of water before taking sublingual tablets.
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