What happens if I overdose Trihexyphen?
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local, or emergency room immediately. Symptoms may include depression; difficulty breathing; dilated or sluggish pupils; dry skin; fast breathing; fast heartbeat; high blood pressure; hot, dry, flushed skin.
Proper storage of Trihexyphen:
Store Trihexyphen at room temperature, between 59 and 86 degrees F (15 and 30 degrees C), in a tight, light-resistant container. Do not freeze. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Trihexyphen out of the reach of children and away from pets.
Overdose of Trihexyphen in details
The mean oral LD of Trihexyphen (Trihexyphen) has been reported to be 365 mg/kg (range, 325 to 410 mg/kg) in mice and 1660 mg/kg (1420 to 1940 mg/kg) in rats. At a dose of 40 mg/kg, dogs have exhibited emesis, restlessness followed by drowsiness, equilibrium disturbances, and mydriasis.
In humans, doses up to 300 mg (5 mg/kg) have been ingested without fatalities or sequelae. However, rare cases of death associated with Trihexyphen overdosages taken in conjunction with other CNS-depressant agents have been reported or in patients with a compromised respiratory condition. Trihexyphen blood concentrations associated with the fatalities ranged from 0.03 to 0.80 mg/l.
Signs and Symptoms
Overdosage with Trihexyphen (Trihexyphen) produces typical central symptoms of atropine intoxication (the central anticholinergic syndrome). Correct diagnosis depends upon recognition of the peripheral signs of parasympathetic blockade, including dilated and sluggish pupils; warm, dry skin; facial flushing; decreased secretions of the mouth, pharynx, nose, and bronchi; foul-smelling breath; elevated temperature; tachycardia, cardiac arrhythmias; decreased bowel sounds; and urinary retention. Neuropsychiatric signs such as delirium, disorientation, anxiety, hallucinations, illusions, confusion, incoherence, agitation, hyperactivity, ataxia, lip smacking and tasting movements, loss of memory, paranoia, combativeness, and seizures may be present. The condition can progress to stupor, coma, paralysis, cardiac and respiratory arrest, and death.
Treatment
Treatment of acute overdose involves symptomatic and supportive therapy. Gastric lavage or other methods to limit absorption should be instituted. A small dose of diazepam or a short-acting barbiturate may be administered if CNS excitation is observed. Phenothiazines are contraindicated because the toxicity may be intensified due to their antimuscarinic action, causing coma. Respiratory support, artificial respiration or vasopressor agents may be necessary. Hyperpyrexia must be reversed, fluid volume replaced and acid-balance maintained. Urinary catheterization may be necessary. It is not known if Trihexyphen (Trihexyphen) is dialyzable.
What should I avoid while taking Trihexyphen?
Use caution when driving, operating machinery, or performing other hazardous activities. Trihexyphen may cause dizziness or blurred vision. If you experience dizziness or blurred vision, avoid these activities.
Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking Trihexyphen.
Avoid becoming overheated. Trihexyphen may cause decreased sweating. This could lead to heat stroke in hot weather or with vigorous exercise. Try to keep as cool as possible and watch for signs of heat stroke such as decreased sweating, nausea, and dizziness.
Trihexyphen warnings
Patients to be treated with Trihexyphen (Trihexyphen) should have a gonioscope evaluation prior to initiation of therapy and close monitoring of intraocular pressures. The use of anticholinergic drugs may precipitate angle closure with an increase in intraocular pressure. If blurring of vision occurs during therapy, the possibility of narrow angle glaucoma should be considered. Blindness has been reported due to aggravation of narrow angle glaucoma
Trihexyphen (Trihexyphen) should be administered with caution in hot weather, especially when given concomitantly with other atropine-like drugs to the chronically ill, alcoholics, those who have central nervous system disease, or those who do manual labor in a hot environment. Anhidrosis may occur more readily when some disturbance of sweating already exists. If there is evidence of anhidrosis, the possibility of hyperthermia should be considered. Dosage should be decreased so that the ability to maintain body heat equilibrium via perspiration is not impaired. Severe anhidrosis and fatal hyperthermia have occurred with the use of anticholinergics under the conditions described above.
Neuroleptic Malignant Syndrome
A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with dose reduction or discontinuation of Trihexyphen. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmias).
The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis, it is important to identify cases where the clinical presentation includes both serious medical illness (eg, pneumonia, systemic infection, etc.) and untreated or inadequately treated extrapyramidal signs and symptoms (EPS). Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever, and primary central nervous system (CNS) pathology.
What should I discuss with my healthcare provider before taking Trihexyphen?
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For Trihexyphen, the following should be considered:
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to Trihexyphen or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Pediatric
No information is available on the relationship of age to the effects of Trihexyphen in the pediatric population. Safety and efficacy have not been established.
Geriatric
No information is available on the relationship of age to the effects of Trihexyphen in geriatric patients. However, elderly men are more likely to have age-related prostate problems, and all elderly patients are more likely to have age-related kidney, liver, or heart problems. These conditions may require caution or an adjustment in the dose for patients receiving Trihexyphen.
Breast Feeding
Studies suggest that this medication may alter milk production or composition. If an alternative to this medication is not prescribed, you should monitor the infant for side effects and adequate milk intake.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking Trihexyphen, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using Trihexyphen with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Potassium
Using Trihexyphen with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Morphine
- Morphine Sulfate Liposome
- Oxymorphone
- Umeclidinium
Using Trihexyphen with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Betel Nut
- Chlorpromazine
- Haloperidol
- Perphenazine
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of Trihexyphen. Make sure you tell your doctor if you have any other medical problems, especially:
- Bowel or stomach blockage or
- Enlarged prostate or
- Glaucoma or
- Hypertension (high blood pressure) or
- Urinary blockage—Use with caution. May make these conditions worse.
- Kidney disease or
- Liver disease—Use with caution. Effects may be increased because of slower removal of the medicine from the body.
Trihexyphen precautions
General
Patients with cardiac, liver, or kidney disorders, or with hypertension, should be closely monitored.
Since Trihexyphen (Trihexyphen) has atropine-like properties, patients on long-term treatment should be carefully monitored for untoward reactions.
Since Trihexyphen (Trihexyphen) has parasympatholytic activity, it should be used with caution in patients with glaucoma, obstructive disease of the gastrointestinal or genitourinary tracts, and in elderly males with possible prostatic hypertrophy. Incipient glaucoma may be precipitated by parasympatholytic drugs such as Trihexyphen (Trihexyphen).
Tardive dyskinesia may appear in some patients on long-term therapy with antipsychotic drugs or may occur after therapy with these drugs has been discontinued. Antiparkinsonism agents do not alleviate the symptoms of tardive dyskinesia, and in some instances may aggravate them. However, parkinsonism and tardive dyskinesia often coexist in patients receiving chronic neuroleptic treatment, and anticholinergic therapy with Trihexyphen (Trihexyphen) may relieve some of these parkinsonism symptoms. Trihexyphen (Trihexyphen) is not recommended for use in patients with tardive dyskinesia unless they have concomitant Parkinson's disease.
Patients with arteriosclerosis or with a history of idiosyncrasy to other drugs may exhibit reactions of mental confusion, agitation, disturbed behavior, or nausea and vomiting. Such patients should be allowed to develop a tolerance through the initial administration of a small dose and gradual increase in dose until an effective level is reached. If a severe reaction should occur, administration of the drug should be discontinued for a few days and then resumed at a lower dosage. Psychiatric disturbances can result from indiscriminate use (leading to overdosage) to sustain continued euphoria.
Abrupt withdrawal of treatment for parkinsonism may result in acute exacerbation of parkinsonism symptoms; therefore, abrupt withdrawal should be avoided
Nursing Mothers
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Trihexyphen (Trihexyphen) is administered to a nursing woman. As with other anticholinergics, Trihexyphen may cause suppression of lactation. Therefore, Trihexyphen should only be used if the expected benefit to the mother outweighs the potential risk to the infant.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established.
What happens if I miss a dose of Trihexyphen?
Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and only take the next regularly scheduled dose. Do not take a double dose of this medication.
References
- DrugBank. "trihexyphenidyl". http://www.drugbank.ca/drugs/DB00376 (accessed September 17, 2018).
- MeSH. "Muscarinic Antagonists". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
