Chlorpromazine hydrochloride (Emetil-DS) is an anti-psychotic medication in a group of drugs called phenothiazines (FEEN-oh-THYE-a-zeens). It works by changing the actions of chemicals in your brain.
Chlorpromazine hydrochloride (Emetil-DS) is used to treat psychotic disorders such as schizophrenia or manic-depression, and severe behavioral problems in children ages 1 through 12.
Chlorpromazine hydrochloride (Emetil-DS) is also used to treat nausea and vomiting, anxiety before surgery, chronic hiccups, acute intermittent porphyria, and symptoms of tetanus.
Chlorpromazine hydrochloride (Emetil-DS) may also be used for purposes not listed in this medication guide.
An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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Oral
Intractable hiccup
Adult: Initially, 25-50 mg 3-4 times daily for 2-3 days; if unresponsive, may admin 25-50 mg via IM inj. If still necessary, 25-50 mg in 500-1000 ml of normal saline may be given via slow IV infusion.
How should I use Chlorpromazine hydrochloride (Emetil-DS)?
Use Chlorpromazine hydrochloride (Emetil-DS) as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Chlorpromazine hydrochloride (Emetil-DS) is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Chlorpromazine hydrochloride (Emetil-DS) at home, a health care provider will teach you how to use it. Be sure you understand how to use Chlorpromazine hydrochloride (Emetil-DS). Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.
Do not use Chlorpromazine hydrochloride (Emetil-DS) if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.
Chlorpromazine hydrochloride (Emetil-DS) may irritate skin. Avoid contact with skin or clothing. Wear rubber gloves while using Chlorpromazine hydrochloride (Emetil-DS).
Do not suddenly stop taking Chlorpromazine hydrochloride (Emetil-DS).
Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.
If you miss a dose of Chlorpromazine hydrochloride (Emetil-DS) and you are using it regularly, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.
Ask your health care provider any questions you may have about how to use Chlorpromazine hydrochloride (Emetil-DS).
Uses of Chlorpromazine hydrochloride (Emetil-DS) in details
There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
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Use: Labeled Indications
Behavioral problems: Treatment of severe behavioral problems in children 1 to 12 years of age marked by combativeness and/or explosive hyperexcitable behavior (out of proportion to immediate provocations).
Bipolar disorder: Treatment of manic episodes associated with bipolar disorder.
Hiccups: Treatment of intractable hiccups.
Hyperactivity: Short-term treatment of hyperactive children who show excessive motor activity with accompanying conduct disorders consisting of some or all of the following symptoms: impulsivity, difficulty sustaining attention, aggressiveness, mood lability, and poor frustration tolerance.
Nausea/Vomiting: Management of nausea and vomiting.
Porphyria, acute intermittent: Treatment of acute intermittent porphyria.
Schizophrenia/Psychotic disorders: Treatment of schizophrenia and psychotic disorders.
Surgery: Management of restlessness and apprehension prior to surgery.
Tetanus: Adjunctive therapy in the treatment of tetanus.
Off Label Uses
Nausea and vomiting of pregnancy
Based on the American College of Obstetricians and Gynecologists (ACOG) Nausea and Vomiting in Pregnancy guidelines, the use of Chlorpromazine hydrochloride (Emetil-DS) may be considered for adjunctive treatment of nausea and vomiting in pregnant women. Use is reserved for women with dehydration when symptoms persist following preferred pharmacologic therapies.
The prototypical phenothiazine antipsychotic drug. Like the other drugs in this class, Chlorpromazine hydrochloride (Emetil-DS)'s antipsychotic actions are thought to be due to long-term adaptation by the brain to blocking dopamine receptors. Chlorpromazine hydrochloride (Emetil-DS) has several other actions and therapeutic uses, including as an antiemetic and in the treatment of intractable hiccup. [PubChem]
Chlorpromazine hydrochloride (Emetil-DS) dosage
Chlorpromazine hydrochloride (Emetil-DS) Dosage
Applies to the following strength(s): 30 mg/mL; 100 mg/mL; 25 mg/mL; 30 mg; 75 mg; 150 mg; 25 mg; 100 mg; 10 mg/5 mL; 10 mg; 50 mg; 200 mg
The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.
Usual Adult Dose for:
Psychosis
Mania
Nausea/Vomiting
Light Sedation
Hiccups
Porphyria
Tetanus
Usual Pediatric Dose for:
Opiate Withdrawal
Schizophrenia
Nausea/Vomiting
Additional dosage information:
Renal Dose Adjustments
Liver Dose Adjustments
Dose Adjustments
Precautions
Dialysis
Other Comments
Usual Adult Dose for Psychosis
IM: Initial Dose 25 to 50 mg. The dose may be repeated in one hour. Subsequent doses may be increased and given every 2 to 4 hours as needed.
Oral: Initial Dose: 10 to 25 mg orally 3 times a day. Total daily doses should be increased in 20 to 50 mg increments every 3 or 4 days until symptoms are controlled.
Usual Maintenance Dose: 200 mg/day orally
Some patients require higher dosages (e.g., 800 mg daily is not uncommon in discharged mental patients). Increase dosage gradually until symptoms are controlled. Maximum improvement may not be seen for weeks or even months. Continue optimum dosage for 2 weeks, then gradually reduce dosage to the lowest effective maintenance level.
Usual Adult Dose for Mania
Oral: 10 mg orally 3 to 4 times a day or 25 mg orally 2 to 3 times a day.
More severe cases: 25 mg orally 3 times a day.
After 1 to 2 days, dose may be increased by 20 to 50 mg/day at semiweekly intervals.
Prompt control of severe symptoms: 25 mg IM one time.
If necessary, repeat in 1 hour. Subsequent doses should be oral, 25 to 50 mg three times a day.
IM: 25 mg injection one time. If necessary, may give additional 25 to 50 mg injection in 1 hour.
Increase subsequent doses gradually over several days up to 400 mg every 4 to 6 hours in exceptionally severe cases.
Usually patient becomes quiet and cooperative within 24 to 48 hours and oral doses may be substituted.
Oral: 500 mg/day is generally sufficient. Gradual increases to 2000 mg/day or more may be necessary.
There is usually little therapeutic gain to be achieved by exceeding 1000 mg/day for extended periods.
Less acutely disturbed
Oral: 25 mg three times a day.
May increase gradually until effective dose is reached, usually 400 mg/day.
Usual Adult Dose for Nausea/Vomiting
Oral: 10 to 25 mg every 4 to 6 hours as needed. May increase, if necessary.
IM: 25 mg one time. If no hypotension occurs, give 25 to 50 mg every 3 to 4 hours as needed, then switch to oral dosage.
Rectal: One 100 mg suppository every 6 to 8 hours as needed. In some patients, half this dose will do.
Nausea/Vomiting During Surgery:
IM: 12.5 mg one time. May repeat in 30 minutes if necessary and if no hypotension occurs.
IV: 2 mg at 2 minute intervals. Do not exceed 25 mg. Dilute to 1 mg/mL.
Usual Adult Dose for Light Sedation
For light sedation prior to a medical or surgical procedure:
Oral: 25 to 50 mg, 2 to 3 hours before the operation.
IM: 12.5 to 25 mg, 1 to 2 hours before operation.
Usual Adult Dose for Hiccups
Oral: 25 to 50 mg 3 to 4 times a day.
IM: If symptoms persist for 2 to 3 days, give 25 to 50 mg IM.
IV infusion: Should symptoms persist, use slow IV infusion: 25 to 50 mg in 500 to 1000 mL of saline.
Usual Adult Dose for Porphyria
Oral: 25 to 50 mg 3 to 4 times a day.
Can usually be discontinued after several weeks, but maintenance therapy may be necessary for some patients.
IM: 25 mg injection 3 to 4 times a day until patient can take oral therapy.
Usual Adult Dose for Tetanus
IM: 25 to 50 mg given 3 to 4 times daily, usually in conjunction with barbiturates. Total doses and frequency of administration must be determined by the patient's response, starting with low doses and increasing gradually.
IV: 25 to 50 mg diluted to at least 1 mg/mL and administered at a rate of 1 mg/min.
Usual Pediatric Dose for Opiate Withdrawal
less than 1 month:
Neonatal abstinence syndrome (withdrawal from maternal opioid use; controls CNS and gastrointestinal symptoms):
Intramuscular: Initial: 0.55 mg/kg/dose given every 6 hours; change to oral after approximately 4 days, decrease dose gradually over 2 to 3 weeks. Note: Chlorpromazine hydrochloride (Emetil-DS) is rarely used for neonatal abstinence syndrome due to adverse effects such as hypothermia, cerebellar dysfunction, decreased seizure threshold, and eosinophilia; other agents are preferred.
Usual Pediatric Dose for Schizophrenia
6 months and older:
Oral: 0.5 to 1 mg/kg/dose orally every 4 to 6 hours; older children may require 200 mg/day or higher
intramuscular or intravenous: 0.5 to 1 mg/kg/dose every 6 to 8 hours
Maximum recommended doses:
less than 5 years (less than 22.7 kg): 40 mg/day
5 years and older: (22.7 to 45.5 kg): 75 mg/day
Usual Pediatric Dose for Nausea/Vomiting
Nausea and vomiting:
Oral: 0.5 to 1 mg/kg/dose every 4 to 6 hours as needed
intramuscular or intravenous: 0.5 to 1 mg/kg/dose every 6 to 8 hours;
Maximum recommended doses:
less than 5 years (less than 22.7 kg): 40 mg/day
5 and older (22.7-45.5 kg): 75 mg/day
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
Data not available
Dose Adjustments
Adjust dosage to individual and the severity of condition, recognizing that the mg for mg potency relationship among all dosage forms has not been precisely established clinically. It is important to increase dosage until symptoms are controlled. Dosage should be increased more gradually in debilitated or emaciated patients. In continued therapy, gradually reduce dosage to the lowest effective maintenance level, after symptoms have been controlled for a reasonable period.
In general, dosage recommendations for other oral forms of the drug may be applied to the sustained release capsules on the basis of total daily dosage in milligrams.
The 100 mg and 200 mg tablets are for use in severe neuropsychiatric conditions.
Precautions
In general, dosage levels should be lower in the elderly, the emaciated and the debilitated. Chlorpromazine hydrochloride (Emetil-DS) should be used cautiously in patients with cardiovascular, liver or renal disease.
Dialysis
Data not available
Other Comments
Chlorpromazine hydrochloride (Emetil-DS) should generally not be used in children under 6 months of age except where potentially lifesaving.
More about Chlorpromazine hydrochloride (Emetil-DS)
Potentiation of anticholinergic effects of antiparkinson agents and TCAs may lead to an anticholinergic crisis. Additive orthostatic hypotensive effect in combination with MAOIs. Reverses antihypertensive effect of guanethidine, methyldopa and clonidine.
Potentially Fatal: Additive depressant effect with sedatives, hypnotics, antihistamines, general anaesthetics, opiates and alcohol.
Chlorpromazine hydrochloride (Emetil-DS) side effects
Note: Some adverse effects of Chlorpromazine hydrochloride (Emetil-DS) may be more likely to occur, or occur with greater intensity, in patients with special medical problems, e.g., patients with mitral insufficiency or pheochromocytoma have experienced severe hypotension following recommended doses.
Drowsiness, usually mild to moderate, may occur, particularly during the first or second week, after which it generally disappears. If troublesome, dosage may be lowered.
Jaundice
Overall incidence has been low, regardless of indication or dosage. Most investigators conclude it is a sensitivity reaction. Most cases occur between the second and fourth weeks of therapy. The clinical picture resembles infectious hepatitis, with laboratory features of obstructive jaundice, rather than those of parenchymal damage. It is usually promptly reversible on withdrawal of the medication; however, chronic jaundice has been reported.
There is no conclusive evidence that preexisting liver disease makes patients more susceptible to jaundice. Alcoholics with cirrhosis have been successfully treated with Chlorpromazine hydrochloride (Emetil-DS) without complications. Nevertheless, the medication should be used cautiously in patients with liver disease. Patients who have experienced jaundice with a phenothiazine should not, if possible, be reexposed to Chlorpromazine hydrochloride (Emetil-DS) or other phenothiazines.
If fever with grippe-like symptoms occurs, appropriate liver studies should be conducted. If tests indicate an abnormality, stop treatment.
Liver function tests in jaundice induced by the drug may mimic extrahepatic obstruction; withhold exploratory laparotomy until extrahepatic obstruction is confirmed.
Hematological Disorders, including agranulocytosis, eosinophilia, leukopenia, hemolytic anemia, aplastic anemia, thrombocytopenic purpura and pancytopenia have been reported.
AGRANULOCYTOSIS
Warn patients to report the sudden appearance of sore throat or other signs of infection. If white blood cell and differential counts indicate cellular depression, stop treatment and start antibiotic and other suitable therapy.
Most cases have occurred between the 4th and 10th weeks of therapy; patients should be watched closely during that period.
Moderate suppression of white blood cells is not an indication for stopping treatment unless accompanied by the symptoms described above.
Cardiovascular
HYPOTENSIVE EFFECTS
Postural hypotension, simple tachycardia, momentary fainting and dizziness may occur after the first injection; occasionally after subsequent injections; rarely, after the first oral dose. Usually recovery is spontaneous and symptoms disappear within 1/2 to 2 hours. Occasionally, these effects may be more severe and prolonged, producing a shock-like condition.
To minimize hypotension after injection, keep patient lying down and observe for at least 1/2 hour. To control hypotension, place patient in head-low position with legs raised. If a vasoconstrictor is required, norepinephrine and phenylephrine are the most suitable. Other pressor agents, including epinephrine, should not be used as they may cause a paradoxical further lowering of blood pressure.
EKG CHANGES
Particularly nonspecific, usually reversible Q and T wave distortions–have been observed in some patients receiving phenothiazine tranquilizers, including Chlorpromazine hydrochloride (Emetil-DS).
Note: Sudden death, apparently due to cardiac arrest, has been reported.
CNS Reactions
NEUROMUSCULAR (EXTRAPYRAMIDAL) REACTIONS
Neuromuscular reactions include dystonia, motor restlessness, pseudo-parkinsonism and tardive dyskinesia, and appear to be dose-related. They are discussed in the following paragraphs:
Dystonia
Class effect: Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue. While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs. An elevated risk of acute dystonia is observed in males and younger age groups.
Motor Restlessness
Symptoms may include agitation or jitteriness and sometimes insomnia. These symptoms often disappear spontaneously. At times these symptoms may be similar to the original neurotic or psychotic symptoms. Dosage should not be increased until these side effects have subsided.
If these symptoms become too troublesome, they can usually be controlled by a reduction of dosage or change of drug. Treatment with anti-parkinsonian agents, benzodiazepines or propranolol may be helpful.
Pseudo-parkinsonism
Symptoms may include: mask-like facies, drooling, tremors, pillrolling motion, cogwheel rigidity and shuffling gait. In most cases, these symptoms are readily controlled when an anti-parkinsonism agent is administered concomitantly. Anti-parkinsonism agents should be used only when required. Generally, therapy of a few weeks to 2 or 3 months will suffice. After this time, patients should be evaluated to determine their need for continued treatment. (Note: Levodopa has not been found effective in antipsychotic-induced pseudo-parkinsonism.) Occasionally it is necessary to lower the dosage of Chlorpromazine hydrochloride (Emetil-DS) or to discontinue the drug.
Tardive Dyskinesia
As with all antipsychotic agents, tardive dyskinesia may appear in some patients on long-term therapy or may appear after drug therapy has been discontinued. The syndrome can also develop, although much less frequently, after relatively brief treatment periods at low doses. This syndrome appears in all age groups. Although its prevalence appears to be highest among elderly patients, especially elderly women, it is impossible to rely upon prevalence estimates to predict at the inception of antipsychotic treatment which patients are likely to develop the syndrome. The symptoms are persistent and in some patients appear to be irreversible. The syndrome is characterized by rhythmical involuntary movements of the tongue, face, mouth or jaw (e.g., protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements). Sometimes these may be accompanied by involuntary movements of extremities. In rare instances, these involuntary movements of the extremities are the only manifestations of tardive dyskinesia. A variant of tardive dyskinesia, tardive dystonia, has also been described.
There is no known effective treatment for tardive dyskinesia; anti-parkinsonism agents do not alleviate the symptoms of this syndrome. If clinically feasible, it is suggested that all antipsychotic agents be discontinued if these symptoms appear. Should it be necessary to reinstitute treatment, or increase the dosage of the agent, or switch to a different antipsychotic agent, the syndrome may be masked. It has been reported that fine vermicular movements of the tongue may be an early sign of the syndrome and if the medication is stopped at that time the syndrome may not develop.
ADVERSE BEHAVIORAL EFFECTS
Psychotic symptoms and catatonic-like states have been reported rarely.
OTHER CNS EFFECTS
Neuroleptic Malignant Syndrome (NMS) has been reported in association with antipsychotic drugs.
Cerebral edema has been reported.
Convulsive seizures (petit mal and grand mal) have been reported, particularly in patients with EEG abnormalities or history of such disorders.
Abnormality of the cerebrospinal fluid proteins has also been reported.
Allergic Reactions of a mild urticarial type or photosensitivity are seen. Avoid undue exposure to sun. More severe reactions, including exfoliative dermatitis, have been reported occasionally.
Contact dermatitis has been reported in nursing personnel; accordingly, the use of rubber gloves when administering Chlorpromazine hydrochloride (Emetil-DS) injectable is recommended.
In addition, asthma, laryngeal edema, angioneurotic edema and anaphylactoid reactions have been reported.
Endocrine Disorders
Lactation and moderate breast engorgement may occur in females on large doses. If persistent, lower dosage or withdraw drug. False-positive pregnancy tests have been reported, but are less likely to occur when a serum test is used. Amenorrhea and gynecomastia have also been reported. Hyperglycemia, hypoglycemia and glycosuria have been reported.
Skin pigmentation and ocular changes have occurred in some patients taking substantial doses of Chlorpromazine hydrochloride (Emetil-DS) for prolonged periods.
SKIN PIGMENTATION
Rare instances of skin pigmentation have been observed in hospitalized mental patients, primarily females who have received the drug usually for 3 years or more in dosages ranging from 500 mg to 1500 mg daily. The pigmentary changes, restricted to exposed areas of the body, range from an almost imperceptible darkening of the skin to a slate gray color, sometimes with a violet hue. Histological examination reveals a pigment, chiefly in the dermis, which is probably a melanin-like complex. The pigmentation may fade following discontinuance of the drug.
OCULAR CHANGES
Ocular changes have occurred more frequently than skin pigmentation and have been observed both in pigmented and nonpigmented patients receiving Chlorpromazine hydrochloride (Emetil-DS) usually for 2 years or more in dosages of 300 mg daily and higher. Eye changes are characterized by deposition of fine particulate matter in the lens and cornea. In more advanced cases, star-shaped opacities have also been observed in the anterior portion of the lens. The nature of the eye deposits has not yet been determined. A small number of patients with more severe ocular changes have had some visual impairment. In addition to these corneal and lenticular changes, epithelial keratopathy and pigmentary retinopathy have been reported. Reports suggest that the eye lesions may regress after withdrawal of the drug. Since the occurrence of eye changes seems to be related to the dosage levels and/or duration of therapy, it is suggested that long-term patients on moderate to high dosage levels have periodic ocular examinations.
ETIOLOGY
The etiology of both of these reactions is not clear, but exposure to light, along with dosage/duration of therapy, appears to be the most significant factor. If either of these reactions is observed, the physician should weigh the benefits of continued therapy against the possible risks and, on the merits of the individual case, determine whether or not to continue present therapy, lower the dosage, or withdraw the drug.
Other Adverse Reactions
Mild fever may occur after large IM doses. Hyperpyrexia has been reported. Increases in appetite and weight sometimes occur. Peripheral edema and a systemic lupus erythematosus-like syndrome have been reported.
Note: There have been occasional reports of sudden death in patients receiving phenothiazines. In some cases, the cause appeared to be cardiac arrest or asphyxia due to failure of the cough reflex.
Trihexyphenidyl hydrochloride (Emetil-DS) is used to treat the stiffness, tremors, spasms, and poor muscle control of Parkinson's disease. It is also used to treat and prevent the same muscular conditions when they are caused by drugs such as Trihexyphenidyl hydrochloride (Emetil-DS) (Thorazine), fluphenazine (Prolixin), perphenazine (Trilafon), haloperidol (Haldol), thiothixene (Navane), and others.
Trihexyphenidyl hydrochloride (Emetil-DS) may also be used for purposes other than those listed in this medication guide.
An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
Trihexyphenidyl hydrochloride (Emetil-DS) Hydrochloride Elixir is indicated as an adjunct in the treatment of all forms of parkinsonism (postencephalitic, arteriosclerotic, and idiopathic). It is often useful as adjuvant therapy when treating these forms of parkinsonism with levodopa. Additionally, it is indicated for the control of extrapyramidal disorders caused by central nervous system drugs such as the dibenzoxazepines, phenothiazines, thioxanthenes, and butyrophenones.
How should I use Trihexyphenidyl hydrochloride (Emetil-DS)?
Use Trihexyphenidyl hydrochloride (Emetil-DS) as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Take Trihexyphenidyl hydrochloride (Emetil-DS) by mouth with or without food.
Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.
If Trihexyphenidyl hydrochloride (Emetil-DS) tends to dry your mouth excessively, it may be better to take it before meals, unless it causes nausea. If taken after meals, thirst can be improved by sucking hard sugarless candy, chewing gum, or drinking water.
If you miss a dose of Trihexyphenidyl hydrochloride (Emetil-DS), take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Trihexyphenidyl hydrochloride (Emetil-DS).
Uses of Trihexyphenidyl hydrochloride (Emetil-DS) in details
There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
Trihexyphenidyl hydrochloride (Emetil-DS) is used to treat symptoms of Parkinson’s disease (a type of nerve disease that causes movement disorder characterized by slowness of movements, muscle stiffness, uncontrolled shaking and poor balance and co-ordination) and drug-induced extra pyramidal symptoms (movement disorders similar to symptoms of Parkinson’s disease) except tardive dyskinesia (involuntary movement of face and jaw). It is often given along with levodopa (anti-Parkinson drug).
A histamine H1 antagonist with low sedative action but frequent gastrointestinal irritation. It is used to treat asthma; HAY fever; urticaria; and rhinitis; and also in veterinary applications. Trihexyphenidyl hydrochloride (Emetil-DS) is administered by various routes, including topically.
Trihexyphenidyl hydrochloride (Emetil-DS) dosage
Dosage should be individualized. The initial dose should be low and then increased gradually, especially in patients over 60 years of age. Whether Trihexyphenidyl hydrochloride (Emetil-DS) may best be given before or after meals should be determined by the way the patient reacts. Postencephalitic patients, who are usually more prone to excessive salivation, may prefer to take it after meals and may, in addition, require small amounts of atropine which, under such circumstances, is sometimes an effective adjuvant. If Trihexyphenidyl hydrochloride (Emetil-DS) tends to dry the mouth excessively, it may be better to take it before meals, unless it causes nausea. If taken after meals, the thirst sometimes induced can be allayed by mint candies, chewing gum or water.
Trihexyphenidyl hydrochloride (Emetil-DS) in Idiopathic Parkinsonism:
As initial therapy for parkinsonism, 1 mg of Trihexyphenidyl hydrochloride (Emetil-DS) hydrochloride may be administered the first day. The dose may then be increased by 2 mg increments at intervals of three to five days, until a total of 6 to 10 mg is given daily. The total daily dose will depend upon what is found to be the optimal level. Many patients derive maximum benefit from this daily total of 6 to 10 mg, but some patients, chiefly those in the postencephalitic group, may require a total daily dose of 12 to 15 mg.
Trihexyphenidyl hydrochloride (Emetil-DS) In Drug-Induced Parkinsonism:
The size and frequency of dose of Trihexyphenidyl hydrochloride (Emetil-DS) hydrochloride needed to control extrapyramidal reactions to commonly employed tranquilizers, notably the phenothiazines, thioxanthenes, and butyrophenones, must be determined empirically. The total daily dosage usually ranges between 5 and 15 mg although, in some cases, these reactions have been satisfactorily controlled on as little as 1 mg daily. It may be advisable to commence therapy with a single 1 mg dose. If the extrapyramidal manifestations are not controlled in a few hours, the subsequent doses may be progressively increased until satisfactory control is achieved. Satisfactory control may sometimes be more rapidly achieved by temporarily reducing the dosage of the tranquilizer on instituting Trihexyphenidyl hydrochloride (Emetil-DS) therapy and then adjusting dosage of both drugs until the desired ataractic effect is retained without onset of extrapyramidal reactions.
It is sometimes possible to maintain the patient on a reduced Trihexyphenidyl hydrochloride (Emetil-DS) dosage after the reactions have remained under control for several days. Instances have been reported in which these reactions have remained in remission for long periods after Trihexyphenidyl hydrochloride (Emetil-DS) therapy was discontinued.
Concomitant Use of Trihexyphenidyl hydrochloride (Emetil-DS) with Levodopa:
When Trihexyphenidyl hydrochloride (Emetil-DS) is used concomitantly with levodopa, the usual dose of each may need to be reduced. Careful adjustment is necessary, depending on side effects and degree of symptom control. Trihexyphenidyl hydrochloride (Emetil-DS) hydrochloride dosage of 3 to 6 mg daily, in divided doses, is usually adequate.
Concomitant Use of Trihexyphenidyl hydrochloride (Emetil-DS) Hydrochloride Elixir with Other Parasympathetic Inhibitors:
Trihexyphenidyl hydrochloride (Emetil-DS) may be substituted in whole or in part, for other parasympathetic inhibitors. The usual technique is partial substitution initially, with progressive reduction in the other medication as the dose of Trihexyphenidyl hydrochloride (Emetil-DS) is increased.
The total daily intake of Trihexyphenidyl hydrochloride (Emetil-DS) is tolerated best if divided into 3 doses and taken at mealtimes. High doses (>10 mg daily) may be divided into 4 parts, with 3 doses administered at mealtimes and the fourth at bedtime.
Cannabinoids, barbiturates, opiates, and alcohol may have additive effects with PMS Trihexyphenidyl hydrochloride (Emetil-DS), and thus, an abuse potential exists.
Concurrent use of alcohol or other CNS depressants with PMS Trihexyphenidyl hydrochloride (Emetil-DS) may cause increased sedative effects.
Monoamine oxidase inhibitors and tricyclic antidepressants possessing significant anticholinergic activity may intensify the anticholinergic effects of antidyskinetic agents because of the secondary anticholinergic activities of these medications
Prophylactic administration of anticholinergic agents, such as Trihexyphenidyl hydrochloride (Emetil-DS), as a prevention of drug-induced parkinsonism during neuroleptic therapy is not recommended. There may be an increased risk for the development of tardive dyskinesia during concomitant administration of anticholinergics and neuroleptics.
The usual dose of either Trihexyphenidyl hydrochloride (Emetil-DS) or levodopa may need to be reduced during concomitant therapy, since concomitant administration may increase drug-induced involuntary movements
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 PMS Trihexyphenidyl hydrochloride (Emetil-DS) is administered to a nursing woman. As with other anticholinergics, Trihexyphenidyl hydrochloride (Emetil-DS) may cause suppression of lactation. Therefore, Trihexyphenidyl hydrochloride (Emetil-DS) 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.
Trihexyphenidyl hydrochloride (Emetil-DS) side effects
Minor side effects, such as dryness of the mouth, blurring of vision, dizziness, mild nausea or nervousness, will be experienced by 30 to 50 percent of all patients. These sensations, however, are much less troublesome with Trihexyphenidyl hydrochloride (Emetil-DS) than with belladonna alkaloids and are usually less disturbing than unalleviated parkinsonism. Such reactions tend to become less pronounced, and even to disappear, as treatment continues. Even before these reactions have remitted spontaneously, they may often be controlled by careful adjustment of dosage form, amount of drug, or interval between doses.
Isolated instances of suppurative parotitis secondary to excessive dryness of the mouth, skin rashes, dilatation of the colon, paralytic ileus, and certain psychiatric manifestations such as delusions and hallucinations, plus one doubtful case of paranoia all of which may occur with any of the atropine-like drugs, have been reported rarely with Trihexyphenidyl hydrochloride (Emetil-DS).
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.
Potential side effects associated with the use of any atropine-like drugs include constipation, drowsiness, urinary hesitancy or retention, tachycardia, dilation of the pupil, increased intraocular tension, weakness, vomiting, and headache.
The occurrence of angle-closure glaucoma due to long-term treatment with Trihexyphenidyl hydrochloride (Emetil-DS) has been reported.
Dose-dependent side effects are frequent. Particularly geriatric patients may react with confusional states or develop delirium.
* CNS : Drowsiness, vertigo, headache, and dizziness are frequent. With high doses nervousness, agitation, anxiety, delirium, and confusion are noted. Trihexyphenidyl hydrochloride (Emetil-DS) may be abused due to a short acting mood-elevating and euphoriant effect. The normal sleep architecture may be altered (REM sleep depression). Trihexyphenidyl hydrochloride (Emetil-DS) may lower the seizure-threshold.
* Peripheral side effects : Blurred vision, dry mouth, impaired sweating, abdominal discomfort, and obstipation are frequent. Tachycardia may be noted. Allergic skin reactions may occur.
Parenteral use may cause orthostatic hypotension.
* Eyes : Trihexyphenidyl hydrochloride (Emetil-DS) causes mydriasis with or without photophobia. It may precipitate narrow angle glaucoma.
* Tolerance may develop during therapy which requires dose adjustments.
DailyMed. "CHLORPROMAZINE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
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