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 parkinsonian symptoms, including tremor, rigidity, and sialorrhea. As a centrally acting muscarinic antagonist, it works by restoring the balance between acetylcholine and dopamine in the basal ganglia, providing targeted symptomatic relief for patients with Parkinson’s disease and drug-induced extrapyramidal symptoms. Its clinical profile is characterized by a rapid onset of action and a favorable side effect spectrum when administered under appropriate medical supervision, making it a valuable therapeutic option in neurology and psychiatric practice.
Features
- Active ingredient: Procyclidine hydrochloride
- Available in 5 mg tablet formulation
- Rapid gastrointestinal absorption with peak plasma concentrations within 1-2 hours
- Extensive hepatic metabolism via cytochrome P450 system
- Elimination half-life of approximately 12 hours
- High bioavailability and blood-brain barrier penetration
- Manufactured under strict GMP guidelines
Benefits
- Significantly reduces Parkinsonian tremor and muscle rigidity
- Improves functional mobility and quality of life
- Decreases excessive salivation (sialorrhea)
- Provides adjunctive therapy for antipsychotic-induced extrapyramidal symptoms
- Offers flexible dosing regimen for individualized treatment
- Demonstrates rapid onset of therapeutic effect within hours of administration
Common use
Kemadrin is primarily indicated for the symptomatic treatment of all forms of Parkinsonism, including post-encephalitic, arteriosclerotic, and idiopathic Parkinson’s disease. It is particularly effective in addressing the triad of tremor, rigidity, and hypersalivation characteristic of these conditions. Additionally, Kemadrin is widely utilized in psychiatric practice to prevent or counteract extrapyramidal symptoms induced by neuroleptic medications, such as dystonic reactions, drug-induced parkinsonism, and akathisia. Off-label uses include management of sialorrhea in neurological disorders and as adjunctive therapy in certain cases of dystonia.
Dosage and direction
Initial dosage for Parkinsonism: 2.5 mg three times daily after meals, gradually increased by 2.5 mg increments every 2-3 days until optimal therapeutic effect is achieved. Maintenance dosage typically ranges from 10-20 mg daily in divided doses, though some patients may require up to 30 mg daily. For drug-induced extrapyramidal symptoms: 2.5 mg three times daily, increasing to 10-20 mg daily if necessary. Elderly patients should start with 2.5 mg once or twice daily due to increased sensitivity to anticholinergic effects. Tablets should be swallowed whole with water, preferably with meals to minimize gastrointestinal discomfort. Dosage adjustments should be made gradually under medical supervision.
Precautions
Patients with cardiovascular disorders, especially those with tachycardia, hypertension, or cardiac arrhythmias, require careful monitoring as Kemadrin may exacerbate these conditions. Those with prostatic hypertrophy or urinary retention should be closely observed for worsening symptoms. Caution is advised in patients with gastrointestinal obstruction, ulcerative colitis, or hyperthyroidism. Kemadrin may impair mental and physical abilities required for driving or operating machinery. Elderly patients are more susceptible to confusion, agitation, and other central anticholinergic effects. Periodic intraocular pressure measurements are recommended in patients with predisposition to glaucoma.
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 obstruction, megacolon, myasthenia gravis, and severe ulcerative colitis. It should not be used in patients with paralytic ileus or intestinal atony. Concurrent use with other anticholinergic agents is generally contraindicated due to additive effects. Kemadrin is not recommended during pregnancy unless potential benefits outweigh risks, and should be avoided during breastfeeding.
Possible side effect
Common side effects (≥1/100) include dry mouth, blurred vision, constipation, and urinary retention. Less frequently (≥1/1000), patients may experience tachycardia, nausea, vomiting, or dizziness. Rare side effects (<1/1000) include confusion, hallucinations, memory impairment, skin rash, and angle-closure glaucoma. Psychiatric effects such as agitation, restlessness, or euphoria may occur, particularly in elderly patients. Dose-related side effects typically diminish with continued therapy or dosage reduction. Patients should report persistent blurred vision, difficulty urinating, or significant behavioral changes promptly.
Drug interaction
Kemadrin exhibits significant interactions with other anticholinergic drugs, including tricyclic antidepressants, antihistamines, and phenothiazines, potentially leading to enhanced anticholinergic effects. Concurrent administration with levodopa may improve therapeutic efficacy in Parkinson’s disease but requires careful dosage adjustment. Kemadrin may decrease gastrointestinal absorption of levodopa and other drugs. Alcohol and CNS depressants may potentiate sedative effects. MAO inhibitors may enhance anticholinergic side effects. Ketoconazole and other CYP3A4 inhibitors may increase Kemadrin plasma concentrations. Close monitoring is essential when used with digoxin due to potential additive effects on heart rate.
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 that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed administration. Consistent dosing is important for maintaining therapeutic effect, but occasional missed doses are unlikely to cause significant clinical deterioration. Patients should maintain a medication diary or use pill organizers to improve adherence. If multiple doses are missed, contact healthcare provider for guidance on resumption of therapy.
Overdose
Symptoms of Kemadrin overdose include severe central nervous system disturbances (agitation, confusion, hallucinations, seizures), cardiovascular effects (tachycardia, hypertension followed by hypotension), hyperthermia, dilated pupils, dry skin and mucous membranes, and urinary retention. Management involves immediate gastric lavage if ingestion was recent, followed by activated charcoal. Physostigmine may be administered as an antidote under careful monitoring. Supportive care includes maintaining airway, controlling hyperthermia, and managing seizures with benzodiazepines. Hemodialysis is not effective due to high protein binding. Patients require hospitalization and continuous cardiac monitoring.
Storage
Store at controlled room temperature (15-30°C) in original container, protected from light and moisture. Keep tightly closed and out of reach of children. Do not transfer tablets to other containers as this may affect stability. Do not use if tablets show signs of discoloration or deterioration. Proper disposal of unused medication through take-back programs is recommended to prevent environmental contamination and accidental ingestion. Avoid storage in bathrooms or areas with high humidity. Check expiration date before administration and discard any expired medication appropriately.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Individual response to Kemadrin may vary, and treatment should be tailored to specific patient needs under professional medical supervision. The prescribing physician should be consulted for complete information regarding indications, dosage, and precautions. This document does not replace comprehensive product labeling or clinical judgment. Patients should not make changes to their medication regimen without consulting their healthcare provider.
Reviews
Clinical studies demonstrate Kemadrin’s efficacy in controlling parkinsonian symptoms, with approximately 70% of patients showing significant improvement in tremor and rigidity. Long-term users report sustained benefit with appropriate dosage adjustment. Some patients note dry mouth and blurred vision as bothersome but manageable side effects. Neurologists appreciate its rapid onset and flexibility in dosing. Comparative studies show similar efficacy to other anticholinergics with potentially better tolerability in some patient populations. Patient satisfaction surveys indicate improved quality of life measures related to mobility and daily functioning.