Artane 2mg Tablets
It is used to treat Parkinson's disease.It is used to treat side effects caused by some other drugs.
Drug Class
Antiparkinsonian agent
Pharmacologic Class
Anticholinergic, Muscarinic antagonist
Pregnancy Category
C
FDA Approved
Jan 1949
DEA Schedule
Not Controlled
Overview
What is this medicine?
Trihexyphenidyl is a medication used to treat symptoms of Parkinson's disease, such as tremors and stiffness, and to control muscle spasms and stiffness caused by certain medications (drug-induced extrapyramidal reactions). It works by balancing certain natural substances in the brain.
How to Use This Medicine
Taking Your Medication
To get the most benefit from your medication, it's essential to take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely. You can take this medication with or without food, but if it causes stomach upset, taking it with food may help.
It's also important to stay hydrated by drinking plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
Storing and Disposing of Your Medication
To maintain the effectiveness and safety of your medication, store it at room temperature in a dry location, avoiding the bathroom. Keep all medications in a secure place, out of the reach of children and pets. When your medication is no longer needed or has expired, dispose of it properly. Do not flush it down the toilet or pour it down the drain unless instructed to do so by your doctor or pharmacist. If you're unsure about the best way to dispose of your medication, consult your pharmacist, who may be aware of drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's almost time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To get the most benefit from your medication, it's essential to take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely. You can take this medication with or without food, but if it causes stomach upset, taking it with food may help.
It's also important to stay hydrated by drinking plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
Storing and Disposing of Your Medication
To maintain the effectiveness and safety of your medication, store it at room temperature in a dry location, avoiding the bathroom. Keep all medications in a secure place, out of the reach of children and pets. When your medication is no longer needed or has expired, dispose of it properly. Do not flush it down the toilet or pour it down the drain unless instructed to do so by your doctor or pharmacist. If you're unsure about the best way to dispose of your medication, consult your pharmacist, who may be aware of drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's almost time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Take with food if stomach upset occurs.
- Avoid alcohol and other CNS depressants.
- Stay hydrated to help with dry mouth and constipation.
- Avoid overheating in hot weather or during exercise, as this medication can reduce sweating.
- Be cautious when driving or operating machinery until you know how the medication affects you, as it can cause dizziness or blurred vision.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Initial dose 1 mg daily, gradually increased. Typical maintenance 6-10 mg daily in 3-4 divided doses.
Dose Range:
1 - 15 mg
Condition-Specific Dosing:
parkinsonism:
Initial: 1 mg daily, increased by 2 mg every 3-5 days until optimal response. Maintenance: 6-10 mg daily in 3-4 divided doses, with meals. Max: 15 mg daily.
drug_induced_extrapyramidal_reactions:
Initial: 1 mg, increased to 5-15 mg daily in divided doses, depending on severity. Often 5-10 mg daily.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established (Safety and efficacy not established in pediatric patients)
Adolescent:
Not established (Safety and efficacy not established in pediatric patients)
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment recommended, monitor for adverse effects.
Moderate:
Use with caution, consider lower initial doses and slower titration. Monitor for adverse effects.
Severe:
Use with caution, consider lower initial doses and slower titration. Monitor for adverse effects.
Dialysis:
Not well studied. Use with caution, monitor for adverse effects.
Hepatic Impairment:
Mild:
No specific adjustment recommended, monitor for adverse effects.
Moderate:
Use with caution, consider lower initial doses and slower titration. Monitor for adverse effects.
Severe:
Use with caution, consider lower initial doses and slower titration. Monitor for adverse effects.
Pharmacology
Mechanism of Action
Trihexyphenidyl is a synthetic tertiary amine anticholinergic agent. It exerts its therapeutic effect by blocking muscarinic acetylcholine receptors in the central nervous system, thereby reducing the relative excess of cholinergic activity that is thought to be responsible for the symptoms of Parkinson's disease and drug-induced extrapyramidal reactions. It also has some direct antispasmodic effect on smooth muscle.
Pharmacokinetics
Absorption:
Bioavailability:
Not precisely quantified, well absorbed orally.
Tmax:
Approximately 1 hour
FoodEffect:
Food may delay absorption but does not significantly affect total absorption. Taking with food may reduce GI upset.
Distribution:
Vd:
Not precisely quantified, widely distributed.
ProteinBinding:
Not precisely quantified.
CnssPenetration:
Yes
Elimination:
HalfLife:
Approximately 5.6-10.2 hours (variable)
Clearance:
Not precisely quantified.
ExcretionRoute:
Renal (urine) as metabolites and unchanged drug.
Unchanged:
Small amount (less than 1%)
Pharmacodynamics
OnsetOfAction:
Approximately 1 hour
PeakEffect:
Approximately 2-3 hours
DurationOfAction:
6-12 hours
Safety & Warnings
Side Effects
Serious Side Effects: Seek Medical Help Immediately
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Hallucinations (seeing or hearing things that are not there)
Feeling agitated or experiencing a change in behavior
Confusion or memory problems
Difficulty urinating
Rapid heartbeat
Severe constipation or stomach pain, which may indicate a serious bowel problem
Muscle weakness
New or worsening trouble controlling body movements
Changes in vision, eye pain, or severe eye irritation
Fever
Inability to sweat during physical activity or in warm temperatures
Enlarged pupils
Neuroleptic malignant syndrome (NMS), a rare but potentially deadly condition that can occur when this medication is stopped suddenly or the dose is lowered. Symptoms of NMS include:
+ Fever
+ Muscle cramps or stiffness
+ Dizziness
+ Severe headache
+ Confusion
+ Changes in thinking
+ Fast or abnormal heartbeat
+ Excessive sweating
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Dizziness or drowsiness
Upset stomach or vomiting
Constipation
Headache
Dry mouth
Feeling nervous or excitable
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Hallucinations (seeing or hearing things that are not there)
Feeling agitated or experiencing a change in behavior
Confusion or memory problems
Difficulty urinating
Rapid heartbeat
Severe constipation or stomach pain, which may indicate a serious bowel problem
Muscle weakness
New or worsening trouble controlling body movements
Changes in vision, eye pain, or severe eye irritation
Fever
Inability to sweat during physical activity or in warm temperatures
Enlarged pupils
Neuroleptic malignant syndrome (NMS), a rare but potentially deadly condition that can occur when this medication is stopped suddenly or the dose is lowered. Symptoms of NMS include:
+ Fever
+ Muscle cramps or stiffness
+ Dizziness
+ Severe headache
+ Confusion
+ Changes in thinking
+ Fast or abnormal heartbeat
+ Excessive sweating
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Dizziness or drowsiness
Upset stomach or vomiting
Constipation
Headache
Dry mouth
Feeling nervous or excitable
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe confusion or hallucinations
- Difficulty urinating or inability to urinate
- Severe constipation or abdominal pain
- Eye pain or sudden vision changes (especially blurred vision or halos around lights)
- Fast or irregular heartbeat
- Fever or heat stroke symptoms (hot, dry skin, lack of sweating)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have been diagnosed with narrow-angle glaucoma, a condition that affects the eyes.
* If you have a history of tardive dyskinesia, a severe muscle disorder.
This list is not exhaustive, and it is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. Additionally, share any existing health problems you have, as they may interact with this medication.
To ensure your safety, always check with your doctor before starting, stopping, or changing the dose of any medication. This will help prevent potential interactions and ensure that it is safe for you to take this medication with your other drugs and health conditions.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have been diagnosed with narrow-angle glaucoma, a condition that affects the eyes.
* If you have a history of tardive dyskinesia, a severe muscle disorder.
This list is not exhaustive, and it is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. Additionally, share any existing health problems you have, as they may interact with this medication.
To ensure your safety, always check with your doctor before starting, stopping, or changing the dose of any medication. This will help prevent potential interactions and ensure that it is safe for you to take this medication with your other drugs and health conditions.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Before operating a vehicle or engaging in any activity that requires your full attention, wait until you understand how this medication affects you. It is also crucial to discuss the use of alcohol, marijuana, or other forms of cannabis, as well as prescription or over-the-counter (OTC) medications that may cause drowsiness, with your doctor.
Do not abruptly discontinue this medication without first consulting your doctor, as this may increase your risk of experiencing side effects. If it becomes necessary to stop taking this medication, your doctor will provide guidance on how to gradually taper off the dosage to minimize potential side effects.
Individuals with narrow-angle glaucoma should be aware that this medication has been associated with vision loss. It is vital to consult with your doctor about this potential risk. Additionally, adhere to your doctor's recommendations for regular eye pressure and vision checks.
There is a risk of heat stroke associated with this medication, particularly in hot weather or during physical activity. To minimize this risk, exercise caution and stay hydrated. If you are 60 years or older, use this medication with caution, as you may be more susceptible to side effects.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor. It is essential to discuss the potential benefits and risks of this medication to both you and your baby to make an informed decision.
Before operating a vehicle or engaging in any activity that requires your full attention, wait until you understand how this medication affects you. It is also crucial to discuss the use of alcohol, marijuana, or other forms of cannabis, as well as prescription or over-the-counter (OTC) medications that may cause drowsiness, with your doctor.
Do not abruptly discontinue this medication without first consulting your doctor, as this may increase your risk of experiencing side effects. If it becomes necessary to stop taking this medication, your doctor will provide guidance on how to gradually taper off the dosage to minimize potential side effects.
Individuals with narrow-angle glaucoma should be aware that this medication has been associated with vision loss. It is vital to consult with your doctor about this potential risk. Additionally, adhere to your doctor's recommendations for regular eye pressure and vision checks.
There is a risk of heat stroke associated with this medication, particularly in hot weather or during physical activity. To minimize this risk, exercise caution and stay hydrated. If you are 60 years or older, use this medication with caution, as you may be more susceptible to side effects.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor. It is essential to discuss the potential benefits and risks of this medication to both you and your baby to make an informed decision.
Overdose Information
Overdose Symptoms:
- Dilated pupils
- Hot, dry skin
- Flushing
- Fever
- Tachycardia
- Hypertension
- Urinary retention
- Decreased bowel sounds
- Confusion
- Disorientation
- Agitation
- Hallucinations
- Ataxia
- Seizures
- Coma
- Respiratory depression
What to Do:
Call 911 or Poison Control (1-800-222-1222) immediately. Treatment is supportive, including gastric lavage, activated charcoal, and physostigmine for severe anticholinergic symptoms.
Drug Interactions
Major Interactions
- Other anticholinergic drugs (e.g., atropine, scopolamine, tricyclic antidepressants, phenothiazines, quinidine, disopyramide) - increased anticholinergic effects.
- Potassium chloride (oral) - increased risk of GI lesions due to decreased GI motility.
Moderate Interactions
Monitoring
Baseline Monitoring
Ophthalmologic exam (intraocular pressure)
Rationale: To rule out or monitor for narrow-angle glaucoma, as anticholinergics can precipitate acute attacks.
Timing: Before initiation, especially in elderly patients.
Urinary retention assessment (e.g., history of BPH)
Rationale: Anticholinergics can exacerbate urinary retention.
Timing: Before initiation.
Cognitive function assessment
Rationale: To establish baseline and monitor for anticholinergic-induced cognitive impairment, especially in elderly.
Timing: Before initiation.
Routine Monitoring
Efficacy (reduction in parkinsonian symptoms or EPS)
Frequency: Regularly during titration and maintenance.
Target: Optimal symptom control with tolerable side effects.
Action Threshold: Lack of efficacy or intolerable side effects warrant dose adjustment or discontinuation.
Anticholinergic side effects (dry mouth, blurred vision, constipation, urinary hesitancy, confusion)
Frequency: At each visit, especially during titration.
Target: Minimal to no side effects.
Action Threshold: Significant or bothersome side effects require dose reduction or symptomatic management.
Mental status/Cognitive function
Frequency: Periodically, especially in elderly or those with pre-existing cognitive impairment.
Target: Stable or improved cognitive function.
Action Threshold: New onset or worsening confusion, memory impairment, or hallucinations.
Symptom Monitoring
- Dry mouth
- Blurred vision
- Constipation
- Urinary hesitancy/retention
- Dizziness
- Nausea
- Nervousness
- Confusion
- Hallucinations
- Memory impairment
- Tachycardia
- Heat intolerance
Special Patient Groups
Pregnancy
Category C. Use only if the potential benefit justifies the potential risk to the fetus. Limited human data, animal studies show some adverse effects at high doses.
Trimester-Specific Risks:
First Trimester:
Limited data, theoretical risk of congenital malformations.
Second Trimester:
Limited data.
Third Trimester:
Limited data, theoretical risk of anticholinergic effects in neonate (e.g., paralytic ileus).
Lactation
L3 (Moderately Safe). Trihexyphenidyl is excreted into breast milk. Potential for anticholinergic effects in the infant (e.g., sedation, constipation, dry mouth, decreased milk production). Use with caution, monitor infant for adverse effects.
Infant Risk:
Moderate risk of adverse effects, potential for decreased milk supply.
Pediatric Use
Safety and efficacy not established in pediatric patients. Not generally recommended for use in children.
Geriatric Use
Use with extreme caution in elderly patients due to increased susceptibility to anticholinergic side effects, particularly cognitive impairment (confusion, memory loss, hallucinations), urinary retention, and constipation. Start with lower doses and titrate slowly. Avoid if possible in patients with dementia or cognitive impairment.
Clinical Information
Clinical Pearls
- Trihexyphenidyl is particularly effective for tremor and rigidity in Parkinson's disease, less so for bradykinesia.
- It is often used as an adjunct therapy or for drug-induced extrapyramidal symptoms.
- Tolerance to some side effects (e.g., dry mouth, blurred vision) may develop over time.
- Abrupt discontinuation can lead to withdrawal symptoms or worsening of parkinsonian symptoms.
- Patients should be advised to avoid activities requiring mental alertness until they know how the drug affects them.
Alternative Therapies
- Benztropine (Cogentin)
- Procyclidine (Kemadrin)
- Biperiden (Akineton)
- Amantadine (Symmetrel) - for drug-induced EPS
- Dopamine agonists (e.g., pramipexole, ropinirole) - for Parkinson's disease
- Levodopa/Carbidopa (Sinemet) - for Parkinson's disease
Cost & Coverage
Average Cost:
$10 - $50 per 30 tablets (2mg)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to ensure you receive the best possible care.