Trihexyphenidyl (Systemic)

Introductory Information
Antimuscarinic antiparkinsonian agent.a, b
Class: 28:36.08 Anticholinergic Agents; au350 (VA primary)
Generic Name: Trihexyphenidyl Hydrochloride
CAS Number: 52-49-3
Synonym: Benzhexol Hydrochloride
Uses
Parkinsonian Syndrome
Adjunctive treatment of all forms of parkinsonian syndrome.a, b
May reduce the frequency and duration of oculogyric crises, salivation, spastic contractions,
and dyskinesia, and relieve mental inertia and depression characteristic of all forms of
parkinsonian syndrome.b
Drug-Induced Extrapyramidal Reactions
Control of extrapyramidal reactions induced by antipsychotic agents (e.g., phenothiazines,
thioxanthenes).a, b
Dosage and Administration
Administration
Oral Administration
Administer orally before or after meals, depending on patient reaction.a, b Administer before
meals in patients with excessive xerostomia.a Administer after meals if nausea occurs.a
May be administered 3 times daily; if a fourth dose is required, administer at bedtime.b
Mint candies, chewing gum, water, or administration of a saliva substitute (e.g., Xero-lube)
may relieve xerostomia that may accompany administration after meals.a, b
Dosage
Available as trihexyphenidyl hydrochloride; dosage expressed in terms of the salt.a
Adjust dosage carefully according to individual requirements and response.b
Adults
Parkinsonian Syndrome
Oral: Initially, 1 mg on first day.a Dosages may be increased in 2-mg increments at 3- to 5day intervals up to a maximum of 6-10 mg daily.a, b

Postencephalitic patients: 12-15 mg daily may be required.a, b

When trihexylphenidyl is used as an adjunct to levodopa, consider reducing levodopa and
trihexyphenidyl dosages.a Generally, 3-6 mg daily of trihexyphenidyl hydrochloride is
adequate.a
If trihexyphenidyl is replacing another antiparkisonian agent, increase trihexyphenidyl dose
as needed while decreasing other drug dose until complete replacement is achieved.b
Drug-Induced Extrapyramidal Reactions
Oral: Usual dosage: 5-15 mg total daily dosage.a, b
Initially, 1 mg; if extrapyramidal reactions are not controlled within a few hours,
progressively increase dosage until control is achieved. a, b
Alternatively, to achieve a more rapid control, reduce dosage of the drug causing the reaction,
then adjust the dosage of both drugs to attain the desired drug effect without extrapyramidal
symptoms.b Once control of extrapyramidal reactions has been maintained for several days,
dosage of trihexyphenidyl may be reduced or discontinued.b
Prescribing Limits
Adults
Parkinsonian Syndrome
Oral: Maximum of 6-10 mg daily in most patients; postencephalitic patients may require 1215 mg daily.a, b
Special Populations
Hepatic Impairment
No specific dosage recommendations at this time.a
Renal Impairment
No specific dosage recommendations at this time.a
Geriatric Patients
Patients 60 years of age: Initiate with low dosage; titrate dosage
gradually.a
Cautions
Contraindications
Known hypersensitivity to trihexylphenidyl or any ingredient in the formulation.c
Warnings/Precautions
Warnings
Ophthalmic Effects
Possible increased ocular tension.a Possible precipitation of glaucoma in patients receiving
prolonged therapy.a, c
Use with caution in patients with glaucoma.a, c
Periodic gonioscopic evaluation and intraocular pressure monitoring recommended.a, b

General Precautions
Tardive Dyskinesia
Antiparkinsonian agents do not alleviate symptoms of tardive dyskinesia and may aggravate
these symptoms.a
Cardiovascular Effects
Possible tachycardia;a use with caution and carefully monitor patients with cardiac disease or
hypertension.a, c
GU Effects
Possible urinary hesitancy and retention;a, c use with caution and carefully monitor patients
with prostatic hypertrophy or obstructive disease of the GU tract.a, c
CNS Effects
Possible mental confusion, disorientation, agitation, hallucinations, and psychotic-like
symptoms.a
GI Effects
Possible decreased intestinal mobility and paralytic ileus; use with caution in patients with
obstructive diseases of the GI tract.a
Specific Populations
Pregnancy
Category C.d
Geriatric Use
Possibility exists of greater sensitivity to the drug in some geriatric individuals.a
Hepatic Impairment
Use with caution; careful monitoring recommended.a
Renal Impairment
Use with caution; careful monitoring recommended.a
Common Adverse Effects
Dry mouth, blurred vision, dizziness, nausea, nervousness.a
Interactions
Specific Drugs
Drug
Anticholinergic
agents

Interaction
Increased risk of adverse anticholinergic
effectsc

Pharmacokinetics
Absorption
Rapidly absorbed from the GI tract following oral administration.b

Onset
Following oral adminstration, onset of action occurs within 1 hour.b
Duration
6-12 hours.b
Elimination
Elimination Route
Excreted principally in urine, probably as unchanged drug.b
Stability
Storage
Oral
Elixir
20-25C.e Do not freeze.e
Tablets
20-25C.a
Actions
Exhibits atropine-like action and exerts antispasmodic effects on parasympathetic-innervated
peripheral structures, including smooth muscle.a, b
Exact mechanism of action in parkinsonian syndrome not understood; may result from
blockade of efferent impulses and from central inhibition of cerebral motor centers.b
Competitively inhibits acetylcholine or other cholinergic stimuli at autonomic effectors
innervated by postganglionic nerves.c
Exhibits weak mydriatic, antisialagogue, and cardiovagal blocking effects.b
Advice to Patients
Potential for drug to impair mental alertness or physical coordination; use caution when
driving or operating machinery until effects on individual are known.a
Importance of informing clinicians of existing or contemplated concomitant therapy, including
prescription and OTC drugs and dietary or herbal supplements, as well as concomitant
illnesses.a
Importance of women informing clinicians if they are or plan to become pregnant or plan to
breast-feed.a
Importance of informing patients of other important precautionary information.a (See
Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects
in some individuals; consult specific product labeling for details.
Trihexyphenidyl Hydrochloride

Rout
es

Dosage
Forms

Strength
s

Brand Names

Manufacturer

Mikart, Pharmaceutical
Associates, Pharmaceutical
Ventures
Trihexyphenidyl
URL, Vintage, Watson, WestTablets
2 mg*
Hydrochloride Tablets
Ward
Trihexyphenidyl
URL, Vintage, Watson, West5 mg*
Hydrochloride Tablets
Ward
* available from one or more manufacturer, distributor, and/or repackager by generic
(nonproprietary) name

Oral

Elixir

2 mg/5
mL*

Trihexyphenidyl
Hydrochloride Elixir

Comparative Pricing
This pricing information is subject to change at the sole discretion of DS Pharmacy. This
pricing information was updated 03/2011. For the most current and up-to-date pricing
information, please visit www.drugstore.com. Actual costs to patients will vary depending on
the use of specific retail or mail-order locations and health insurance copays.
Trihexyphenidyl HCl 0.4MG/ML Elixir (PHARMACEUTICAL ASSOCIATES): 473/$30.99
or 1419/$79.97
Trihexyphenidyl HCl 2MG Tablets (WATSON LABS): 90/$22.99 or 180/$39.97
Trihexyphenidyl HCl 5MG Tablets (WEST-WARD): 180/$65.99 or 280/$95.97
References
a. Watson Laboratories Inc. trihexyphenidyl hydrochloride tablets, USP. prescribing
information. Corona, CA; 2005 May.
b. AHFS drug information 2006. McEvoy GK, ed. Trihexyphenidyl. Bethesda, MD: American
Society of Health-System Pharmacists; 2006:1256.
c. AHFS drug information 2006. McEvoy GK, ed. Antimuscarinics/Antispasmodics General
Statement. Bethesda, MD: American Society of Health-System Pharmacists; 2006:1257-64].
d. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation, 7th ed. Philadelphia,
PA: Lippincott Williams & Wilkins; 2005:1628
e. Pharmaceutical Associates, Inc. Trihexyphenidyl HCl elixir prescribing information.
Greenville, SC; 2002 May.