Dear Johanna, Following is the patient insert listing the recommended dosage and possible adverse effects of Artane. The insert strongly recommends the doctor dispensing the drug carefully monitor the patient. The dosage you state your father was taking would be at the lower end of the recommended dosage. If the doctor started him immediately on that amount, even though he had taken the drug several weeks before, I would think it might explain the severity of your Dad's hallucinations. If there is a neurologist out there willing to risk putting forward an opinion I would sure be interested in hearing it. The pharmaceutical company recommends a gradual introduction of the drug. Of particular interest to you could be the following found about 1/2 way through the section on adverse effects: "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 medicines, have been less frequently reported with ARTANE*." My question is why they use the word "doubtful" case of paranoia. If the manifestation was reported by a patient in the trial of the drug, why do they assume the patient would lie? ARTANE* 2 Tablets ARTANE* 5 Tablets SCHEDULING STATUS: S5 Zimbabwe PP 2 mg Appl. No: Z193 5 mg Appl. No: Z197 PROPRIETARY NAME (and dosage form): ARTANE* 2 Tablets ARTANE* 5 Tablets COMPOSITION: Tablet containing 2 mg or 5 mg trihexyphenidyl hydrochloride. PHARMACOLOGICAL CLASSIFICATION: Category A 5.4.1 Anti-Parkinsonism preparations PHARMACOLOGICAL ACTION: ARTANE* trihexyphenidyl HCl Lederle, is a synthetic antispasmodic medicine and is the substituted piperidine salt, 3-(1-piperidyl)-1-phenyl-cyclohexyl-1-propanol hydrochloride, which exerts a direct inhibitory effect upon the parasympathetic nervous system. It also has a relaxing effect on smooth musculature; exerted both directly upon the muscle tissue itself and indirectly through an inhibitory effect upon the parasympathetic nervous system. Its therapeutic properties are similar to those of atropine, although undesirable side effects are ordinarily less frequent and severe than with the latter. INDICATIONS: This medicine is indicated as an adjunct in the therapy of all forms of Parkinsonism (postencephalitic, arteriosclerotic and idiopathic). It is useful in the prevention or control of extrapyramidal disorders due to central nervous system medicines such as reserpine and phenothiazines. These disorders are similar to those encountered in Parkinson’s disease and include: tremor, rigidity and increased salivation, akathisia manifested by extreme restlessness, and dyskinesias characterised by spastic contractions and involuntary movements. It decreases sialorrhoea, but with less excessive mouth-dryness, blurred vision or mydriasis than are encountered with atropine. CONTRA-INDICATIONS Hypersensitivity to any of the ingredients. Although trihexyphenidyl HCl is not contraindicated for patients with cardiac, liver or kidney disorders, or with hypertension, such patients should be maintained under close observation. WARNINGS: Patients to be treated with ARTANE* should have a gonioscope evaluation and close monitoring of intraocular pressures at regular periodic intervals. DOSAGE AND DIRECTIONS FOR USE: Dosage should be individualised. The initial dose should be low and then increased gradually, especially in patients over 60 years of age. Whether ARTANE* trihexyphenidyl HCl 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 ARTANE* trihexyphenidyl HCl tends to dry the mount 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. As initial therapy for Parkinsonism, 1 mg of ARTANE* 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. The lower levels of daily intake of ARTANE* are tolerated best if divided into 3 doses and taken at mealtimes. High doses may be divided into 4 parts, with 3 doses administered at mealtimes and the fourth at bedtime. Concomitant Use of ARTANE* trihexyphenidyl HCl Tablets with Levodopa: When ARTANE* 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. ARTANE* dosage of 1 to 2 mg three times a day is usually adequate. Concomitant Use of ARTANE* trihexyphenidyl HCl Tablets with Other Parasympathetic Inhibitors: ARTANE* trihexyphenidyl HCl tablets 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 HCl is increased. ARTANE* trihexyphenidyl HCl in Drug-Induced Parkinsonism: The size and frequency of the dose of ARTANE* needed to control extrapyramidal reactions to commonly employed tranquillisers, 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 tranquilliser on instituting ARTANE* therapy and then adjusting dosage of both medicines until the desired ataractic effect is retained without onset of extrapyramidal reactions. It is sometimes possible to maintain the patient on a reduced ARTANE* 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 therapy was discontinued. SIDE EFFECTS AND SPECIAL PRECAUTIONS: 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 per cent of all patients. These sensations, however, are much less troublesome with ARTANE* trihexyphenidyl HCl 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 medicine, 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 medicines, have been less frequently reported with ARTANE*. Patients with arteriosclerosis or with a history of idiosyncrasy to other medicines may exhibit reactions of mental confusion, agitation, disturbed behaviour 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 medicine 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 medicines 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 has been reported. Precautions: Since the use of trihexyphenidyl HCl must, of necessity continue indefinitely and since it has atropine-like properties, patients should be subjected to constant and careful long-term observation to avoid allergic and other untoward reactions. Inasmuch as trihexyphenidyl HCl possesses some 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. Geriatric patients, particualarly over the age of 60, frequently develop increased sensitivity to the actions of medicines of this type, and hence, require strict dosage regulation. Incipient glaucoma may be precipitated by parasympatholytic medicines such as trihexyphenidyl HCl. It is advisable to have periodic gonioscopic evaluations in all patients who are to be treated with trihexyphenidyl hydrochloride or any related medicine. KNOWN SYMPTOMS OF OVERDOSAGE AND PARTICULARS OF ITS TREATMENT: Symptoms which may occur may be any of those described under ‘SIDE EFFECTS AND SPECIAL PRECAUTIONS’. Any such symptoms should be treated symptomatically and supportively. IDENTIFICATION: 2 mg Tablets: White, flat, round tablets, 8 mm in diameter, scored on one side with “Lederle”above and “4434”below the score; unmarked on the other side. 5 mg Tablets: White, flat, round tablets, 9.5 mm in diameter, scored on one side. PRESENTATION: 2 mg tablets: Containers of 100 tablets. Product code 4434 5 mg tablets: Containers of 100 tablets. Product code 4436. STORAGE INSTRUCTIONS: Store below 25°C. Keep out of reach of children. REFERENCE NUMBERS: 2 mg C786 (Act 101/1965) 5 mg C787 (Act 101/1965) NAME AND BUSINESS ADDRESS OF THE APPLICANT: Wyeth South Africa (Pty) Ltd Thornhill Office Park 94 Bekker Road Vorna Valley, Ext 60 Midrand, 1683 DATE OF PUBLICATION OF THIS PACKAGE INSERT: November 1997 Best Regards, Vicky Lynn __________________________________________________ Do You Yahoo!? Yahoo! Greetings - Send FREE e-cards for every occasion! http://greetings.yahoo.com ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn