Hexinor 2mg Tablet 1 Strip

✔️ Pharmacology:

Trihexyphenidyl, the active ingredient, is a non-selective muscarinic acetylcholine receptor antagonist with a higher affinity for the M1 subtype. Research indicates that it primarily targets central muscarinic receptors in the cerebral cortex rather than peripheral ones. Some studies suggest it may also influence nicotinic acetylcholine receptor transmission, indirectly increasing dopamine release in the striatum. Despite its effectiveness in treating Parkinson’s disease and other movement disorders, the exact mechanism of action remains unclear.

✔️ Overdose Effects:

• Doses up to 300 mg have been reported without fatal outcomes, though deaths have occurred when combined with other CNS depressants or in individuals with respiratory conditions.
• Overdose symptoms include dilated pupils, warm and dry skin, facial flushing, dry mouth, elevated temperature, rapid heart rate, cardiac arrhythmias, reduced bowel sounds, urinary retention, and a range of neuropsychiatric effects such as delirium, disorientation, hallucinations, agitation, paranoia, seizures, and, in severe cases, coma and death.

✔️ Treatment for Overdose:

• Supportive care is required, including gastric lavage to reduce absorption.
• If CNS overstimulation occurs, a small dose of diazepam or a short-acting barbiturate may be given (except phenothiazines, which can worsen toxicity).
• Respiratory support, artificial respiration, and vasopressors may be necessary.
• Hyperthermia should be corrected, and fluid and acid-base balance maintained.
• Urinary catheterization may be needed in cases of urinary retention.
• It is unknown whether Trihexyphenidyl can be removed via dialysis.

✔️ Side Effects:

• Common side effects include dry mouth, blurred vision, dizziness, mild nausea, and nervousness, affecting 30-50% of users. These reactions are typically less severe than untreated Parkinsonism and tend to diminish over time.
• In rare cases, side effects such as skin rashes, excessive dry mouth leading to parotitis, constipation, drowsiness, urinary retention, pupil dilation, increased intraocular pressure, hallucinations, memory issues, tachycardia, and choreiform movements may occur.
• Abrupt discontinuation may exacerbate Parkinsonism symptoms or trigger neuroleptic malignant syndrome (NMS).
• Narrow-angle glaucoma has been reported in some cases, with potential blindness as a result.
• Rare side effects include paradoxical sinus bradycardia, dry skin, and cycloplegia.
• In pediatric patients, additional side effects such as hyperactivity, psychosis, forgetfulness, weight loss, restlessness, chorea, and sleep disturbances have been observed.

✔️ Dosage & Administration:

Dosage should be tailored to individual patient needs. It is generally recommended to start with a low dose and gradually increase it, especially in patients over 60 years of age. The best time to take the medication—before or after meals—depends on the patient's response. Patients experiencing excessive salivation may prefer taking it after meals, sometimes with small amounts of atropine. However, if it causes excessive dry mouth, taking it before meals may be better, unless it leads to nausea. If taken after meals, thirst can be managed with mint candies, chewing gum, or water. Abrupt discontinuation should be avoided as it may cause a worsening of Parkinson’s symptoms or lead to neuroleptic malignant syndrome (NMS).

• Idiopathic Parkinsonism: Start with 1 mg on the first day, then increase by 2 mg every three to five days until reaching an optimal daily dose of 6 to 10 mg. Some patients, particularly those with postencephalitic Parkinsonism, may require 12 to 15 mg daily.
• Drug-Induced Parkinsonism: Dosage is determined individually, usually ranging between 5 to 15 mg per day. Some patients respond well to as little as 1 mg daily. Starting with 1 mg is advisable, and if symptoms persist, the dosage may be gradually increased. It may also help to temporarily reduce the dosage of the causative drug while introducing Trihexyphenidyl.
• Concomitant Use with Levodopa: When taken together, the doses of both medications may need adjustment. A daily Trihexyphenidyl dose of 3 to 6 mg, divided into multiple doses, is typically sufficient.
• Use in Children: The safety and effectiveness in pediatric patients have not been established.
• Administration: The total daily dose is best divided into three doses taken at mealtimes. If the dose exceeds 10 mg per day, it should be split into four doses, with the fourth taken at bedtime.

✔️ Drug Interactions:

• Substances such as cannabinoids, barbiturates, opiates, and alcohol may enhance its sedative effects, increasing the potential for abuse.
• Combining Trihexyphenidyl with alcohol or other CNS depressants may result in excessive sedation.
• Monoamine oxidase inhibitors and tricyclic antidepressants with anticholinergic properties may intensify the effects of Trihexyphenidyl.
• Prophylactic use of anticholinergics, like Trihexyphenidyl, to prevent drug-induced Parkinsonism during neuroleptic therapy is not recommended.
• Using it alongside neuroleptics may increase the risk of tardive dyskinesia.
• The usual doses of both Trihexyphenidyl and levodopa may need adjustment when used together, as it may increase involuntary movements.

✔️ Contraindications:

• Patients allergic to Trihexyphenidyl should not take this medication.
• It is contraindicated in individuals with narrow-angle glaucoma, as long-term use has been linked to blindness in such patients.

✔️ Pregnancy & Lactation:

• There is no conclusive data on its safety during pregnancy. It should only be used if the benefits outweigh the potential risks.
• It is unclear whether Trihexyphenidyl is excreted in breast milk. Since many drugs are excreted in milk and may suppress lactation, caution is advised when prescribing to nursing mothers.

✔️ Precautions & Warnings:

• Patients should undergo a gonioscopic eye exam before starting treatment and have their intraocular pressure monitored.
• Anticholinergic drugs may trigger an increase in intraocular pressure and cause angle-closure glaucoma. If vision blurs, glaucoma should be considered as a possible cause.
• Caution is necessary in hot weather, especially for chronically ill patients, alcoholics, those with CNS disorders, or those performing manual labor, as it may cause anhidrosis and hyperthermia.
• Sudden discontinuation of the drug may lead to neuroleptic malignant syndrome (NMS), which is characterized by fever, muscle rigidity, altered mental status, and autonomic instability (e.g., irregular pulse, tachycardia, or cardiac arrhythmias).

✔️ Storage Conditions:

• Store below 30ºC in a dry place, protected from light.