Tricalm 5 | 10'S

✔️ Dosage & Administration

Adults (Parkinsonism): Start with 1 mg daily, increase gradually (every 3–5 days) by 2 mg until 6–10 mg/day in 3–4 divided doses. Maintenance: 5–15 mg/day.

Drug-induced extrapyramidal symptoms: 5–15 mg/day in divided doses.

Elderly: May require lower doses due to higher sensitivity.

Children: Safety and efficacy not established.

Administration advice:

Take at the same time each day.

Preferably on an empty stomach; however, if nausea/dry mouth occurs, timing can be adjusted (before meals if dry mouth, after meals if drooling/nausea).

Swallow whole; do not crush or chew.

Do not stop abruptly → may worsen Parkinsonism or trigger Neuroleptic Malignant Syndrome (NMS).

✔️ Side Effects

Common (>10%)

Dry mouth, constipation, blurred vision, dizziness, drowsiness, upset stomach, nausea, vomiting, difficulty urinating, nervousness, headache.

Uncommon / Rare

Hallucinations, confusion, memory impairment, rash, paralytic ileus, suppurative parotitis.

Exacerbation of glaucoma (risk of blindness).

Neuroleptic Malignant Syndrome may be withdrawn suddenly.

✔️ Contraindications

Hypersensitivity to trihexyphenidyl.

Closed-angle glaucoma.

Thyrotoxicosis, sick sinus syndrome, severe cardiac failure with tachycardia.

Chronic pulmonary disease.

✔️ Interaction

Additive anticholinergic effects: With phenothiazines, clozapine, antihistamines, TCAs, amantadine.

With MAOIs: May cause severe dryness, blurred vision, urinary retention.

With levodopa: Reduced absorption and increased involuntary movements → dose adjustment may be required.

With parasympathomimetics: Antagonizes their effect.

With metoclopramide/domperidone: May reduce their GI effects.

Additive CNS depression with alcohol, opioids, barbiturates.

✔️ Pregnancy & Lactation

Safety is not fully established. Use only if the benefits outweigh the risks.

May suppress lactation → caution during breastfeeding.

✔️ Precautions & Warnings

• Use with caution in elderly patients, arteriosclerosis, cardiovascular disease, hepatic/renal impairment, GI obstruction, prostatic hypertrophy, or urinary stricture.
• Not recommended for tardive dyskinesia.
• May impair mental or physical abilities → avoid driving or operating machinery.
• Avoid overheating/dehydration (risk of anhidrosis & hyperthermia).
• Monitor intraocular pressure regularly during prolonged use.
• Avoid abrupt discontinuation.

✔️ Storage

Store below 30°C, in a dry place, protected from light.

Keep out of reach of children.