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What is Artane?

Artane alters unusual nerve impulses and relaxes stiff muscles.

Artane is used to treat the stiffness, tremors, spasms, and poor muscle control of Parkinson's disease. It is also used to treat and prevent the same muscular conditions when they are caused by drugs such as chlorpromazine (Thorazine), fluphenazine (Prolixin), perphenazine (Trilafon), haloperidol (Haldol), thiothixene (Navane), and others.

Artane may also be used for purposes other than those listed in this medication guide.

Misdiagnosis: Righting The Wrong
SLIDESHOW
Misdiagnosis: Righting The Wrong
Important Information
Use caution when driving, operating machinery, or performing other hazardous activities. Artane may cause dizziness or blurred vision. If you experience dizziness or blurred vision, avoid these activities.

Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking Artane.

Avoid becoming overheated. Artane may cause decreased sweating. This could lead to heat stroke in hot weather or with vigorous exercise.

Before taking this medicine
Do not use Artane without first talking to your doctor if you have

ever had an allergic reaction to it;

narrow-angle glaucoma;

an obstruction in the bowel or a complication of bowel disease known as megacolon; or

myasthenia gravis.

Before taking this medication, tell your doctor if you have

enlargement of the prostate or difficulty urinating;

epilepsy or another seizure disorder;

heart disease or an irregular heartbeat;

depression or any other psychiatric illness;

kidney disease; or

liver disease.

You may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

It is not known whether Artane will be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment.

It is not known whether Artane passes into breast milk. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.

How should I take Artane?
Take Artane exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.



Take each dose with a full glass of water.

Artane may be taken with or without meals. Taking this medicine with food may lessen stomach upset.

To ensure that you get a correct dose, measure the liquid form of Artane with a special dose-measuring spoon or cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.

Store Artane at room temperature away from moisture and heat.

What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and only take the next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?
Seek emergency medical attention.

Symptoms of a Artane overdose include large pupils; warm, dry skin; flushed face; fever; dry mouth; fast or irregular heartbeat; anxiety; hallucinations; confusion; agitation; hyperactivity; loss of consciousness; and seizures.

What should I avoid while taking Artane?
Use caution when driving, operating machinery, or performing other hazardous activities. Artane may cause dizziness or blurred vision. If you experience dizziness or blurred vision, avoid these activities.

Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking Artane.

Avoid becoming overheated. Artane may cause decreased sweating. This could lead to heat stroke in hot weather or with vigorous exercise. Try to keep as cool as possible and watch for signs of heat stroke such as decreased sweating, nausea, and dizziness.

Artane side effects
If you experience any of the following serious side effects, stop taking Artane and seek emergency medical attention or contact your doctor immediately:

an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);

fever;

fast or irregular heartbeats;

anxiety, hallucinations, confusion, agitation, hyperactivity, or loss of consciousness;

seizures;

eye pain; or

a rash.

Other, less serious side effects may be more likely to occur. Continue to take Artane and talk to your doctor if you experience

dryness of the mouth;

large pupils or blurred vision;

drowsiness or dizziness;

difficulty urinating or constipation;

nervousness or anxiety;

upset stomach; or

decreased sweating.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)



What other drugs will affect Artane?
Before taking this medication, tell your doctor if you are taking any of the following medicines:

a tricyclic antidepressant (used to treat depression, pain, or obsessive-compulsive disorder) such as amitriptyline (Elavil, Endep), doxepin (Sinequan), clomipramine (Anafranil), amoxapine (Asendin), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), or protriptyline (Vivactil);

a phenothiazine (used to treat mania, schizophrenia, other psychiatric conditions, and nausea and vomiting) such as chlorpromazine (Thorazine), fluphenazine (Prolixin), perphenazine (Trilafon), mesoridazine (Serentil), thioridazine (Mellaril), promazine (Sparine), trifluoperazine (Stelazine), and others;

thiothixene (Navane) or chlorprothixene (Taractan);

an antihistamine such as diphenhydramine (Benadryl, others), chlorpheniramine (Chlor-Trimeton, others), triprolidine (Actifed, others), brompheniramine (Dimetapp, others), clemastine (Tavist), and others (antihistamines are often found in prescription and over-the-counter cold, allergy, and sleep medicines);

quinidine (Quinora, Quinaglute, Quinidex, Cardioquin);

amantadine (Symmetrel);

digoxin (Lanoxin, Lanoxicaps); or

haloperidol (Haldol).

You may not be able to take Artane or you may require a dosage adjustment or special monitoring if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with Artane. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.
Artane Side Effects
For the Consumer
Applies to trihexyphenidyl: oral capsule extended release, oral elixir, oral tablet

Along with its needed effects, trihexyphenidyl (the active ingredient contained in Artane) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.


Check with your doctor immediately if any of the following side effects occur while taking trihexyphenidyl:

Rare
Abdominal or stomach cramps or pain
bloating
constipation
delusions of persecution, mistrust, suspiciousness, or combativeness
excessive dryness of the mouth
false beliefs that cannot be changed by facts
loss of appetite
nausea or vomiting
seeing, hearing, or feeling things that are not there
skin rash
stomach pain
swollen, painful, or tender lymph glands on the side of the face or neck
Incidence not known
Anxiety
blurred vision
change in vision
decrease in frequency of urination
decrease in urine volume
difficult urination
difficulty in passing urine (dribbling)
disturbed behavior
dry mouth
enlarged pupils
eye pain
fast, pounding, or irregular heartbeat or pulse
hyperventilation
irritability
loss of vision
mental confusion
nervousness
painful urination
restlessness
shaking
shortness of breath
trouble sleeping
Some side effects of trihexyphenidyl may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common


Dizziness
mild nausea
nervousness
Incidence not known
Drowsiness
weakness
For Healthcare Professionals
Applies to trihexyphenidyl: oral elixir, oral tablet

General
Most adverse effects of trihexyphenidyl (the active ingredient contained in Artane) are extensions of its pharmacologic activity and are anticholinergic in nature. Between 30% and 50% of all patients experience minor side effects (dry mouth, nausea, blurred vision, dizziness, nervousness). Elderly patients and those with underlying organic brain disease tend to be the most susceptible, especially to the central effects.[Ref]

Gastrointestinal
Gastrointestinal side effects have included dry mouth, difficulty swallowing, anorexia, constipation, nausea, and vomiting. A reduction in dosage will sometimes help alleviate these problems. Paralytic ileus may develop, particularly in patients on concomitant phenothiazine or tricyclic antidepressant therapy, and may occasionally be fatal. Upon withdrawal of medication, nausea and vomiting may occur due to a cholinergic rebound.[Ref]

Nervous system
Bucco-linguo-masticatory dyskinesias and chorea have been reported mostly in elderly patients being treated for Parkinson's disease with various anticholinergic agents, including trihexyphenidyl (the active ingredient contained in Artane) [Ref]

Nervous system side effects have included depression, anxiety, listlessness, drowsiness, numbness of fingers and dyskinesia. Chorea has been reported at higher dosages (>=15 mg/day). Trihexyphenidyl may also aggravate symptoms of tardive dyskinesia or elicit previously suppressed symptoms. Sleepwalking has been attributed to drugs or combination of drugs with anticholinergic activity.

Cognitive deficits, such as impairment of recent and short-term memory and inability to concentrate, may occur with clinical doses of anticholinergic agents and may be dose-related.[Ref]

Psychiatric
Psychiatric side effects have included toxic psychosis which manifested as confusion, disorientation, agitation, excitation, memory impairment, delusions and hallucinations (usually visual, but may be auditory or tactile or all three), at toxic and therapeutic dosages (2% to 4%, up to 19% in elderly patients). Psychiatric deterioration and psychotic flare-ups have also been reported following withdrawal of therapy. Symptoms include delusions, hallucinations, aggression or violent behavior, and suicidal tendencies. In high dosages, trihexyphenidyl (the active ingredient contained in Artane) may sometimes produce euphorigenic effects. For this reason, it can be a drug of abuse.[Ref]

Toxic psychosis, when present, tends to occur quickly, generally within several days to a week of initiating trihexyphenidyl therapy or within hours after an acute overdose. However, occasionally the onset may be delayed by months. Symptoms generally resolve spontaneously within a few days after the discontinuation of medication.[Ref]

Ocular
Ocular side effects have included blurred vision, mydriasis, and cycloplegia. Trihexyphenidyl (the active ingredient contained in Artane) may also cause angle-closure glaucoma, which has rarely led to blindness.[Ref]

Cardiovascular
Cardiovascular side effects have included tachycardia, although an isolated case of bradycardia has also been described. Orthostatic hypotension has been reported during withdrawal syndromes following discontinuation of long-term trihexyphenidyl (the active ingredient contained in Artane) therapy.[Ref]

Genitourinary
Genitourinary side effects have included urinary retention and dysuria.[Ref]

Metabolic
Metabolic side effects have included alterations in thermal homeostasis as a result of trihexyphenidyl (the active ingredient contained in Artane) s inhibition of the body's sweating mechanism. Heat stroke, hyperthermia, and fever have occurred with anticholinergic agents, most commonly in patients on concomitant neuroleptic or tricyclic antidepressant therapy.[Ref]



Other
Anticholinergic poisoning syndrome may persist for more than a week's duration following trihexyphenidyl (the active ingredient contained in Artane) overdose. Most patients with anticholinergic intoxication require only supportive therapy of vital functions and/or discontinuation of medications. However, severely agitated, delirious, or comatose patients may be treated with physostigmine salicylate, an acetylcholinesterase inhibitor with both central and peripheral effects.[Ref]

Anticholinergic intoxication may present with central and peripheral symptoms including those listed above, in addition to warm and dry skin, EKG abnormalities, insomnia, twitching or jerking movements, pantomime activity with nonexistent objects, hyperactivity, hyperreflexia, respiratory arrest, delirium, convulsions, shock and coma.[Ref]

References
1. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ.

2. Baker LA, Cheng LY, Amara IB "The withdrawal of benztropine mesylate in chronic schizophrenic patients." Br J Psychiatry 143 (1983): 584-90

3. Kalman T, Warner GM "Protracted vomiting following abrupt cessation of psychotropics: a case report." Can Psychiatr Assoc J 23 (1978): 163-5

4. Glassman JN, Darko D, Gillin JC "Medication-induced somnambulism in a patient with schizoaffective disorder." J Clin Psychiatry 47 (1986): 523-4

5. McEvoy JP "A double-blind crossover comparison of antiparkinson drug therapy: amantadine versus anticholinergics in 90 normal volunteers, with an emphasis on differential effects on memory function." J Clin Psychiatry 48(9 suppl (1987): 20-3

6. Nomoto M, Thompson PD, Sheehy MP, Quinn NP, Marsden CD "Anticholinergic-induced chorea in the treatment of focal dystonia." Mov Disord 2 (1987): 53-6

7. Moreau A, Jones BD, Banno V "Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia." Can J Psychiatry 31 (1986): 339-41

8. Burnett GB, Prange AJ Jr, Wilson IC, Jolliff LA, Creese IC, Synder SH "Adverse effects of anticholinergic antiparkinsonian drugs in tardive dyskinesia. An investigation of mechanism." Neuropsychobiology 6 (1980): 109-20

9. West RR, Newgreen DB "Choreiform movements induced by anticholinergic therapy." Med J Aust 2 (1979): 87-8

10. Warne RW, Gubbay SS "Choreiform movements induced by anticholinergic therapy." Med J Aust 1 (1979): 465

11. Birket-Smith E "Abnormal involuntary movements induced by anticholinergic therapy." Acta Neurol Scand 50 (1974): 801-11

12. el-Yousef MK, Janowsky D, Davis JM, Sekerke HJ "Reversal of antiparkinsonian drug toxicity by physostigmine: a controlled study." Am J Psychiatry 130 (1973): 141-5

13. Hauser RA, Olanow CW "Orobuccal dyskinesia associated with trihexyphenidyl therapy in a patient with Parkinson's disease." Mov Disord 8 (1993): 512-4

14. Kiloh LG, Smith JS, Williams SE "Antiparkinson drugs as causal agents in tardive dykinesia." Med J Aust 2 (1973): 591-3

15. McEvoy JP, Freter S "The dose-response relationship for memory impairment by anticholinergic drugs." Compr Psychiatry 30 (1989): 135-8

16. McEvoy JP, McCue M, Spring B, Mohs RC, Lavori PW, Farr RM "Effects of amantadine and trihexyphenidyl on memory in elderly normal volunteers." Am J Psychiatry 144 (1987): 573-7

17. Koller WC "Disturbance of recent memory function in parkinsonian patients on anticholinergic therapy." Cortex 20 (1984): 307-11

18. Yassa R "Antiparkinsonian medication withdrawal in the treatment of tardive dyskinesia: a report of three cases." Can J Psychiatry 30 (1985): 440-2

19. Warnes H "Toxic psychosis due to antiparkinsonian drugs." Can Psychiatr Assoc J 12 (1967): 323-6

20. Laski E, Taleporos E "Anticholinergic psychosis in a bilingual: a case study." Am J Psychiatry 134 (1977): 1038-40

21. Wilcox JA "Psychoactive properties of benztropine and trihexyphenidyl." J Psychoactive Drugs 15 (1983): 319-21

22. Trend P, Trimble M, Wessely S "Schizophrenic psychosis associated with benzhexol (artane) therapy." J Neurol Neurosurg Psychiatry 52 (1989): 1115

23. Stephens DA "Psychotoxic effects of benzhexol hydrochloride (Artane)." Br J Psychiatry 113 (1967): 213-8

24. Friedman Z, Neumann E "Benzhexol-induced blindness in Parkinson's disease." Br Med J 1 (1972): 605

25. Blumensohn R, Razoni G, Shalev A, Munitz H "Bradycardia due to trihexyphenidyl hydrochloride." Drug Intell Clin Pharm 20 (1986): 786-7

26. Lee BS "Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs." J Clin Psychiatry 47 (1986): 571

27. Sarnquist F, Larson CP Jr "Drug-induced heat stroke." Anesthesiology 39 (1973): 348-50

28. Forester D "Fatal drug-induced heat stroke." JACEP 7 (1978): 243-4

29. Stadnyk AN, Glezos JD "Drug-induced heat stroke." Can Med Assoc J 128 (1983): 957-9

30. Johnson AL, Hollister LE, Berger PA "The anticholinergic intoxication syndrome: diagnosis and treatment." J Clin Psychiatry 42 (1981): 313-7

31. Kulik AV, Wilbur R "Delirium and stereotypy from anticholinergic antiparkinson drugs." Prog Neuropsychopharmacol Biol Psychiatry 6 (1982): 75-82

32. Hussey HH "Physostigmine: value in treatment of central toxic effects of anti-cholinergic drugs." JAMA 231 (1975): 1066

Some side effects of Artane may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.