Tricalm^®

Tricalm is a preparation of Trihexyphenidyl Hydrochloride which is a synthetic antispasmodic. Trihexyphenidyl 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.

No Data

Tricalm is indicated-

• In the treatment of all forms of Parkinsonism (postencephalitic, arteriosclerotic and idiopathic)
• As adjuvant therapy in treating Parkinsonism with levodopa
• In reducing the rigidity of muscle spasm, tremor and excessive salivation associated with Parkinsonism
• To control extrapyramidal disorders caused by central nervous system drugs such as the dibenzoxazepines, phenothiazines, thioxanthenes and butyrophenones

Route of administration: Tricalm is taken in oral route.

Adults
The usual dosage for parkinsonism is 6 to 10 mg per day. It should be given orally either 3 or 4 times a day at mealtimes.

In idiopathic parkinsonism
As initial therapy for parkinsonism, 1 mg may be administered the first day. The dose may then be increased by 2 mg increments at intervals of 3 to 5 days until a total of 6 to 10 mg is given daily.

Concomitant use with levodopa
When Tricalm is used concomitantly with levodopa, the usual dose of each may need to be reduced. The total daily dosage usually 3 to 6 mg, in divided doses, is usually adequate.

Treatment of drug induced extrapyramidal disorder
The total daily intake of Tricalm is tolerated best if divided into 3 doses & taken at mealtimes. High doses (more than 10 mg daily) may be divided into 4 parts, with 3 doses administered at mealtimes & the fourth at bedtime.

In drug induced parkinsonism
The total daily dosage usually ranges between 5 to 15 mg, although some cases have been controlled by 1 mg daily. In all cases, dosage should be increased or decreased only by small increments over a period of several days. In initial therapy the dose should be 1 mg the first day, 2 mg the second day with further increases of 2 mg per day at 3 to 5 days intervals until the optimum dose is reached.

Elderly
Patients over 65 years of age tend to be relatively more sensitive and require smaller amounts of the drug.

Pregnancy: There is inadequate information regarding the use of trihexyphenidyl in pregnancy. Trihexyphenidyl should not be used during pregnancy unless clearly necessary.

Lactation: It is unknown whether trihexyphenidyl is excreted in human breast milk. Trihexyphenidyl should not be used during breastfeeding.

Use in children and adolescents
Not recommended.

Trihexyphenidyl may be the subject of abuse (on the basis of hallucinogenic or euphoriant properties, common to all antimcholinergic drugs) if given in sufficient amounts. Patients with cardiac, liver, kidney disorders or with hypertension should closely be observed. Since trihexyphenidyl has parasympathetic 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. Trihexyphenidyl is not recommended for use in patients with tardive dyskinesia unless they have concomitant parkinson's disease.

The most common side effects are dryness of mouth, constipation, blurring of vision, dizziness, mild nausea and nenvtousness. Elderly and patients with arteriosclerosis may exhibit restlessness, confusional states, agitation, delusions, hallucinations, insomnia. Trihexyphenidyl can also cause hypersensitivity, euphoria, impairment of immediate and short term memory, worsening of myasthenia gravis, dilatation of the pupils with loss of accommodation and photophobia, raised intraocular pressure, tachycardia, decreased bronchial secretions, vomiting, flushing and dryness of skin, skin rashes, urinary retention, difficulty in micturition, thirst and pyrexia.

Trihexyphenidyl is contraindicated in patients with known hypersensitivity to trihexyphenidyl or any other components of this product. It is also contraindicated in patients with narrow angle glaucoma.

Drug interaction with medication: CExtra care should be taken when trihexyphenidyl is given concomitantly with phenothiazines, clozapine, antihistamines, disopyramide, nefopam, amantadine, monoamine oxidase inhibitors, tricyclic antidepressants, metoclopramide, domperidone, levodopa and parasympathomimetics.

Drug interaction with food and others: Not applicable.

Symptoms of overdose with antimuscarinic agents include flushing and dryness of the skin, dilated pupils, dry mouth and tongue, tachycardia, rapid respiration, hyperpyrexia, hypertension, nausea, vomiting, rash, restlessness, confusion, hallucinations, paranoid, psychotic reactions, incoordination, delirium and occasionally convulsions. In severe overdose, CNS depression may occur with coma, circulatory and respiratory failure and death. Treatment should always be supportive. An adequate airway should be maintained. Diazepam may be administered to control excitement and convulsions but the risk of central nervous system depression should be considered. Hypoxia and acidosis should be corrected. Antiarrhythmic drugs are not recommended if dysrhythmias occur.

No Data

Keep away from the reach of children. Store in a cool & dry place. Protect from light.

Tricalm 2 tablet: Each tablet contains Trihexyphenidyl Hydrochloride USP 2 mg.
Tricalm 5 tablet: Each tablet contains Trihexyphenidyl Hydrochloride USP 5 mg.

Storage
Store in a cool (below 30°C) and dry place protected from light. Keep away from the reach of children.

Packing
Tricalm 2 tablet: Carton of 50 tablets in blister pack.
Tricalm 5 tablet: Carton of 50 tablets in blister pack.