Efficacy of Trihexyphenidyl in Preventing Haloperidol-Induced Acute dystonia

• Main Authors: Weng, Meng-Yu, 翁孟玉
• Other Authors: Weng F.Huang
• Format: Others
• Language: zh-TW
• Published: 1997
• Online Access: http://ndltd.ncl.edu.tw/handle/68989564206204417451

碩士 === 國立成功大學 === 臨床藥學研究所 === 85 === AbstractAntipsychotics are currently most widely used and effective treatment for schizophrenia. Since its application clinically, psychiatric admission has been reducing dramatically, leading to reduction of health budget as well as possibility for patient to return to family and community. However, the extrapyramidal system side effects (EPS) resulted from blockade of striatal dopamine receptor may often appear simultaneously with the antipsychotic effect. Anticholinergics can be used in the treatment of EPS or prevention from their appearance, with a possibility of enhancing anticholinergic side effects of anitpsyhcotics. Though it has generally been believed that anticholinergic is indicated for prevention of EPS in high risk group, the concomitant use of anticholinergic for prevention of EPS has been hitherto a controversial issue since the development of chlorpromazine in 1950s.This study consists of two separated parts. Firstly a retrospective survey was carried out to investigate the prescription behaviour when using anticholinergic and antipsychotics for treatment of schizophrenia through review of medical record. The second part was a randomized double-blind placebo-controlled clinical trial to examine the efficacy of trihexyphenidyl, an anticholinergics for prevention of EPS induced by haloperidol.229 admissions of schizophrenic patient in 19 months, from January 1995 to July 1996, were included in the analysis of the first study. The result showed that in 82.5% of the total index admissions anticholinergics was prescribed in combination with antipsychotics initially. Drug induced parkinsonism (19.2%) was the most common EPS, followed by acute dystonia (14.4%) and akathisia (14.0%). On the other hand, constipation (30.6%) was the most common anticholinergic side effects noted, followed by urine stasis and reduced urine stream (12.2%) , palpitation (5.2%) , blurred vision (2.2%) and dry mouth (1.3%).Regarding placebo-controlled drug trial, 51 psychiatric inpatients with schizophrenia participated in the study. Twenty-seven cases administered haloperidol with trihexyphenidyl, remained 24 with placebo . Two out of 27 cases of trihexyphenidyl group, compared to 7 out of 24 placebo group, developed acute dystonia within 14 days of the treatment period ((2=6.80, p=0.009). No significant differences were found between two groups on the other types of EPS and anticholinergic side effects. The study results suggest that trihexyphenidyl (Artane() is able to reduced the development of acute dystonia significantly .