Hexinor 2 mg

Description

Indications
Hexinor tablets are indicated as an adjunctive treatment for various forms of parkinsonism, including postencephalitic, arteriosclerotic, and idiopathic types. It is commonly used alongside levodopa therapy to manage these forms of Parkinsonism. Hexinor is also indicated for the control of extrapyramidal symptoms resulting from the use of central nervous system (CNS) drugs such as dibenzoxazepines, phenothiazines, thioxanthenes, and butyrophenones.
Take the medication as prescribed by a registered physician.

Description
Hexinor works by directly inhibiting the parasympathetic nervous system and promoting relaxation of smooth muscles. This effect is achieved both directly on muscle tissue and indirectly by inhibiting the parasympathetic system.

Pharmacology
Trihexyphenidyl, the active ingredient in Hexinor, is a non-selective muscarinic acetylcholine receptor antagonist, with a higher affinity for the M1 subtype. It has been shown in studies to bind predominantly to central muscarinic receptors in the cerebral cortex, while having a lower affinity for peripheral receptors. Additionally, trihexyphenidyl may influence nicotinic acetylcholine receptor activity, indirectly stimulating dopamine release in the striatum. Despite its proven utility in alleviating symptoms of Parkinson’s disease and other movement disorders, its exact mechanism of action remains incompletely understood.

Dosage & Administration
Dosage should be individualized, starting with a low dose and gradually increasing, particularly in patients over 60 years old. The timing of the dose—before or after meals—should be adjusted based on patient response.

• Idiopathic Parkinsonism: Start with 1 mg on day 1. Increase by 2 mg every 3 to 5 days until the dose reaches 6-10 mg per day. Some postencephalitic patients may need 12-15 mg daily for optimal effect.
• Drug-induced Parkinsonism: The dose should be determined empirically, generally ranging between 5 to 15 mg per day. Start with 1 mg, and adjust as necessary. Reducing the dose of the offending tranquilizer may help achieve control more quickly.
• Concomitant use with Levodopa: Trihexyphenidyl should be administered in doses of 3-6 mg daily, adjusted as needed.
• Concomitant use with other parasympathetic inhibitors: Trihexyphenidyl can replace other parasympathetic inhibitors, with gradual substitution and dose reduction.

High doses (above 10 mg per day) can be split into 3 or 4 doses, taken at mealtimes, with an additional dose at bedtime if needed. The medication should be taken as prescribed, and abrupt withdrawal may worsen Parkinson’s symptoms or lead to neuroleptic malignant syndrome (NMS).

Use in Children
Safety and effectiveness in pediatric patients have not been established.
Take the medication as prescribed by a registered physician.

Interactions
Combining Hexinor with CNS depressants such as cannabinoids, barbiturates, opiates, or alcohol may enhance sedative effects and increase abuse potential. Anticholinergic medications, particularly monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants, may intensify Hexinor’s anticholinergic effects. Be cautious when using Hexinor with other CNS drugs, as this could increase the risk of tardive dyskinesia or involuntary movements.

Contraindications
Hexinor is contraindicated for patients with hypersensitivity to trihexyphenidyl or any of its components. It should not be used by individuals with narrow-angle glaucoma, as prolonged use may result in blindness due to this condition.

Side Effects
Common side effects include dryness of the mouth, blurred vision, dizziness, mild nausea, or nervousness, which occur in 30-50% of patients. These effects are generally less severe than those associated with belladonna alkaloids and tend to subside with continued use. Rare side effects include skin rashes, swelling of the parotid gland, dilatation of the colon, paralytic ileus, and psychiatric symptoms like delusions, hallucinations, or paranoia. Other potential effects include cognitive dysfunctions, constipation, drowsiness, urinary retention, tachycardia, pupil dilation, and increased intraocular pressure.
Note: Sudden withdrawal may exacerbate Parkinsonism or cause neuroleptic malignant syndrome. The occurrence of angle-closure glaucoma has been reported in some cases.

Pregnancy & Lactation
Trihexyphenidyl should only be used during pregnancy when the benefits outweigh the risks, as there are no controlled studies in humans. It is unknown whether the drug is excreted in human milk, so caution is advised when administering it to nursing women. Since it may suppress lactation, it should only be used if necessary, and the benefits to the mother outweigh the risks to the infant.

Precautions & Warnings
Before starting treatment with Hexinor, a gonioscope evaluation of the eyes should be conducted, and intraocular pressure should be monitored regularly, as anticholinergics may cause angle-closure glaucoma. If blurred vision occurs during therapy, narrow-angle glaucoma should be considered.
Hexinor should be used with caution in hot environments or when combined with other anticholinergic drugs. Anhidrosis and hyperthermia are risks under such conditions, so the dosage may need to be adjusted.
Discontinuation of treatment can lead to neuroleptic malignant syndrome (NMS), a potentially fatal condition that presents with symptoms like high fever, muscle rigidity, altered mental status, and autonomic instability.

Overdose Effects
Overdose with Hexinor may cause central anticholinergic syndrome, including symptoms such as dilated pupils, dry skin, increased heart rate, elevated body temperature, confusion, hallucinations, and, in severe cases, coma or death. In case of overdose, immediate symptomatic and supportive treatment should be provided, including gastric lavage and the administration of anticonvulsants if necessary. Phenothiazines should be avoided due to their potential to worsen toxicity.

Therapeutic Class
Antiparkinson drugs

Storage Conditions
Store at temperatures not exceeding 30ºC, in a dry place, and protect from light. Keep out of the reach of children.