netFormulary Leicestershire Health Community NHS
Medicines Formulary  
 Formulary Chapter 4: Central nervous system - Full Chapter
Chapter Links...
04.09.02  Expand sub section  Antimuscarinic drugs used in parkinsonism
  • Anticholinergic agents may sometimes be of use in reducing mild tremor but have little effect on rigidity or bradykinesia. They are no longer routinely recommended in treatment of Parkinson’s disease but may be used in selected patients under specialist advice. 
  • Anticholinergic agents can reduce the severity of drug induced parkinsonian symptoms. Akathisia does not usually respond well and tardive dyskinesias may be made worse
  • Prophylactic use with antipsychotics is not recommended. Treatment may be started if symptoms occur but should be reviewed every 3 months for continuing need.
  • Use with caution in elderly patients because they tend to cause mental confusion.
  • Cumulative anticholinergic medication use  has been shown to be associated with an increased risk for dementia. The long-term impact of prescribing these drugs should be considered when initiating them as the untoward effects may not be reversed by withdrawing them later down the line.


Procyclidine Hydrochloride
View adult BNF View SPC online  Track Changes
First Choice
Drug induced parkinsonian symptoms.
Injection acts quickly and is effective in relieving acute dystonic reactions caused by dopamine- blocking agents including antipsychotics and metoclopramide.
Trihexyphenidyl (Benzhexol)
View adult BNF View SPC online  Track Changes
Second Choice
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Track Changes
Display tracking information
click to search
Link to adult BNF
click to search
Link to children's BNF
click to search
Link to SPCs
Scottish Medicines Consortium
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHS England

Traffic Light Status Information

Status Description


Drugs not recommended for use in the Leicestershire Health Community because of lack of evidence of clinical effectiveness, cost prioritization or concerns over safety. All new drugs will be black until they have been through the appropriate approval process - then they will appear as a specific entry   


Drugs which should be prescribed only by hospital specialists (clinical review by specialist as appropriate and annually as a minimum).  

Amber SCA

Drugs which would initially be prescribed by a hospital specialist and then by a GP where full agreement to share the care of each specific patient has been reached under a LMSG Shared Care Agreement (SCA). Specific patient monitoring or intervention required.   

Amber Simple

Drugs suitable to be initiated and prescribed in primary care only after specialist assessment and recommendation. A shared care agreement is not required.  

Green Conditional

Drugs for which GPs are able to take full responsibility for prescribing and monitoring subject to specified conditions e.g. prescribing in line with agreed LMSG guidance or able to demonstrate suitable competence see comments under individual entries.   


Drugs for which GPs would normally take full responsibility for prescribing and monitoring. Drugs included in this list have been specifically considered by LMSG.