propantheline bromide: clinical use

Prescribing considerations

• Licensed indications apply to adults; paediatric safety and efficacy have not been established for the selected product.
• Older people may be particularly susceptible to confusion, glaucoma, urinary retention and other antimuscarinic effects.
• Assess antimuscarinic burden and medicines whose absorption or gastrointestinal action may be altered.
• Use caution with autonomic neuropathy, renal or hepatic disease, hyperthyroidism, cardiovascular disease, arrhythmia, hypertension, reflux, pyrexia, Down’s syndrome and ulcerative colitis.
• Reduced sweating increases heatstroke risk in hot environments.
• The tablets contain lactose and sucrose; check relevant hereditary sugar intolerances.

Contraindications and cautions

• Hypersensitivity to propantheline or an excipient
• Gastrointestinal or urinary obstruction, pyloric stenosis, paralytic ileus or intestinal atony
• Severe ulcerative colitis or toxic megacolon
• Hiatus hernia associated with reflux oesophagitis
• Unstable cardiovascular adjustment during acute haemorrhage
• Myasthenia gravis or prostatic enlargement
• Closed-angle glaucoma or a shallow anterior chamber

Monitoring

• Review symptom response and antimuscarinic adverse effects.
• Monitor bowel function and urinary retention risk, particularly in older people and those with gastrointestinal or urinary disease.
• Consider pulse and rhythm monitoring where tachycardia would be clinically important.
• Ask about visual symptoms, cognition, sweating and heat intolerance.
• During breastfeeding, consider infant feeding, weight gain, alertness, bowel function and wet nappies.

Clinical pharmacology

Propantheline is a quaternary ammonium antimuscarinic that inhibits acetylcholine-mediated parasympathetic activity, reducing gastrointestinal motility, gastric secretion and sweating. It is extensively metabolised, and some hydrolysis may occur in the gastrointestinal tract before absorption.

Formulation and product differences

• The selected product is an oral, pink, sugar-coated tablet containing lactose and sucrose.
• Food reduces its bioavailability.
• Available pack sizes may vary, and not every authorised pack is necessarily marketed.

Tablet

Route: Oral

Strengths: 15 mg