Prophylactic use of trihexyphenidyl (artane) in schizophrenia and psychosis: a critical review of literature to guide for evidence based practice in Zambia

Abstract

Background: Anticholinergic drugs are particularly used in psychiatric practice to counteract the EPS secondary to antipsychotic drugs. Trihexyphenidyl (Benzhexol), commonly known as 'Artane' is most widely used anticholinergic drug in Zambia. It is routinely prescribed as prophylaxis to counteract the side-effects in patients taking FGA. In anecdotal experience the abuse of artane is very common among mental patients as well as in the general public in Zambia. This article reviews the literature about psychiatric use, mechanism of action and abuse potential of trihexyphenidyl.

Objective: This review aim to critically review the literature about use of trihexyphenidyl to guide whether it is justified to use this drug for prophylaxis to counteract the side-effects of antipsychotics in Zambia.

Methodology: Literature search was conducted using MEDLINE via PubMed (from 1970- 2018).Initially broad search was undertaken to find controlled studies, case reports and review articles and later some relevant bibliographic articles were reviewed to find some more studies.

Conclusion: There is generally no need to start an anticholinergic drugs when a patient is prescribed antipsychotics. For patients who are already on anticholinergic drugs, discontinuation of these drugs should be considered in patients with stable EPS. Anticholinergic drugs can be considered only in individuals with significant EPS when dose reduction and switching strategies have proven ineffective, or when the side effects are acute or severe.

Keywords: Antipsychotics, Schizophrenia, Trihexyphenidyl, Zambia