trihexyphenidyl

Adjunctive therapy

Brands: Artane

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

What is trihexyphenidyl?
Trihexyphenidyl (brand Artane; generics) is an anticholinergic antiparkinson agent. In psychiatric care it is commonly used to treat antipsychotic-induced Parkinsonism and acute Dystonia, and sometimes other medication-induced extrapyramidal reactions (label/clinical).
What is Artane?
Artane is a brand name for trihexyphenidyl.
What is Artane (trihexyphenidyl) used for?
Label indications include: Parkinsonism (label). Common use includes control of antipsychotic-induced extrapyramidal reactions (label/clinical).
What drug class is Artane (trihexyphenidyl)?
Anticholinergic (antimuscarinic) antiparkinson agent used for parkinsonism and to manage extrapyramidal reactions to antipsychotics. It can improve drug-induced parkinsonism and acute dystonia, but does not treat tardive dyskinesia and may worsen it; anticholinergic adverse effects often limit use.
What strengths does Artane (trihexyphenidyl) come in?
Tablets: 2 mg and 5 mg (label).

Snapshot

Primary label indications include: Parkinsonism (label).
Class: Adjunctive therapy
Common US brands: Artane
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-30

Label indications

Parkinsonism (label). Common use includes control of antipsychotic-induced extrapyramidal reactions (label/clinical).

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Clinical Highlights

Trihexyphenidyl (brand Artane; generics) is an anticholinergic antiparkinson agent. In psychiatric care it is commonly used to treat antipsychotic-induced Parkinsonism and acute Dystonia, and sometimes other medication-induced extrapyramidal reactions (label/clinical). Trihexyphenidyl does not treat tardive dyskinesia (TD) and may worsen it; labeling explicitly notes anticholinergics do not alleviate TD and can aggravate symptoms (label).

The main limitation is anticholinergic adverse effects (dry mouth, constipation, urinary retention, blurry vision, confusion), which can be particularly problematic in older adults and in patients with cognitive vulnerability (label/clinical).
For drug-induced parkinsonism, clinical reviews emphasize addressing the causative antipsychotic exposure (dose reduction or switching when feasible) alongside symptomatic medications (review).
The compare view, trihexyphenidyl evidence feed, and trihexyphenidyl print page support EPS counseling and regimen review.

Dosing & Formulations

Tablets: 2 mg and 5 mg (label). Label initiation for parkinsonism can start at 1 mg on day 1, then increase by 2 mg increments every 3–5 days toward a typical total daily dose of 6–10 mg/day (label).

For antipsychotic-induced extrapyramidal reactions, total daily dosing is individualized; labeling notes ranges often between 5–15 mg/day, divided across doses with meals (label/clinical).
Because cumulative anticholinergic effects can build over days, slow titration and the lowest effective dose are common strategies to reduce confusion and constipation risk (label/clinical).

Monitoring & Risks

Anticholinergic adverse effects: monitor bowel function, urinary retention, blurry vision, dry mouth, tachycardia, and confusion, especially in older adults (label/clinical). Cognitive and delirium risk increases with higher anticholinergic burden and polypharmacy; reassess the ongoing need if attention, memory, or agitation worsens (review/clinical).

Heat intolerance and decreased sweating can occur; counsel about overheating risk during hot weather or strenuous activity (label).
If glaucoma risk or urinary obstruction symptoms are present, the risk–benefit calculation often shifts away from anticholinergics (label/clinical).

Drug Interactions

Additive anticholinergic burden occurs with TCAs, first-generation antihistamines, many antipsychotics (notably clozapine), and other anticholinergic agents; regimen review is often higher yield than “stacking” anticholinergics (clinical). Sedatives and alcohol can worsen dizziness and falls risk when anticholinergic load is high (clinical).

Anticholinergics can counteract cholinesterase inhibitors; co-use is generally avoided when dementia medications are present (clinical).

Practice Notes

For antipsychotic-induced parkinsonism, many frameworks emphasize first assessing whether antipsychotic dose reduction or switching is feasible before adding chronic anticholinergic therapy (Wisidagama 2021/clinical). When anticholinergic cognitive burden is a concern, amantadine is sometimes considered as an alternative symptomatic option (clinical).

Avoid “automatic prophylaxis” (routine anticholinergics with every antipsychotic) unless there is a clear indication and follow-up plan, because unnecessary anticholinergic exposure can worsen cognition and constipation (review/clinical).

References

Trihexyphenidyl hydrochloride tablets prescribing information — DailyMed (2023)
Recognition AND Management OF Antipsychotic Induced Parkinsonism IN Older Adults A Narrative Review — Medicines (2021)
Managing Antipsychotic Induced Acute AND Tardive Dystonia — Drug Safety (1998)
Anticholinergic Burden and Cognitive Performance in Patients With Schizophrenia A Systematic Literature Review — Frontiers in Psychiatry (2021)
AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)