Antimuscarinic (Parkinsonian)
Orphenadrine hydrochloride
Brand names: Disipal, Biorphen
Adult dose
Dose: 150mg/day in divided doses, increase by 50mg every 2–3 days; max 400mg/day
Route: PO
Frequency: divided
Clinical pearls
- Drug-induced parkinsonism, mild Parkinson's tremor — largely superseded
- Limited evidence; significant anticholinergic burden — avoid in elderly
Contraindications
- Closed-angle glaucoma
- GI obstruction
- Urinary retention
- Myasthenia gravis
- Tardive dyskinesia
Side effects
- Anticholinergic effects (dry mouth, blurred vision, retention, confusion)
- Sedation
- Tachycardia
Interactions
- Other antimuscarinics — additive
- CNS depressants
Reference: BNF; NICE NG71; https://bnf.nice.org.uk/drugs/orphenadrine-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS