Pro-Banthine

Pro-Banthine,

trademark for an anticholinergic (propantheline bromide).

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propantheline bromide

Pro-Banthine, Propanthel (CA)

Pharmacologic class: Parasympatholytic

Therapeutic class: Anticholinergic, antimuscarinic, antispasmodic

Pregnancy risk category C

Action

Prevents muscarinic action of acetylcholine at postganglionic parasympathetic neuroeffector sites, relaxing GI tract and blocking gastric acid secretion

Availability

Tablets: 7.5 mg, 15 mg

⊘Indications and dosages

➣ Peptic ulcer

Adults: 15 mg P.O. 30 minutes before each meal and 30 mg at bedtime, for a total of four daily doses

Adults of small stature: 7.5 mg P.O. t.i.d. before each meal

Dosage adjustment

• Mild peptic ulcer symptoms
• Elderly patients

Off-label uses

• Neurogenic bladder
• Urinary incontinence
• Antisecretory and antispasmodic effects

Contraindications

• Hypersensitivity to drug or other anticholinergics
• Angle-closure glaucoma
• Unstable cardiovascular adjustment in acute hemorrhage
• GI tract obstruction
• GI atony in elderly or debilitated patients
• Toxic megacolon, severe ulcerative colitis
• GU tract obstruction
• Myasthenia gravis

Precautions

Use cautiously in:
• heart failure, hypertension, arrhythmias, coronary artery disease, hepatic disease, hiatal hernia, chronic lung disease in debilitated patients, hyperthyroidism, autonomic neuropathy
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

• Give 30 minutes before meals and at bedtime - except in adults of small stature, who should receive doses three times daily before meals.

Route	Onset	Peak	Duration
P.O.	30-60 min	2-6 hr	6 hr

Adverse reactions

CNS: confusion, stimulation, headache, insomnia, dizziness, anxiety, asthenia, hallucinations

CV: palpitations, orthostatic hypotension, tachycardia

EENT: blurred vision, photophobia, mydriasis, cycloplegia, increased intraocular pressure, nasal congestion

GI: nausea, vomiting, constipation, heartburn, dysphagia, bloating, gastroesophageal reflux disease (GERD), dry mouth, paralytic ileus

GU: urinary hesitancy or retention, erectile dysfunction, suppressed lactation

Skin: rash, urticaria, pruritus, anhidrosis

Other: taste loss, fever, heat prostration, allergic reaction

Interactions

Drug-drug. Amantadine: increased propantheline effects

Atenolol: increased pharmacologic effects of atenolol

Phenothiazines: decreased antipsychotic efficacy of phenothiazines, increased adverse effects of propantheline

Tricyclic antidepressants: increased anticholinergic effects

Drug-herbs. Henbane, jimsonweed, scopolia: increased anticholinergic effects

Patient monitoring

• Monitor vital signs. Watch for orthostatic hypotension.
• Assess patient for sensory and neurologic impairment.

Patient teaching

• Tell patient drug may inhibit sweating and make him susceptible to heat prostration. Teach him effective ways to maintain normal body temperature.
• Describe drug's adverse anticholinergic effects. Recommend appropriate measures to minimize these.
• Advise patient to report GERD symptoms.
• Tell male patient drug may cause erectile dysfunction. Encourage him to discuss this problem with prescriber.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, vision, and alertness.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure decrease.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and herbs mentioned above.