Announcement

Collapse
No announcement yet.

Procycladine as cause of sleep disturbance ?

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Procycladine as cause of sleep disturbance ?

    My wife has had considerable sleep disturbance since she was placed on Procyclidine (at a dose of 2.5mg taken 3 times per day) to control her Essential Tremor.

    She used to sleep well, if anything oversleeping to late in the day, but after starting Procyclidine she started waking up earlier in the morning then started waking through the night for up to a 1 hour at a time several times a night. Her sleep pattern is now very disrupted and she sleeps erratically during night and day causing constant tiredness.

    She has tested negative for Parkinson's Disease but suffers from long standing Bipolar Disorder which is effectively controlled with Aripiprazole (10mg per day) and Escitalopram (10mg per day).

    She recently attended a Sleep Clinic who only discussed the possibility of Sleep Aponea being the cause which I severely doubted as I do not hear her stop breathing and an overnight trial showed only very mild Aponea with an AHI below 10 and a month long trial of a CPAP machine made absolutely no difference to her sleep pattern. We are going back to the Sleep Clinic in two weeks so I did some digging on the net.

    What we found was that Procycladine
    works by reducing the neurotransmitter A
    cetylcholine working on four receptors in the brain and that Acetylcholine plays an important part in regulating the adjustment of the circadian clock, thereby altering the pattern of sleep and wake phases through the day and night.

    As she does not have Parkinsons Disease then could the Procyclidine be sending her Acetylcholine so low that it has caused her sleep patter to be disturbed ?


    Last edited by PaulB67; 13th, March 2020, 11:50 AM. Reason: Improving format

  • #2
    Originally posted by PaulB67 View Post
    My wife has had considerable sleep disturbance since she was placed on Procyclidine (at a dose of 2.5mg taken 3 times per day) to control her Essential Tremor.

    She used to sleep well but after starting Procycladine she started waking up earlier in the morning then started waking through the night for up to a 1 hour at a time several times a night. Her sleep pattern is now very disrupted and she sleeps eratically during night and day.

    She has tested negative for Parkinson's Disease but suffers from long standing Bipolar Disorder which is effectively controlled with Aripiprazole (10mg per day) and Escitalopram (10mg per day).

    Having done considerable research on this, we linked the following concepts found in different places on the net:



    Procyclidine Drug Action from

    https://bnf.nice.org.uk/drug/procycl...ochloride.html

    Procyclidine exerts its antiparkinsonian action by reducing the effects of the relative central cholinergic excess that occurs as a result of dopamine deficiency.


    Procyclidine Pharmacodynamics from https://www.drugbank.ca/drugs/DB00387

    Procyclidine has an atropine-like action on parasympathetic-innervated peripheral structures including smooth muscle. It's antispasmodic effects are thought to be related to the blockage of central cholinergic receptors M1, M2 and M4. It is used to treat symptomatic Parkinsonism and extrapyramidal dysfunction caused by antipsychotic agents.


    Cholinergic Receptor M1 from https://www.drugbank.ca/polypeptides/P11229

    Processes
    adenylate cyclase-inhibiting G-protein coupled acetylcholine receptor signaling pathway / cell proliferation / cellular protein modification process / cognition / entrainment of circadian clock / G-protein coupled acetylcholine receptor signaling pathway / G-protein coupled receptor signaling pathway / nervous system development / neuromuscular synaptic transmission / phospholipase C-activating G-protein coupled acetylcholine receptor signaling pathway / phototransduction, visible light / positive regulation of cell proliferation / positive regulation of intracellular protein transport / positive regulation of ion transport / protein kinase C-activating G-protein coupled receptor signaling pathway / regulation of locomotion / saliva secretion / sensory perception of chemical stimulus / signal transduction / synaptic transmission, cholinergic


    Cholinergic Receptor from https://www.sciencedirect.com/scienc...7961230862422X

    Acetylcholine, in conjunction with other neurotransmitter systems, plays a very important role in the regulation of circadian and sleepwake states. To briefly recapitulate, several current basic concepts about the regulation of sleepwake states include: (a) REM sleep, or at least its phasic events (eye movements and PGO spikes), are promoted by cholinergic neurons originating within the peribrachial regions [LDTPPT]; (b) REM sleep may be inhibited by noradrenergic and serotonergic neurons in the locus coeruleus and dorsal raphe, respectively; (c) stages 3 and 4 (Delta) sleep are inhibited by cholinergic terminals from basal forebrain to cortex and from LDT/PPT to thalamus; (d) Delta sleep is modulated by the complex serotonergic mechanisms, for example, it is increased by pharmacological antagonists of 5HT, receptors, although the mechanism and neuroanatomical site at which this effect occurs is unknown.
    Using pirenzepine, a selective ligand for the M1 mACHR subtype, investigators have shown that M1 receptor subtypes predominate in the hippocampus and in the cortex, whereas the M2 receptor subtypes predominate in the septum, thalamus and brainstem areas.


    Physiology of Circadian Entrainment from https://journals.physiology.org/doi/...rev.00009.2009

    Mammalian circadian rhythms are controlled by endogenous biological oscillators, including a master clock located in the hypothalamic suprachiasmatic nuclei (SCN). Since the period of this oscillation is of 24 h, to keep synchrony with the environment, circadian rhythms need to be entrained daily by means of Zeitgeber (“time giver”) signals, such as the light-dark cycle


    Are we in any way correct that this be true that Procycladine is disrupting her circadian clock and resulting in her sleep disturbance.
    Hi. Looking at all the copied and pasted pharmacology, in various fonts, I’m not sure what you’re trying to achieve. In practice, no doctor will even think of the above when prescribing a drug or considering side effects such as sleep disturbance. They will basically swap medication until she finds one that suits her and controls her symptoms. Patients suffering from mental health issues often have sleep issues as it’s unfortunately part of the package. She may have to find a balance between the tremor and the sleep issues but you basically need to go back to the prescriber and tell them that it appears to effect her quality of sleep.

    Lively debate is encouraged but please respect the opinions and feelings of others.
    Please help keep the forum vibrant by spreading the work to friends and colleagues via word of mouth or social media.
    Thank you for contributing to this site.

    Comment

    Working...
    X