From: mdkline@rodan.acs.syr.edu (Mark D. Kline)
Subject: Re: Orphenadrine in depression
Keywords: Disipal
Organization: Syracuse University
Date: Wed, 14 Oct 92 20:54:00 EDT

In article <1992Oct14.064103.1@kosmos.wcc.govt.nz> macridis_g@kosmos.wcc.govt.nz (Gerry Macridis) writes:
>According to the New Ethicals Compendium, a New Zealand publication
>containing prescribing information by trade name (presumably provided
>by the manufacturers), one indication for Disipal (orphenadrine HCl),
>an anticholinergic antiparkinsonian, is 'senile and presenile
>depressions' - in doses of 50-150 mg/day.

This is very interesting - orphenadrine citrate is prescribed in the
USA as an analgesic used in painful musculoskeletal conditions, in
preparations such as Norflex and Norgesic.  It is frequently prescribed
to patients with muscle spasm in chronic soft tissue pain
("fibromyalgia" or "fibrositis"); my impression is that it is generally
not very helpful and I've taken a lot of people with chronic pain
states off it.  Orthopedists dealing with acute painful states might
find it more useful, but my experience with the drug is not favorable.

>The anticholinergic antiparkinsonians are often misused for euphoric
>effects (and hallucinogenic effects in high doses).  Orphenadrine has
>been stated to be more euphoric than other drugs of this class.  In
>patients with parkinsonism, orphenadrine has been shown to have an
>outstanding effect in relieving depression (1).

My impression is that orphenadrine is only weakly anticholinergic;
I don't believe this drug is FDA approved for use in Parkinsonism
and I am not aware of neurologic colleagues prescribing for this
indication.

>The indication 'senile and presenile depressions' has appeared in the
>data on Disipal here in New Zealand only a couple of years or so ago.
>One question I have is:  Has there been recent (i.e., in the past few
>years) research into the use of orphenadrine for the treatment of
>depression in patients not suffering from parkinsonism or drug-induced
>extrapyramidal effects?  I cannot find any reference to this in the
>latest issues of Martindale's Extra Pharmacopoeia or other
>publications.

I am unaware of any published studies on orphenadrine in depression.
I vaguely remember a couple of studies in which anticholinergics were
used as "active placebos" in comparative studies with amitriptyline.
I will check this out and report back...

>Another question I have, for clinicians, is:  What are your comments on
>the trial use of small doses of orphenadrine in selected patients with
>depression in general, who have not responded to conventional
>antidepressant drugs?  Orphenadrine is a drug which has been available
>for several decades and, as far as I understand, it does not have any
>serious side effects.

I have not observed any antidepressant effects of this drug in several
patients with chronic pain I have seen (most of whom I started on
tricyclic antidepressants with resultant greater or lesser relief
of pain and/or depressive symptoms).

>(1) Onuaguluchi, G.  Assessment of Drug Therapy in Parkinsonism.
>    British Medical Journal, February 16, 1963, p. 443-448.

			                  ^^^^^^
Is this REALLY a 30 year old reference?  This could be hard to check! :) 


--
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mark kline                              mdkline@rodan.acs.syr.edu
suny health science center, syracuse    voice: (315) 422-1050
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