Discontinue if signs & symptoms indicative of neuroleptic malignant syndrome develop. Patients w/ severe Alzheimer's dementia, other types of dementia or memory impairment (eg, age-related cognitive decline). Potential cause of generalised convulsions, exacerbation or induction of extrapyramidal symptoms. May have vagotonic effects on heart rate (eg, bradycardia) particularly in patients w/ sick sinus syndrome or other supraventricular cardiac conduction conditions eg, SA or AV block. Consider possibility of heart blockade or long sinusal pauses in patients experiencing syncope & seizures. Patients at increased risk of ulcer development eg, those w/ history of ulcer disease or in concomitant use w/ NSAIDs. May cause bladder outflow obstruction. History of asthma or obstructive pulmonary disease. May exaggerate succinylcholine-type muscle relaxation during anesth. Do not give to patients w/ rare hereditary problems of galactose intolerance, lactose deficiency or glucose-galactose malabsorption. Concomitant use w/ other acetylcholinesterase inhibitors, cholinergic agonists or antagonists. May influence ability to drive & use machines. Possible increased exposure in mild to moderate hepatic impairment; severe hepatic impairment. Pregnancy & lactation. Not recommended in childn & adolescent <18 yr.
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