Benzatropine

What is Benzatropine?

• Benzatropine (Cogentin) possesses both anticholinergic and antihistaminic effects used to treat a type of movement disorder due to antipsychotics known as dystonia and parkinsonism.
• It is not useful for tardive dyskinesia.

Benzatropine

What are the uses of this medicine?

Benzatropine (Cogentin) is used as an adjunct in the therapy of all forms of parkinsonism. It is also used in the control of extrapyramidal disorders (except tardive dyskinesia) due to neuroleptic drugs (e.g., phenothiazine's).

Limitations of use:

• It is not useful for tardive dyskinesia.

How does this medicine work?

• Benztropine is in a class of medications called anticholinergics.
• It works by blocking a certain natural substance (acetylcholine) to help to decrease symptoms in people with Parkinson's disease.
• The anticholinergic activity of this drug is about equal to that of atropine.

Who Should Not Use this medicine ?

This medicine cannot be used in patients with:

• Hypersensitivity to benztropine mesylate.
• in pediatric patients under three years of age.

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Be sure to mention any of the following:

• tricyclic antidepressants such as desipramine (Norpramin)
• clomipramine (Anafranil)
• imipramine (Tofranil)
• trimipramine (Surmontil)
• haloperidol (Haldol)

Is this medicine FDA approved?

• Benzatropine was approved for medical use in the United States in 1954.
• It is available as a generic medication.
• In 2020, it was the 229th most commonly prescribed medication in the United States, with more than 2 million prescriptions.

How should this medicine be used?

Recommended dosage: Postencephalitic and Idiopathic Parkinsonism:

• The usual daily dose is 1 to 2 mg, with a range of 0.5 to 6 mg orally.
• As with any agent used in parkinsonism, dosage must be individualized according to age and weight and the type of parkinsonism being treated.
• Benztropine mesylate may be used concomitantly with Carbidopa-Levodopa, or with levodopa, in which case periodic dosage adjustment may be required in order to maintain optimum response.

Drug-Induced Extrapyramidal Disorders:

• In treating extrapyramidal disorders due to neuroleptic drugs (e.g., phenothiazines), the recommended dosage is 1 to 4 mg once or twice a day orally.
• Dosage must be individualized according to the need of the patient.
• Some patients require more than recommended; others do not need as much.
• In acute dystonic reactions, 1 to 2 mL of the injection usually relieves the condition quickly.
• After that, the tablets 1 to 2 mg twice a day, usually prevents recurrence.

Administration:

• Benztropine comes as a tablet to take by mouth.
• It usually is taken at bedtime.
• It is usually taken once daily but may be taken up to four times a day depending on your symptoms.
• Take benztropine at around the same time(s) every day.
• Your doctor may start with a small dose and increase it slowly after seeing your response to benztropine.
• Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.
• Do not stop taking benztropine suddenly without talking with your doctor, especially if you are also taking other medications.
• Sudden stoppage can cause symptoms of Parkinson's disease to return.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As tablet, for oral administration, contains 0.5 mg, 1 mg or 2 mg of benztropine mesylate.
• As Benztropine mesylate Injection is supplied as a sterile injection for intravenous and intramuscular use.

This medicine is available in fallowing brand namesː

• Cogentin

What side effects can this medication cause?

The most common side effects of this medicine include:

• Tachycardia
• Paralytic ileus
• constipation
• vomiting
• nausea
• dry mouth
• confusion
• disorientation
• memory impairment
• visual hallucinations
• nervousness
• depression
• listlessness
• numbness of fingers
• Blurred vision
• dilated pupils
• Urinary retention
• dysuria
• skin rash
• Heat stroke
• hyperthermia
• fever

What special precautions should I follow?

• Benztropine mesylate may impair mental and/or physical abilities required for performance of hazardous tasks, such as operating machinery or driving a motor vehicle.
• Patients should be advised to report gastrointestinal complaints, fever or heat intolerance promptly.
• Paralytic ileus, hyperthermia and heat stroke, all of which have sometimes been fatal, have occurred in patients taking anti-cholinergic-type antiparkinsonism drugs, including benztropine mesylate, in combination with phenothiazines and/or tricyclic antidepressants.
• Since benztropine mesylate contains structural features of atropine, it may produce anhidrosis. For this reason, it should be administered with caution during hot weather, especially when given concomitantly with other atropine-like drugs to the chronically ill, the alcoholic, those who have central nervous system disease, and those who do manual labor in a hot environment. If there is evidence of anhidrosis, the possibility of hyperthermia should be considered. Dosage should be decreased.

What to do in case of emergency/overdose?

Symptoms of overdose may include:

• CNS depression
• confusion
• nervousness
• listlessness
• hallucinations
• dizziness
• muscle weakness
• ataxia
• dry mouth
• mydriasis
• blurred vision
• palpitations
• tachycardia
• elevated blood pressure
• nausea
• vomiting
• dysuria
• numbness of fingers
• dysphagia
• allergic reactions
• skin rash
• headache
• hot, dry, flushed skin
• delirium
• coma
• shock
• convulsions
• respiratory arrest
• anhidrosis
• hyperthermia
• glaucoma
• constipation

Management of overdosage:

• Physostigmine salicylate, 1 to 2 mg, SC or IV, reportedly will reverse symptoms of anticholinergic intoxication.
• A second injection may be given after 2 hours if required.
• Otherwise treatment is symptomatic and supportive.
• Induce emesis or perform gastric lavage.
• Maintain respiration.
• A short-acting barbiturate may be used for CNS excitement.
• Use artificial respiration for severe respiratory depression and a local miotic for mydriasis and cycloplegia.
• Use ice bags or other cold applications and alcohol sponges for hyperpyrexia, a vasopressor and fluids for circulatory collapse.
• Darken room for photophobia.

Can this medicine be used in pregnancy?

• Safe use in pregnancy has not been established.

Can this medicine be used in children?

• This drug is contraindicated in pediatric patients under three years of age, and should be used with caution in older pediatric patients.

What are the active and inactive ingredients in this medicine?

Active Ingredients:

• BENZTROPINE MESYLATE

Inactive Ingredients:

• WATER
• SODIUM CHLORIDE

Who manufactures and distributes this medicine?

• Manufactured in the USA for: Nexus Pharmaceuticals, Inc., Lincolnshire, IL
• Registered trademark of MERCK & CO., Inc.

What should I know about storage and disposal of this medication?

• Store at 25°C (77°F): excursions permitted to 15° to 30°C (59 to 86°F), protect from light, retain in carton until time of use.

• Dailymed label info on Benzatropine
• FDA Benzatropine