II. Indications

  1. Drug-Induced Extrapyramidal Side Effects
  2. Parkinsonism
    1. Adjunctive, symptomatic management of Tremor or Drooling

III. Contraindications

  1. Narrow Angle Glaucoma
  2. Acute Bowel Obstruction
  3. Megacolon
  4. Elderly (relative)
    1. On Beer's List, due to risk of Delirium, pscyhosis, Fall Risk

IV. Mechanism

  1. Centrally acting Muscarinic Antagonist
  2. Decreases imbalance of Acetylcholine to Dopamine ratio within corpus striatum (Basal Ganglia)

V. Dosing: Parkinsonism

  1. Start: 0.5 to 1 mg/day orally, IM or IV divided once at bedtime to four times daily
  2. Increase by 0.5 mg/day each week as needed
  3. Maximum: 6 mg/day

VI. Dosing: Extrapyramidal Side Effects

  1. Acute Dystonic Reaction
    1. Administer 1 to 2 mg orally, IM or IV
  2. Chronic
    1. Start 1 to 4 mg orally, IM or IV once to twice daily
    2. Consider taper off after 1-2 weeks

VII. Adverse Effects

  1. See Anticholinergic Symptoms
  2. Avoid in pregnancy (may be Teratogenic)
  3. Unknown safety in Lactation
  4. Withdrawal symptoms with severe increase in Parkinsonism symptoms
    1. Titrate medication off without abruptly stopping

IX. References

  1. (2021) Med Lett Drugs Ther 63(1618): 25-32
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 46-7
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

benztropine (on 4/5/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
BENZTROPINE MES 0.5 MG TAB Generic $0.08 each
BENZTROPINE MES 1 MG TABLET Generic $0.08 each
BENZTROPINE MES 2 MG TABLET Generic $0.11 each

Ontology: Benztropine (C0005098)

Definition (MSH) A centrally active muscarinic antagonist that has been used in the symptomatic treatment of PARKINSON DISEASE. Benztropine also inhibits the uptake of dopamine.
Definition (CSP) centrally active muscarinic antagonist that has been used in the symptomatic treatment of Parkinson disease; also inhibits the uptake of dopamine.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D001590
SnomedCT 372846002, 77390008
LNC LP17858-9, MTHU019541
English Benztropine, 8-Azabicyclo(3.2.1)octane, 3-(diphenylmethoxy)-8-methyl-, endo-, Benzatropine, Benztropine [Chemical/Ingredient], BENZTROPINE, benzatropine, benztropine, Benztropine (product), Benztropine (substance)
Swedish Benstropin
Czech benztropin
Finnish Bentstropiini
Russian BENZTROPIN, БЕНЗТРОПИН
Japanese ベンズトロピン, コゲンチン, ベンズアトロピン
Polish Benzatropina
Spanish benzotropina, benztropina (producto), benztropina (sustancia), benztropina, Benzotropina
French Benzatropine
German Benzatropin
Italian Benztropina
Portuguese Benzotropina

Ontology: Cogentin (C0591275)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D001590
German Cogentin
English cogentin, Cogentin