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  • Benztropine
    (benztropine mesylate)

    OTHER BRAND NAMES

    Cogentin

    THERAPEUTIC CLASS

    Anticholinergic

    DEA CLASS

    RX

    INDICATIONS

    Adjunct in the therapy of all forms of parkinsonism. Control of extrapyramidal disorders (except tardive dyskinesia [TD]) due to neuroleptic drugs (eg, phenothiazines).

    ADULT DOSAGE

    Parkinsonism

    Adjunct in the Therapy of All Forms of Parkinsonism:
    Initiate w/ a low dose
    Titrate: May increase in increments of 0.5mg, to a max of 6mg, or until optimal results obtained, at 5- to 6-day intervals

    Idiopathic Parkinsonism:
    Initial: 0.5-1mg qhs; 4-6mg/day may be required in other patients

    Postencephalitic Parkinsonism:
    Initial: 2mg/day given in 1 or more doses; 0.5mg qhs and increase as necessary in highly sensitive patients

    Postencephalitic and Idiopathic Parkinsonism:
    Usual: 1-2mg/day
    Range: 0.5-6mg/day

    Inj:
    Emergency Situations:
    1-2mL
    Dose can be repeated if the parkinsonian effect begins to return

    Do not terminate other antiparkinsonian agents abruptly when therapy is started; gradually reduce or d/c other agents

    Drug-Induced Extrapyramidal Reactions

    Control of extrapyramidal disorders (except tardive dyskinesia) due to neuroleptic drugs (eg, phenothiazines)
    Usual: 1-4mg qd or bid
    1-2mg bid or tid for extrapyramidal disorders that develop soon after initiation of neuroleptic drugs

    Tab:
    D/C to determine continued need after 1 or 2 weeks
    May reinstitute therapy if disorders recur

    Acute Dystonic Reactions:
    1-2mL IM/IV relieves the condition quickly
    After the inj, 1-2mg tab bid usually prevents recurrence

    PEDIATRIC DOSAGE

    Parkinsonism

    Adjunct in the Therapy of All Forms of Parkinsonism:
    >3 Years
    :
    Initiate w/ a low dose
    Titrate: May increase in increments of 0.5mg, to a max of 6mg, or until optimal results obtained, at 5- to 6-day intervals

    Idiopathic Parkinsonism:
    Initial: 0.5-1mg qhs; 4-6mg/day may be required in other patients

    Postencephalitic Parkinsonism:
    Initial: 2mg/day given in 1 or more doses; 0.5mg qhs and increase as necessary in highly sensitive patients

    Postencephalitic and Idiopathic Parkinsonism:
    Usual: 1-2mg/day
    Range: 0.5-6mg/day

    Inj:
    Emergency Situations:
    1-2mL
    Dose can be repeated if the parkinsonian effect begins to return

    Do not terminate other antiparkinsonian agents abruptly when therapy is started; gradually reduce or d/c other agents

    Drug-Induced Extrapyramidal Reactions

    Control of extrapyramidal disorders (except tardive dyskinesia) due to neuroleptic drugs (eg, phenothiazines)

    >3 Years:
    Usual: 1-4mg qd or bid
    1-2mg bid or tid for extrapyramidal disorders that develop soon after initiation of neuroleptic drugs

    Tab:
    D/C to determine continued need after 1 or 2 weeks
    May reinstitute therapy if disorders recur

    Acute Dystonic Reactions:
    1-2mL IM/IV relieves the condition quickly
    After the inj, 1-2mg tab bid usually prevents recurrence

    DOSING CONSIDERATIONS

    Concomitant Medications
    Concomitant Carbidopa-Levodopa or Levodopa: May require periodic dose adjustment

    Elderly
    Start at lower end of dosing range, and increase dose prn w/ monitoring for the emergence of adverse events

    ADMINISTRATION

    IV/IM/Oral route

    HOW SUPPLIED

    Inj: (Cogentin) 1mg/mL [2mL, ampul]; Tab: 0.5mg*, 1mg*, 2mg* *scored

    CONTRAINDICATIONS

    Pediatric patients <3 yrs of age.

    WARNINGS/PRECAUTIONS

    May impair mental/physical abilities. Caution with use during hot weather, especially when given with other atropine-like drugs to the chronically ill, alcoholics, those who have CNS disease, or those who do manual labor in a hot environment; severe anhidrosis and hyperthermia may occur; consider dose reduction. Continued supervision is advisable. Closely monitor patients with a tendency to tachycardia and those with prostatic hypertrophy. Dysuria may occur. Urinary retention reported. May cause weakness and inability to move particular muscle groups, especially in large doses; may require dose adjustment. Mental confusion and excitement may occur with large doses, or in susceptible patients. Visual hallucinations reported occasionally. In the treatment of extrapyramidal disorders due to neuroleptic drugs, may intensify mental symptoms in patients with mental disorders and precipitate toxic psychosis; monitor patients with mental disorders, especially at start of therapy or if dose is increased. Not recommended for use in patients with TD; may aggravate TD symptoms. Glaucoma may develop; avoid with angle-closure glaucoma. Certain drug-induced extrapyramidal disorders that develop slowly may not respond to therapy. Caution in pediatric patients >3 yrs of age.

    ADVERSE REACTIONS

    Tachycardia, paralytic ileus, constipation, N/V, dry mouth, toxic psychosis, blurred vision, dilated pupils, urinary retention, dysuria, allergic reaction, heat stroke, hyperthermia, fever.

    DRUG INTERACTIONS

    May cause GI complaints, fever, or heat intolerance with phenothiazines, haloperidol, or other drugs with anticholinergic/antidopaminergic activity. Paralytic ileus, hyperthermia, and heat stroke reported with phenothiazines and/or TCAs.

    PREGNANCY AND LACTATION

    Safety not known in pregnancy/nursing.

    MECHANISM OF ACTION

    Anticholinergic agent; therapeutically significant in the management of parkinsonism. Also possesses antihistaminic activity.

    ASSESSMENT

    Assess for drug hypersensitivity, exposure to hot weather, tachycardia, prostatic hypertrophy, mental disorders, TD, angle-closure glaucoma, chronic illness, alcohol consumption, CNS disease, pregnancy/nursing status, and for possible drug interactions.

    MONITORING

    Monitor for anhidrosis, hyperthermia, tachycardia, dysuria, urinary retention, weakness, inability to move muscles, mental confusion and excitement, toxic psychosis, visual hallucinations, glaucoma, and other adverse reactions. Monitor patients with mental disorders at start of therapy or if dose is increased.

    PATIENT COUNSELING

    Inform of the risks/benefits of therapy. Advise to use with caution during hot weather. Inform that drug may impair mental/physical abilities; caution against performing hazardous tasks (eg, operating machinery/driving). Advise to report GI complaints, fever, or heat intolerance promptly.

    STORAGE

    (Inj) 20-25°C (68-77°F). (Tab) 15-30°C (59-86°F).