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  • Benztropine
    (Benztropine Mesylate) - Various

    OTHER BRAND NAMES

    Cogentin (Oak)

    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

    Adults: Individualize dose based on age and weight, and type of parkinsonism treated. Initiate with a low dose. Titrate: May increase in increments of 0.5mg, to a max of 6mg, or until optimal results obtained, at 5-6 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. Highly Sensitive Patients: Initial: 0.5mg qhs; increase as necessary. Postencephalitic/Idiopathic Parkinsonism: Usual: 1-2mg/day. Range: 0.5-6mg/day. Do not terminate other antiparkinsonian agents abruptly when therapy is started; gradually reduce or d/c other agents. Concomitant Carbidopa-Levodopa or Levodopa: May require periodic dose adjustment. Extrapyramidal Disorders: Usual: 1-4mg qd or bid. Give 1-2mg bid or tid for transient 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. (Inj) Emergency Situations: 1-2mL. Dose can be repeated if the parkinsonian effect begins to return. Elderly: Start at lower end of dosing range, and increase dose PRN with monitoring for the emergence of adverse events.

    PEDIATRIC DOSAGE

    Pediatrics: >3 Yrs: Individualize dose based on age and weight, and type of parkinsonism treated. Initiate with a low dose. Titrate: May increase in increments of 0.5mg, to a max of 6mg, or until optimal results obtained, at 5-6 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. Highly Sensitive Patients: Initial: 0.5mg qhs; increase as necessary. Postencephalitic/Idiopathic Parkinsonism: Usual: 1-2mg/day. Range: 0.5-6mg/day. Do not terminate other antiparkinsonian agents abruptly when therapy is started; gradually reduce or d/c other agents. Concomitant Carbidopa-Levodopa or Levodopa: May require periodic dose adjustment. Extrapyramidal Disorders: Usual: 1-4mg qd or bid. Give 1-2mg bid or tid for transient 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. (Inj) Emergency Situations: 1-2mL. Dose can be repeated if the parkinsonian effect begins to return.

    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

    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.

    ADMINISTRATION/STORAGE

    Administration: IV/IM/Oral route. Storage: (Inj) 20-25°C (68-77°F). (Tab) 15-30°C (59-86°F).