Benztropine Mesylate(benz’ troe peen)
Apo-Benztropine (CAN), Cogentin
PREGNANCY CATEGORY C
Drug class
Antiparkinsonian (anticholinergic type)
Therapeutic Actions
Has anticholinergic activity in the CNS that is believed to help normalize the hypothesized imbalance of cholinergic and dopaminergic neurotransmission in the basal ganglia of the brain of a parkinsonism patient. Reduces severity of rigidity and, to a lesser extent, akinesia and tremor; less effective overall than levodopa; peripheral anticholinergic effects suppress secondary symptoms of parkinsonism, such as drooling.
Indications
Adjunct in the therapy of parkinsonism (postencephalitic, arteriosclerotic, and idiopathic types)
Control of extrapyramidal disorders (except tardive dyskinesia) due to neuroleptic drugs (phenothiazines)
Contraindications and Cautions
Contraindicated with hypersensitivity to benztropine; glaucoma, especially angle-closure glaucoma; pyloric or duodenal obstruction, stenosing peptic ulcers, achalasia (megaesophagus); prostatic hypertrophy or bladder neck obstructions; myasthenia gravis, megacolon.
Use cautiously with tachycardia, cardiac arrhythmias, hypertension, hypotension, hepatic or renal impairment, alcoholism, chronic illness, work in hot environments; hot weather; lactation, Alzheimer’s disease, thin patients, pregnancy.
Available Forms
Tablets—0.5, 1, 2 mg; injection—1 mg/mL
Dosages
Adults
Parkinsonism: Initially, 0.5–1 mg PO at bedtime; a total daily dose of 0.5–6 mg given at bedtime or in two to four divided doses is usual. Increase initial dose in 0.5-mg increments at 5- to 6-day intervals to the smallest amount necessary for optimal relief. Maximum daily dose, 6 mg. May be given IM or IV in same dosage as oral. When used with other drugs, gradually substitute benztropine for all or part of them and gradually reduce dosage of the other drug.
Drug-induced extrapyramidal symptoms: For acute dystonic reactions, initially, 1–2 mg IM (preferred) or IV to control condition; may repeat if parkinsonian effect begins to return. After that, 1–4 mg PO daily or bid to prevent recurrences. Some patients may require higher doses.
Extrapyramidal disorders occurring early in neuroleptic treatment: 1–2 mg PO bid to tid. Withdraw drug after 1 or 2 wk to determine its continued need; reinstitute if disorder reappears.
Pediatric patients
Safety and efficacy not established.
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