benztropine COGENTIN

Class: Anticholinergic
FDA Indications: Parkinsonism, Drug-induced Extrapyramidal Reactions
Off-Label Use: Idiopathic Generalized Dystonia, Focal Dystonias, Dopa-responsive Dystonia, Acute Dystonia
Forms: 0.5, 1, 2mg tablet; 1mg/mL IV; 1 mg/mL injectable
Dose Range: 1-8 mg/day
Starting: For EPS, recommended dosage is 1–4 mg qd-bid. Taking benztropine with meals can reduce side effects.

NAMI drug fact sheet

Contraindications: Do not use in children ages 3 and younger
Serious Side Effects: Angle-closure glaucoma, heat stroke, especially in elderly patients, tachycardia, cardiac arrhythmias, hypotension; can exacerbate or unmask tardive dyskinesia
Side Effects: anticholinergic side effects, erectile dysfunction, confusion
1° MOA: Centrally-acting antimuscarinic agent; reinstates balance of dopaminergic to cholinergic activity in the nigrostriatal pathway (as dopaminergic activity ↓ d/t D2-blockade, the anti-ACh aims to likewise ↓ cholineric activity and restore the DA/ACh ratio)
2° MOA: Inhibit the reuptake and storage of dopamine at central dopamine receptors, prolonging dopamine action
Target: M1, H1, DAT
t½: 24° TMAX: 1-2°
Substrate of: Renally cleared
Inhibits: ∅ ; Induces:
Active Metabolites:
  • - amantadine may amplify such adverse anticholinergic effects as confusion and hallucinations
  • - caution with co-prescribed CNS depressants which can ↑ sedative effects
  • - First-line agent for extrapyramidal disorders related to antipsychotic use
  • - Patients with cognitive impairment may do poorly; can cause cognitive side effects with chronic use, so periodic trials of discontinuation may be useful to justify continuous use
  • - Commonly used in an oral or intramuscular formulation as needed with concomitant antipsychotics to reduce or prevent EPS
Special Populations

Category C—Limited Human Data—probably Compatible. One surveillance study found a possible association between benztropine and cardiovascular defects, but confirmation is required. Exposure near term has been associated with paralytic ileus in the newborn.

No reports describing the use of benztropine during human lactation have been located. In general, however, agents in this class are probably compatible with breast feeding.

Elderly patients may be more susceptible to side effects (especially sedation)

2019 BEE℞S Recommendation: Avoid. Not recommended for prevention or treatment of extrapyramidal symptoms with antipsychotics; more effective agents available for treatment of Parkinson disease.

No known effects, but use with caution

No known effects, but use with caution


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Last updated February 29 2024 20:54:18. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.