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|Benztropine Mesylate

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Benztropine Mesylate

Pronouncation: (BENZ-troe-peen MEH-sih-LATE)
Class: Anticholinergic

Trade Names:
Cogentin
- Tablets 0.5 mg
- Tablets 1 mg
- Tablets 2 mg
- Injection 1 mg/mL

Apo-Benztropine (Canada)
Benztropine Omega (Canada)

Mechanism of Action

Pharmacology

Thought to act by competitively antagonizing acetylcholine receptors in corpus striatum to restore neuromuscular balance.

Indications and Usage

Treatment of all forms of parkinsonism; control of extrapyramidal disorders (except tardive dyskinesia) caused by neuroleptic drugs.

Contraindications

Angle-closure glaucoma; myasthenia gravis; pyloric or duodenal obstruction; stenosing peptic ulcer; prostatic hypertrophy or bladder neck obstructions; megacolon; tardive dyskinesia; children under 3 yr of age.

Dosage and Administration

Parkinsonism
Adults

PO 1 to 2 mg/day; range, 0.5 to 6 mg. Individualize dosage.

Idiopathic Parkinsonism
Adults

PO Initially 0.5 to 1 mg at bedtime; 4 to 6 mg/day may be required.

Postencephalitic Parkinsonism
Adults

PO 2 mg/day in 1 or more doses; some patients may require initial dose of 0.5 mg.

Drug-Induced Extrapyramidal Disorders
Adults

1 to 4 mg every day or twice daily.

Acute Dystonic Reactions
Adults

PO/IM/IV Initial dose is IM/IV 1 to 2 mg; then PO 1 to 2 mg twice daily.

Storage/Stability

Store in a dry place in tightly closed, light-resistant container.

Drug Interactions

Amantadine

May increase anticholinergic effects.

Digoxin

May increase digoxin serum levels, especially with slow-dissolution oral digoxin tablets.

Haloperidol

May worsen schizophrenic symptoms; may decrease haloperidol serum levels; tardive dyskinesia may develop.

Phenothiazines

May decrease action of phenothiazines. May increase incidence of anticholinergic effects.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Tachycardia; bradycardia.

CNS

Toxic psychosis including confusion, disorientation, memory impairment, visual hallucinations; exacerbation of pre-existing psychosis; nervousness; depression; finger numbness.

Dermatologic

Skin rash.

EENT

Blurred vision; dilated pupils; narrow-angle glaucoma.

GI

Paralytic ileus; constipation; nausea; vomiting; dry mouth.

Genitourinary

Urinary retention; dysuria.

Miscellaneous

Heat stroke; hyperthermia; fever; weakness; inability to move particular muscle groups.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established

Elderly

Patients above 60 yr of age may have increased side effects; dosage reduction and observation may be needed.

Special Risk Patients

Use with caution in patients with glaucoma, prostatic hypertrophy, epilepsy, cardiac arrhythmias, hypertension, hypotension, tendency toward urinary retention, liver or kidney disorders, obstructive disease of GI or GU tract, tachycardia or those who are taking other drugs with anticholinergic activity.

Heat illness

Fatal hyperthermia has occurred. Use with caution during hot weather.

Ophthalmic

Narrow-angle glaucoma may occur.

Tardive dyskinesia

May aggravate tardive dyskinesia.

Overdosage

Symptoms

Circulatory collapse, cardiac arrest, respiratory depression, CNS depression or stimulation, shock, coma, stupor, seizures, convulsions, ataxia, anxiety, incoherence, hyperactivity, foul-smelling breath, decreased bowel sounds, dilated and sluggish pupils.

Patient Information

Explain that full effectiveness of drug may not occur for 2 to 3 days after initiation of drug therapy. Explain that doses will be tapered gradually before stopping.
Advise patient that increasing fluid intake will help decrease dry mouth and constipation.
Instruct patient to take sips of water frequently, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs.
Warn patient to pay particular attention to dental hygiene because of problems associated with decreased salivation.
Tell patient that stool softeners may be used if constipation occurs.
Warn patient to drink plenty of fluids and take precautions against hyperthermia in hot weather.
Tell patient that vision may be blurry during the first 2 to 3 wk of treatment.
Advise patient that wearing sunglasses outdoors will help to minimize photophobia.
Instruct patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
Advise patient to avoid intake of alcoholic beverages or other CNS depressants.
Instruct patient to obtain periodic eye examinations during long-term treatment to monitor for glaucoma.

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