Benztropine (A complete guide)

Benztropine is a medication used to treat movement disorders that occur from unknown causes or from the continuous use of antipsychotics.

These movement disorders are known as dystonia and parkinsonism. Benztropine, however, is not beneficial for tardive dyskinesia.

It is taken by mouth or by injection into a vein or muscle.

Benztropine belongs to a class of medications known as anticholinergic drugs.

Anticholinergics work by reducing the amount of the chemical acetylcholine throughout the body.

Acetylcholine is one of the chemicals responsible for muscle contractions, and thus without unnecessary muscle contractions and movements, people with Parkinson’s disease, for example, may be able to walk better. 

Benztropine is sometimes referred to by its trade name Cogentin.

How should I take benztropine?  

Take this medicine by mouth as guided by your family doctor or specialist, generally 2 to 4 times in 24 hours with food and at bedtime, or as a single dose at bedtime.

Your clinician may start you off at a low dose and raise your dose gradually to find the best dose for you.

The best dosage is chosen based on your medical history, symptoms, age, and response to therapy.

If you are taking benztropine as an oral solution, measure your dose with a measuring spoon or any other accurate measuring device.

Do not use a domestic spoon because it may not deliver the correct dose.Take this medicine as frequently as prescribed by your doctor in order to obtain the greatest benefit from it.

To help you remember to take benztropine, take it at a similar time each day.

You should take this medication at least 60 minutes before taking any antacids containing magnesium, aluminium, or calcium.

Wait at least 1-2 hours between doses of benztropine and certain other  drugs for diarrhea (adsorbent antidiarrheals such as kaolinite, pectin, attapulgite).

Take this medicine at least 2 hours after ketoconazole.

Antacids and some treatments for diarrhea may prevent the full therapeutic potential of benztropine, and this may prevent the complete absorption of benztropine when these products are taken collectively.

If you are taking this medicine for side effects from another treatment, your doctor may guide you to take it on a daily basis or only as desired.

If you are taking this treatment for Parkinson’s disease, your doctor may alternate the dose of your other medicines (such as levodopa).

Follow your doctor’s directions carefully. When this medication is used for a long time, it may not work as well.

Talk with your doctor if this medicine is not working well to relieve your symptoms. 

What is some important information I should know before taking benztropine? 

Although this medication has been proven to be effective for antipsychotic-induced movement disorders and other movement disorders, it does have addictive potential.

This danger may be exacerbated if you have a preexisting substance use disorder (such as misuse of or addiction to drugs/alcohol).

Take this medicine precisely as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.

Do not increase your dose, use it more frequently, or use it for a longer time than given.

Correctly stop the medication when so directed by your doctor. 

Withdrawal effects can happen if the drug is abruptly stopped. Your dose may need to be slowly reduced.

It may take 2-3 days before the advantage of this drug takes effect.

Tell your clinician if your symptoms do not go away or get worse.

Does benztropine interact with other drugs?

If your doctor has prescribed you this medicine, he or she should be aware of other medications you are taking to avoid adverse interactions.

Do not switch, stop, or change the dosage of any drug before checking with your doctor, health care worker or pharmacologist first. 

Benztropine has mild interactions with the following drugs:

×       desipramine

×       levodopa

×       trazodone

This information does not cover all possible interactions or adverse effects.

Consequently, before using this drug, tell your doctor or pharmacist of all the medications you are currently taking or have taken in the past.

Keep a list of all your medicines with you, and share this list with your doctor and pharmacist.

Check with your health care specialist or doctor for supplementary medical advice, or if you have health inquiries, concerns or for more information about this medicine.

Who should take benztropine?

Benztropine is used to treat the symptoms of Parkinson’s disease or movement disorders due to the side effects of psychiatric medications (antipsychotics such as chlorpromazine/haloperidol). 

Anticholinergics can reduce muscle spasms of the back, neck, and eyes that are occasionally produced by psychiatric medications.

It can also reduce other side effects such as muscle stiffness/rigidity (extrapyramidal signs-EPS).

It is not effective in treatment movement problems caused by tardive dyskinesia and may even worsen this condition.

Benztropine should not be used by children younger than 3 years.

Dosages of Benztropine

Tablets are usually taken at the following doses:

·       0.5mg

·       1mg

·       2mg

In severe cases, injection is viable. The injectable solution contains

·       1 mg

Dosage Considerations – Should be Given as Follows:

Parkinsonism(Adults):

·      Postencephalitic parkinsonism (people with who have Parkinson’s-like symptoms after swelling of the brain) should take 1-2 mg/day (usually between, 0.5-6 mg/day) orally/intravenously/intramuscularly at bedtime or every 6-12 hours, The dose should not exceed 6 mg/day. 

·      Idiopathic parkinsonism (Parkinson’s disease developed from an unknown cause) patients should take 0.5-1 mg at bedtime. The dose should be titrated in 0.5-mg increments every 5-6 days and should not to exceed 6 mg/day.

Geriatric:

·      0.5 mg orally once everyday or every 12 hours, titrate dose in 0.5-mg increments every 5-6 days, not to surpass 4 mg/day.

Drug-Induced Extrapyramidal Disorders

·      For adults, 1-2 mg of benztropine should be taken intravenously, intramuscularly, orally every 8-12 hours. This should be reevaluated after 1-2 weeks.

·     People with acute dystonia should take 1-2 mg intravenously (IV), then 1-2 mg orally once or twice day–to-day for 7-28 days to stop recurrence of symptoms·      

For children over 3 years, benztropine should be taken 0.02-0.05 mg/kg intravenously, intramuscularly, or orally once daily or every 12 hours.

·      For Children under 3 years it is not recommended.

Dosing considerations, geriatric

·      Non-anticholinergic anti-Parkinson mediators should be used first for treatment of Parkinson disease (Beers criteria)

·      Benztropine is not well-tolerated in geriatric patients because of bowel, bladder, and central nervous system (CNS) effects, and avoid use if possible.

What are the side effects of benztropine?

The following are the side effects of benztropine:

Sleepiness, faintness, constipation, flushing, nausea, vomiting, anxiety, blurry vision, or dry mouth may happen as your body adjusts to the medication.

If any of these side effects do not resolve or become worse, tell your clinician or pharmacist promptly.

To reduce dizziness and light-headedness, get up gradually when transitioning from a sitting or lying down position.

To reduce dry mouth, eat (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or get a saliva substitute.

Recall that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects.

Many people using this medication do not have serious side effects.

Tell your specialist right away if you have any serious side effects, including: high fever, decreased sexual drive or ability, severe stomach/abdominal pain, difficult/painful swallowing, difficulty urinating, weakness.

Get medical assistance right away if you have any very serious side effects, including: chest pain, plain faintness/fainting, fast/irregular/slow heartbeat, mental/mood changes (such as confusion, hallucinations, memory difficulties), eye pain/swelling/soreness, vision abnormalities (such as seeing arches around illuminations at night).

A very serious allergic reaction to this medication is infrequent.

Though, get medical help right away if you notice any indications of a serious allergic reaction, including: rash, itching/bulge (particularly of the face/tongue/throat), severe dizziness, trouble breathing.

This is not an exhaustive list of side effects.

If you notice other side effects not listed above, make an appointment to talk with your doctor or pharmacist.

Individuals with Parkinson’s disease may be at an increased risk for developing skin cancer (melanoma).

If you are using this medication to treat Parkinson’s disease, tell your doctor immediately if you notice any new moles or changes in the appearance or size of existing moles, as well as other uncommon skin aliments.

Notify your clinician that you would like to have consistent skin exams.

Precautions:

Before taking benztropine, inform your doctor or pharmacist if you are sensitive to it or if you have any allergies to medications.

Before taking this medication, tell your doctor or pharmacist all of your medical history, including family history of diseases.

These include any of the following: If you have had diarrhea produced by contamination, heart problems (such as angina, heart attack, heart failure, rapid /irregular heartbeat), high/low blood pressure, intestinal issues (such as chronic constipation, ileus, ulcerative colitis, bowel obstruction), obstruction of the bladder/oesophagus/stomach/bowels, kidney disease, liver disease, cerebral/mood issues (such as nervousness, dementia, psychosis), a certain muscle disease (myasthenia gravis), a certain nerve disease (autonomic neuropathy), seizure, stomach issues(such as acid reflux, hiatal hernia, ulcer), stroke, feverish thyroid (hyperthyroidism), complications urinating (for example, due to distended prostate, neurogenic bladder), personal or family history of a substance use disorder.

What should I do if I miss a dose of benztropine? 

If you miss a dose, take it as soon as you remember.

However, if it is close to the time where you are supposed to take the following dose, skip the missed dose.

Take your next dose at the regular time. Do not double the dose to catch up.

Where and how should I store benztropine?  

Store at room temperature away from bright light and moisture. Do not store in the bathroom.

Keep all medicines away from children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so.

Correctly disposed of this product when it is expired or no longer desirable.

Check the directions for disposal from your pharmacist or local waste disposal company. 

In this article, we discussed how benztropine works, who is prescribed benztropine, and some important information to know before taking this medication. 

Side Note: I have tried and tested various products and services to help with my anxiety and depression. See my top recommendations here, as well as a full list of all products and services our team has tested for various mental health conditions and general wellness.

Frequently asked questions (FAQs) about benztropine: 

Want to learn more about benztropine? Try these recommended readings!

Benztropine Mesylate: Second Edition 

This book has extensive details to answer all your questions regarding benztropine.

If you are wondering about drug interactions, allergies, or how to take this medication you can find that information here.

This guide will help you formulate the right questions to ask your doctor and includes room for notes so you can jot down important information during your appointments.

In addition, if you are a healthcare provider and want to make sure you can answer every question your patient has, then this guide book is for you as well. 

References

Benztropine Mesylate. Web MD. 2020. 
Benztropine. Drugs.com. February 17th, 2020.