Urquhart and her colleagues performed a double-blinded, randomized, controlled trial of 118 patients with chronic LBP who received either low-dose amitriptyline (25 mg per day) or an active comparator (benztropine
mesylate, 1 mg per day) for 6 months.
She was prescribed the following medications prior to the presentation to the state psychiatric hospital: diazepam up to 20 mg/day as needed, clomipramine 50 mg/day, haloperidol 20 mg/day, benztropine
4 mg/day, and divalproex sodium 750 mg/day.
Clozapine was stopped and her benztropine
and lithium were initially continued as she had been on these for many years.
Medications for PD include levodopa, a precursor of DA; DA receptor agonist like bromocriptine and ropinirole which can act on the dopamine receptors in the CNS; and anticholinergic drugs such as benztropine
which acts to give symptomatic relief to tremors and muscle stiffness .
It can also develop in PD patients following treatment with anticholinergic drugs, such as benzhexol and benztropine
. More than 80% of PD patients with cognitive impairment develop dementia over a long-term disease duration .
He received diphenhydramine and benztropine
from the Emergency Department physicians without relief.
EPSEs are caused by an imbalance between acetylcholine and dopamine in the brain and are usually treated by administering an anticholinergic agent, such as benztropine
(Cogentin[R]) or diphenhydramine (Benadryl[R]); this may be administered intramuscularly in emergent situations or orally in patients who are known to be susceptible (Keltner & Steele, 2015).
Her other medications included risperidone (an antipsychotic), benztropine
(an anticholinergic), and bupropion (an antidepressant).
Patients who do not respond to the dopaminergic are to be tried with anticholinergic agents like Trihexyphenidyl and Benztropine
. (5) Trihexyphenidyl is started with lmg 2 times a day and later 0.5mg twice daily.
Other anticholinergic treatments such as ipratropium bromide spray, transdermal scopolamine, and benztropine
have also been investigated for treating drooling/dysphagia [123, 176-178].
Drug Mechanism of action L-DOPA DA precursor L-DOPA + benserazide or carbidopa DA precursor + peripheral dopa- decarboxylase inhibitor Bromocriptine, pergolide, DA receptor agonists pramipexole, ropinirole Selegiline, rasagiline Monoamine oxidase B inhibitors Increase of DA release and Amantadine glutamate NMDA receptor antagonist Trihexyphenidyl, benztropine
Muscarinic receptor antagonists Catechol-O- Entacapone, tolcapone methyltransferase inhibitors Adapted from .
At that time, he was given two doses of benztropine
intramuscularly, and transferred to our hospital for further evaluation.