benztropine mesylate

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benztropine mesylate

Apo-Benztropine (CA), Cogentin, PMS Benztropine (CA)

Pharmacologic class: Anticholinergic

Therapeutic class: Antiparkinsonian

Pregnancy risk category C


Inhibits cholinergic excitatory pathways and restores balance of dopamine and acetylcholine in CNS, thereby decreasing excess salivation, rigidity, and tremors (parkinsonian symptoms)


Injection: 1 mg/ml in 2-ml ampules

Tablets: 0.5 mg, 1 mg, 2 mg

Indications and dosages


Adults: Initially, 1 to 2 mg/day P.O. or I.M. at bedtime or in two or four divided doses. Dosage range is 0.5 to 6 mg/day.

Acute dystonic reactions

Adults: Initially, 1 to 2 mg I.M. or I.V., then 1 to 2 mg P.O. b.i.d.

Drug-induced extrapyramidal reactions (except tardive dyskinesia)

Adults: 1 to 4 mg P.O. or I.M. once or twice daily

Dosage adjustment

• Elderly patients

Off-label uses

• Excessive salivation


• Hypersensitivity to drug

• Angle-closure glaucoma

• Tardive dyskinesia

• Children younger than age 3


Use cautiously in:

• seizure disorders, arrhythmias, tachycardia, hypertension, hypotension, hepatic or renal dysfunction, alcoholism, prostatic hypertrophy

• elderly patients

• pregnant or breastfeeding patients.


• Give after meals to prevent GI upset.

• Crush tablets if patient has difficulty swallowing them.

• Know that I.V. route is seldom used.

• Be aware that entire dose may be given at bedtime. (Drug has long duration of action.)

Adverse reactions

CNS: confusion, depression, dizziness, hallucinations, headache, weakness, memory impairment, nervousness, delusions, euphoria, paresthesia, sensation of heaviness in limbs, toxic psychosis

CV: hypotension, palpitations, tachycardia, arrhythmias

EENT: blurred vision, diplopia, mydriasis, angle-closure glaucoma

GI: nausea, constipation, dry mouth, ileus

GU: urinary hesitancy or retention, dysuria, difficulty maintaining erection

Musculoskeletal: paratonia, muscle weakness and cramps

Skin: rash, urticaria, decreased sweating, dermatoses


Drug-drug. Antacids, antidiarrheals: decreased benztropine absorption

Antihistamines, bethanechol, disopyramide, phenothiazines, quinidine, tricyclic antidepressants: additive anticholinergic effects

Drug-herbs. Angel's trumpet, jimsonweed, scopolia: increased anticholinergic effects

Drug-behaviors. Alcohol use: increased sedation

Patient monitoring

• Monitor blood pressure closely, especially in elderly patients.

• Monitor fluid intake and output; check for urinary retention.

• Assess for signs and symptoms of ileus, including constipation and abdominal distention.

Patient teaching

• Advise patient to use caution during activities that require physical or mental alertness, because drug causes sedation.

• Tell patient to avoid increased heat exposure.

Caution patient not to stop therapy abruptly.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

benztropine mesylate

An antiparasympathomimetic agent usually used with other drugs in treating parkinsonism.
Medical Dictionary, © 2009 Farlex and Partners
References in periodicals archive ?
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.
At 3-month follow-up, patients in the low-dose amitriptyline group reported less disability, compared with the benztropine mesylate group (adjusted difference, -1.62; 95% confidence interval, -2.88 to -0.36).
It was reported yesterday that Fresenius Kabi USA, a business-focused on infusion therapy and clinical nutrition in Europe and in its most important countries of Latin America and Asia Pacific, is recalling four lots of benztropine mesylate injection, USP two mg/two mL (1mg/mL), in two mL single dose vials.
Both dystonia and akathisia are reversible when antipsychotic medication is lowered or stopped, and both can be treated with anticholinergic medications such as benztropine mesylate (Cogentin) and trihexyphenidyl (Artane).
However, anticholinergic medications, such as trihexyphenidyl (Artane) and benztropine mesylate (Cogentin), which are useful for treating muscle stiffness, may worsen the symptoms of TD.