Benztropine (Cogentin) is an anticholinergic drug with antihistamine-like properties.

Benztropine Uses:

• It is used to treat neuroleptic-induced extrapyramidal symptoms except for tardive dyskinesia.
• It is also used as an adjunctive treatment in patients with Parkinsonism.

Benztropine (Cogentin) Dose in Adults:

Benztropine use in the treatment of drug-induced extrapyramidal symptoms:

• 1 to 2 mg two or three times a day
• The dose may be titrated gradually at 0.5 mg increments at 5 - 6-day intervals based on the patients' response and tolerability.
• Improvement in the symptoms is generally noted in a day or two.
• The usual dose is 1 - 4 mg once or twice daily up to a maximum dose of 6 mg daily.
• The treatment may be continued for a week or two after which the treatment may be withdrawn to assess the need to continue the treatment.

Benztropine dose in Acute dystonic reactions:

• 1 to 2 mg is given to treat the acute reactions followed by 1 - 2 mg orally once or twice daily for up to 7 - 28 days to prevent a recurrence.

Benztropine (Cogentin) use in the treatment of Parkinsonism:

• Idiopathic parkinsonism:

  • 0.5 - 1 mg/day as a single daily dose at bedtime or in 2 - 4 divided doses.
  • The dose may be titrated in 0.5 mg increments every 5 - 6 days based on the patients' response and tolerability.
  • The usual dose is 1 to 2 mg/day ranging from 0.5 - 6 mg/day.
  • The maximum dose is 6 mg/day.

• Postencephalitic parkinsonism:

  • 2 mg/day initially as a single dose at bedtime or in 2 - 4 divided doses.
  • A lower initial dose may be given to patients who may develop anticholinergic side effects.
  • The dose may be titrated in 0.5 mg increments every 5 - 6 days based on the patients' response and tolerability.
  • The usual dose is 1 to 2 mg/day ranging from 0.5 - 6 mg/day.
  • The maximum dose is 6 mg/day.

Benztropine (Cogentin) Dose in Children:  

Benztropine dose in the treatment of Drug-induced extra-pyramidal symptoms (EPS):

Note: It should be preferably administered orally or IM. Prophylactic use should be avoided. It may only be used for life-threatening emergencies in children less than 3 years of age.

• Children older than 3 years and Adolescents:

  • 0.02 to 0.05 mg/kg/dose once or twice daily.
  • The usual adult dose range is 1 to 4 mg/dose

Pregnancy Risk Category: C

• It has not yet been tested in pregnant women.

Use while breastfeeding

• Breastmilk production may be affected by anticholinergic drugs.
• However, it is unknown if the drug can be absorbed into breastmilk.

Benztropine dose in Kidney disease:

• No dose adjustments have been recommended by the manufacturer in a patient with kidney disease.

Benztropine Dose in Liver Disease:

• No dose adjustments have been recommended by manufacturer in patient with liver disease.

Side Effects of Benztropine (Cogentin):

• Cardiovascular:

  • Tachycardia

• Central nervous system:

  • Confusion
  • Depression
  • Disorientation
  • Heatstroke
  • Hyperthermia
  • Lethargy
  • Memory impairment
  • Nervousness
  • Numbness Of Fingers
  • Psychotic Symptoms (exacerbation Of pre-existing symptoms)
  • Toxic Psychosis
  • Visual Hallucination

• Dermatologic:

  • Skin Rash

• Gastrointestinal:

  • Constipation
  • Nausea
  • Paralytic Ileus
  • Vomiting
  • Xerostomia

• Genitourinary:

  • Dysuria
  • Urinary Retention

• Ophthalmic:

  • Blurred Vision
  • Mydriasis

Contraindication to Benzatropine (Cogentin):

• Allergy reactions to benztropine mesylate and any component of the formulation
• Children younger than 3 years old

Warnings and precautions

• Hyperthermia and anhidrosis:

  • It can cause anhidrosis and hyperthermia. 
  • These issues are particularly problematic during hot weather or exercise.
  • Hyperthermia is a serious condition that can be fatal to anyone, including alcoholics, the elderly, people who work outdoors and people with central nervous system disorders.

• Anticholinergic effects

  • It can cause anticholinergic side effects such as constipation, xerostomia and blurred vision.

• CNS effects

  • It can cause confusion, visual hallucinations, or excitement in the CNS.
  • These symptoms are more common when taken in large doses.
  • CNS depression can also be caused by it. Patients who are required to use heavy machinery or perform other activities that require mental alertness should not take it.

• Weakness

  • If taken in large amounts, it can cause weakness of the limbs.

• Cardiovascular disease

  • Avoid patients suffering from tachyarrhythmias.

• Obstructive GI:

  • Patients at high risk for gastrointestinal obstruction, such as those suffering from pyloric stasis, should not use it.

• Glaucoma

  • It can lead to acute angle-closure vision loss.
  • Patients with glaucoma should use it with caution.

• Prostatic hyperplasia, urinary stricture

  • It can cause urinary retention so patients with prostatic enlargement or urinary stricture should not use it.

Monitoring Parameters:

• Pulse,
• Observe for anticholinergic effects

How to administer Benzatropine (Cogentin)?

• You can take the oral tablet with or without food.
• You can also administer it intramuscularly, or intravenously. 
• Because there are no differences in the onset time between the IV and IM routes, the manufacturer recommends intramuscular administration.

Mechanism of action of Benztropine (Cogentin):

• Benztropine is anticholinergic as well as antihistaminic. 
• The anticholinergic effects of benztropine are about half that of atropine.
• The onset of action after an IV or IM injection takes only a few minutes, while it takes approximately one hour to occur after oral administration.
• It takes approximately 7 hours to reach the peak serum concentration following oral intake. It is metabolized in the liver.

Benztropine Brand Names (International):

• Benztropine Omega
• PDP-Benztropine
• PMS-Benztropine
• Bencogen
• Bentrop
• Benzogrand
• Cogentin
• Cogetropine Mesylate
• Cogintol

Benztropine Brand Names in Pakistan:

No Brands available in Pakistan