BENZTROPINE MESYLATE
(benz'troe-peen)
Apo-Benztropine  , Bensylate , Cogentin, PMS Benztropine
Classifications: autonomic nervous system agent; anticholinergic (parasympatholytic); antiparkinsonism agent
Prototype: Levodopa
Pregnancy Category: C
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0.5 mg, 1 mg, 2 mg tablets; 1 mg/mL ampules
Synthetic centrally acting anticholinergic (antimuscarinic) agent. Acts by diminishing excess cholinergic effect associated
with dopamine deficiency.
Suppresses tremor and rigidity; does not alleviate tardive dyskinesia.
Symptomatic treatment of all forms of parkinsonism (arteriosclerotic, idiopathic, postencephalitic) and to relieve extrapyramidal
symptoms associated with neuroleptic drugs, e.g., haloperidol (Haldol), phenothiazines, thiothixene (Navane). Commonly used
as supplement with trihexyphenidyl, carbidopa, or levodopa therapy.
Narrow angle glaucoma; myasthenia gravis; obstructive diseases of GU and GI tracts; tendency to tachycardia; tardive dyskinesia,
children <3 y. Safety during pregnancy (category C) or lactation is not established.
Older children, older adults or debilitated patients, patients with poor mental outlook, mental disorders; enlarged prostate;
hypertension; history of renal or hepatic disease.
Parkinsonism
Adult: PO 0.5–1 mg/d, may gradually increase as needed up to 6 mg/d
Extrapyramidal Reactions
Adult: PO 1–2 mg b.i.d. IM/IV 1–2 mg as needed
Child: PO/IM/IV
>3 y, 0.02–0.05 mg/kg, 1–2 times/d
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Oral
- Give immediately after meals or with food to prevent gastric irritation. Tablet can be crushed and sprinkled on or mixed with
food.
- Initiate and withdraw drug therapy gradually; effects are cumulative.
- Store in tightly covered, light-resistant container at 15°–30° C (59°–86° F) unless otherwise
directed.
Intravenous
- IV administration to infants and children: Verify correct IV concentration with physician.
PREPARE: Direct: Give undiluted.
ADMINISTER: Direct: Give 1 mg or a fraction thereof over 1 min.
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CNS:
Sedation, drowsiness, dizziness, paresthesias; agitation, irritability, restlessness, nervousness, insomnia, hallucinations, delirium,
mental confusion, toxic psychosis, muscular weakness, ataxia, inability to move certain muscle groups. CV: Palpitation, tachycardia, flushing. Special Senses: Blurred vision, mydriasis, photophobia. GI: Nausea, vomiting, constipation, dry mouth, distention, paralytic ileus. Urogenital: Dysuria.
Drug:
Alcohol,
cns depressants have additive sedation and depressant effects; amantadine,
tricyclic antidepressants, mao inhibitors, phenothiazines, procainamide,
quinidine have additive anticholinergic effects and cause confusion, hallucinations, paralytic ileus.
Onset: 15 min IM/IV; 1 h PO. Duration: 6–10 h.
Assessment & Drug Effects
- Assess therapeutic effectiveness. Clinical improvement may not be evident for 2–3 d after oral drug is started.
- Monitor I&O ratio and pattern. Advise patient to report difficulty in urination or infrequent voiding. Dosage reduction may
be indicated.
- Closely monitor for appearance of S&S of onset of paralytic ileus including intermittent constipation, abdominal pain, diminution
of bowel sounds on auscultation, and distention.
- Monitor for and report muscle weakness or inability to move certain muscle groups. Dosage reduction may be needed.
- Supervise ambulation and use bed side rails as necessary.
- Report immediately S&S of CNS depression or stimulation. These usually require interruption of drug therapy.
Patient & Family Education
- Do not drive or engage in potentially hazardous activities until response to drug is known. Seek help walking as necessary.
- Avoid alcohol and other CNS depressants because they may cause additive drowsiness. Do not take OTC cold, cough, or hay fever
remedies unless approved by physician.
- Sugarless gum, hard candy, and rinsing mouth with tepid water will help dry mouth.
- Avoid doing manual labor or strenuous exercise in hot weather; diminished sweating may require dose adjustments because of
possibility of heat stroke. This condition is most apt to occur in the older adults.
- Do not breast feed while taking this drug without consulting physician.
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Prototype drug