BenztropineBenztropine Mesylate

About Benztropine

Benztropine has both anticholinergic and antihistamine effects. The label covers its use as an add-on in all forms of parkinsonism and for movement disorders (extrapyramidal disorders) caused by antipsychotic drugs, except tardive dyskinesia. For Parkinson’s symptoms the usual dose is 1 to 2 mg a day, within a range of 0.5 to 6 mg; for drug-induced movement problems it is 1 to 4 mg once or twice a day. Because its action is cumulative, it starts low and rises by 0.5 mg no faster than every five or six days, to at most 6 mg a day, and older and thin people may not tolerate large doses. When movement effects appear soon after an antipsychotic is started, the label calls for stopping benztropine after one or two weeks to see whether it is still needed. The injection, 1 mg per mL, is given into a muscle or a vein for emergencies and acute dystonic reactions, where 1 to 2 mL usually brings quick relief.

Benztropine has no boxed warning. Its main danger is heat: it can reduce sweating, and severe loss of sweating and fatal overheating have occurred, so it is used with caution in hot weather, especially by people who are chronically ill, drink heavily, have a disease of the brain or nerves, or do manual work in a hot environment. Taken with phenothiazines, haloperidol or tricyclic antidepressants, it has been linked to bowel paralysis, overheating and heat stroke, sometimes fatal. Large doses or sensitive people can bring on confusion, excitement or psychosis; it probably should not be used in angle-closure glaucoma, can cause urinary retention, needs close watching with a fast heart rate or an enlarged prostate, and does not help tardive dyskinesia, which it may make worse. It must not be used in children under 3 and is used with caution in older children. MedlinePlus lists dry mouth, constipation, nausea, vomiting, loss of appetite and painful urination among the common side effects.

The FDA lists Cogentin tablets and Cogentin injection as discontinued, and it determined they were not withdrawn for safety or effectiveness reasons. When benztropine is added for Parkinson’s disease, other antiparkinson medicines are not stopped abruptly, but reduced gradually if needed, and it can be taken with levodopa or carbidopa-levodopa, with periodic dose adjustments. It can impair driving and other hazardous tasks, MedlinePlus advises that adults 65 and older usually should not take it, and safe use in pregnancy has not been established.

Taking Benztropine

How to take it

Usually once a day, often at bedtime, though some people do better with divided doses; take it exactly as prescribed. Avoid overheating, and do not drive until you know how it affects you. Do not stop it suddenly without talking to the prescriber.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose.

Storage

At room temperature in the original container, tightly closed, away from heat and moisture, out of reach of children. Use a take-back program rather than flushing it.

Interactions to know about

With phenothiazine antipsychotics, haloperidol or tricyclic antidepressants, bowel paralysis, overheating and heat stroke have occurred, so report stomach or bowel problems, fever or heat intolerance promptly. Alcohol adds to drowsiness. Doses may need periodic adjustment alongside levodopa or carbidopa-levodopa.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Benztropine differs from pharmacy to pharmacy

Benztropine tablets are an old generic made by many companies, so they cost pharmacies little and a cash quote is mostly the dispensing fee and markup. That is why quotes for the same tablets can differ widely between pharmacies, and why a small fill is priced mostly on the fee. A dose taken two or three times a day, or written as several small tablets, raises the count.

Ways to pay less for Benztropine without insurance

• Ask whether benztropine is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Ask the prescriber to write the dose in the fewest tablets, such as one 2 mg tablet rather than four 0.5 mg tablets.
• Once your dose is settled, ask for a ninety-day supply; it is not a controlled substance.
• If it was started for movement side effects of an antipsychotic, ask the prescriber whether you still need it, since the label suggests checking after one or two weeks.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Benztropine

1. 1.How do I stay safe in hot weather or when I work or exercise in the heat?
2. 2.Do I still need it, and when should my prescriber review that?
3. 3.Is it safe with my antipsychotic, antidepressant or allergy medicines?
4. 4.Which eye, bladder or confusion symptoms mean I should call?

Related medications