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Benztropine is classified as a synthetic muscarinic receptor antagonist, also known as an anticholinergic drug, and shares a structural resemblance with diphenhydramine and atropine. Benztropine is approved by the US Food and Drug Administration (FDA) as an adjunctive therapy for various forms of parkinsonism, including idiopathic and postencephalitic parkinsonism. This medication extends its therapeutic application beyond Parkinson disease, effectively addressing drug-induced extrapyramidal symptoms and playing a crucial role in preventing and treating acute dystonic reactions. Due to its prolonged duration of action, benztropine requires less frequent dosing than diphenhydramine. Benztropine exerts its action in the central nervous system (CNS) and smooth muscles by competing with acetylcholine at muscarinic receptors. Consequently, it reduces central cholinergic effects by blocking muscarinic receptors, which appears to alleviate the symptoms of Parkinson disease. With a lower level of CNS stimulation than trihexyphenidyl, benztropine is the preferred drug for geriatric patients. This activity reviews the indications, mechanism of action, administration, contraindications, and adverse effects of benztropine in managing Parkinson disease. This activity is tailored to provide interprofessional healthcare team members with the knowledge necessary for making well-informed decisions regarding the use of benztropine in diverse clinical scenarios. Objectives: Identify the approved indications for benztropine, recognizing its role as an adjunctive therapy in various forms of parkinsonism, including idiopathic and postencephalitic parkinsonism. Implement proper dosing strategies for benztropine, considering its prolonged duration of action and adjusting dosages according to individual patient needs. Assess patients for potential adverse effects and drug interactions associated with benztropine, emphasizing a comprehensive understanding of its impact on the central nervous system. Collaborate with interprofessional healthcare teams to enhance patient outcomes through coordinated efforts in managing Parkinson disease and associated conditions with benztropine. Access free multiple choice questions on this topic.

Signs and Symptoms of Overdose Benztropine has been in use for over 50 years, and no reported incidents of liver injury exist due to the drug. The absence of liver injury is typical of anticholinergic agents and may also relate to the low therapeutic dose. However, benztropine overdose can cause an anticholinergic toxidrome, which, in its role, may require supportive care. The risk assessment for benztropine overdose can take place as soon as 6 hours after ingestion, and toxicity effects may vary between 12 hours and 5 days.[30] The most crucial step of proper detection of benztropine overdose involves conducting thorough investigations. It is recommended to obtain a 12-lead electrocardiogram (ECG). Monitoring the drug concentrations and blood glucose concentrations can become valuable for toxicity investigations if the toxicant is unknown. Patients who do not exhibit specific toxicity symptoms may need additional investigations, such as a lumbar puncture or brain CT scan. Management of Overdose Physostigmine is the antidote for benztropine toxicity in the event delirium is not controlled through benzodiazepines. It can be used for toxicity diagnosis if the patient regains a normal state after administration. However, caution should be practiced in determining its proper dose and route of administration since it can cause a cholinergic crisis that endangers the patient's life.[31] Decontaminating benztropine toxicity in cooperative and alert patients occurs by administering 50 g of activated charcoal during the first 2 hours of benztropine ingestion. Proper supportive care includes controlling delirium through IV administration of benzodiazepines such as diazepam. Also, catheter and bladder scans can help in case of urinary retention.[32]

The effective management of benztropine dosage and administration methods necessitates collaboration among interprofessional healthcare teams. The coordinated efforts of healthcare team members, including clinicians, neurologists, pharmacists, and nurses, can markedly enhance patient outcomes and contribute to successfully managing symptoms requiring benztropine therapy. Prescribers should start benztropine at a lower dosage and taper on gradually, especially in the geriatric population and patients with mental or behavioral issues. Neurologists should be consulted for advanced cases. Nurses should monitor patients for therapeutic success and any adverse events. When benztropine overdose is suspected, ICU nursing staff should monitor patients until the resolution of toxicity symptoms. The pharmacist can verify the appropriate dosing for the patient and review the patient's medication profile to find potential drug interactions. The ultimate objective is empowering healthcare professionals to deliver precise, patient-centered care, significantly improving management outcomes.