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Variable (consult detailed reference): Haloperidol. Use Adjunctive treatment of parkinsonism; also used in treatment of drug-induced extrapyramidal effects (except tardive dyskinesia) and acute dystonic reactions Medication Safety Issues Sound-alike/look-alike issues: Benztropine may be confused with bromocriptine BEERS Criteria medication: This drug may be potentially inappropriate for use in geriatric patients (Parkinson's disease: Quality of evidence - moderate; Strength of recommendation - strong). Adverse Reactions Cardiovascular: Tachycardia Central nervous system: Confusion, depression, disorientation, exacerbation of preexisting psychotic symptoms, fever, listlessness, memory impairment, nervousness, toxic psychosis, visual hallucinations Dermatologic: Rash Endocrine & metabolic: Heat stroke, hyperthermia Gastrointestinal: Constipation, nausea, paralytic ileus, vomiting, xerostomia Genitourinary: Urinary retention, dysuria Neuromuscular & skeletal: Numbness of fingers Ocular: Blurred vision, mydriasis Contraindications Hypersensitivity to benztropine mesylate or any component; children <3 years of age; patients with narrow-angle glaucoma, pyloric or duodenal obstruction, stenosing peptic ulcers; bladder neck obstructions; achalasia; myasthenia gravis Precautions Use with caution in hot weather or during exercise; may cause anhydrosis and hyperthermia; increased risk of hyperthermia in alcoholics, patients with CNS disease, and with prolonged outdoor exposure Metabolism/Transport Effects

Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Risk C: Monitor therapy Acetylcholinesterase Inhibitors (Central): Anticholinergics may diminish the therapeutic effect of Acetylcholinesterase Inhibitors (Central). Acetylcholinesterase Inhibitors (Central) may diminish the therapeutic effect of Anticholinergics. If the anticholinergic action is a side effect of the agent, the result may be beneficial. Risk C: Monitor therapy Aclidinium: May enhance the anticholinergic effect of Anticholinergics. Risk X: Avoid combination Anticholinergics: May enhance the adverse/toxic effect of other Anticholinergics.

Exceptions: Levocabastine (Nasal). Risk C: Monitor therapy Cannabinoids: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoids. Risk C: Monitor therapy Ioflupane I 123: Benztropine may diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergics. Risk X: Avoid combination Mirabegron: Anticholinergic Agents may enhance the therapeutic effect of Mirabegron. This may result in acute urinary retention. Risk C: Monitor therapy OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Risk C: Monitor therapy Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates. Risk C: Monitor therapy Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid combination Pramlintide: May enhance the anticholinergic effect of Anticholinergics. These effects are specific to the GI tract. Risk D: Consider therapy modification RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Risk C: Monitor therapy Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Risk D: Consider therapy modification Tiotropium: Anticholinergics may enhance the anticholinergic effect of Tiotropium. Risk X: Avoid combination Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Specifically, the risk of oligohidrosis and hyperthermia may be enhanced. Risk C: Monitor therapy Pregnancy Implications Animal reproduction studies have not been conducted. Paralytic ileus (which resolved rapidly) was reported in two newborns exposed to a combination of benztropine and chlorpromazine during the second and third trimesters and the last 6 weeks of pregnancy, respectively (Falterman, 1980). Mechanism of Action Thought to partially block striatal cholinergic receptors to help balance cholinergic and dopaminergic activity Pharmacodynamics Onset of action: Oral: Within 1 hour Parenteral: Within 15 minutes Duration: 6-48 hours Patient Information (For additional information see "Benztropine: Patient drug information" )

Mechanism of Action Thought to partially block striatal cholinergic receptors to help balance cholinergic and dopaminergic activity Pharmacodynamics Onset of action: Oral: Within 1 hour Parenteral: Within 15 minutes Duration: 6-48 hours Patient Information (For additional information see "Benztropine: Patient drug information" ) May causes drowsiness and impair ability to perform activities requiring mental alertness or physical coordination; may cause dry mouth. Use of UpToDate is subject to the Subscription and License Agreement . Topic 13024 Version 44.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.4 - C21.36 Licensed to: Southeast Alabama Med Ctr | Support Tag: [0504-125.39.66.147-8E53C3882F-S244013.14]