Names and pronunciation
(benz′troe-peen) Cogentin
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Drug reference
(benz′troe-peen) Cogentin
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Func. class.: Anticholinergic, antipar- kinson agent
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Chem. class.: Tertiary amine
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Do not confuse: benztropine/bromocriptine
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ACTION: Blockade of central acetylcho- line receptors, balances cholinergic activity
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USES: Parkinson’s symptoms, EPS associated with neuroleptic products, acute dystonic reactions
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CONTRAINDICATIONS: Children <3 yr, hypersensitivity, closed-angle glau- coma, dementia, tardive dyskinesia Precautions: Pregnancy, breastfeeding, geriatric patients, tachycardia, renal/ hepatic disease, substance abuse history, dysrhythmias, hypo/hypertension, myasthe- nia gravis, GI/GU obstruction, peptic ulcer, megacolon, prostate hypertrophy, psychosis
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SIDE EFFECTS CNS: Hallucinations, depression, dizzi- ness, memory loss; confusion; delirium (geriatric headache, sedation) CV: Palpitations, tachycardia, hypoten- sion, bradycardia EENT: Blurred vision, photophobia GI: Dry mouth, constipation, nausea GU: Urinary hesitancy/retention INTEG: Rash MISC: Decreased sweating
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INTERACTIONS Increase: anticholinergic effect— antihista- mines, phenothiazines, tricyclics, disopyra- mide, quiNIDine; reduce dose Decrease: absorption—antidiarrheals, antacids Decrease: anticholinergic effect of— cholinergics; monitor response Drug/Herb Increase: anticholinergic action—jim- sonweed, Scopola
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DOSAGE AND ROUTES Drug-induced EPS (not tardive dyskinesia) • Adult: IM/IV/PO 1-4 mg daily/bid; give PO dose as soon as possible • Child >3 yr: IM/IV/PO 0.02-0.05 mg/ kg/dose 1-2×/day Transient EPS • Adult: PO/IM/IV 1-2 mg bid or tid, after ≤2 wk discontinue and see if still re- quired Parkinson’s symptoms • Adult: PO/IM 0.5-1 mg at bedtime; increase by 0.5 mg q5-6days titrated to patient response, max 6 mg/day Acute dystonic reactions • Adult: IM/IV 1-2 mg, may increase to 1-2 mg bid (PO) Postencephalitic parkinsonism • Adult: PO/IM/IV 2 mg/day in 1 dose or divided, max 6 mg/day
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Available forms: Tablets 0.5, 1, 2 mg; injection 1 mg/mL in 2-mL ampule
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Administer: PO route • With or after meals to prevent GI up- set; may give with fluids other than water • At bedtime to avoid daytime drowsi- ness with parkinsonism • Store at room temperature IM route • Inject deeply in muscle; use filtered needle to remove solution from ampule IV, direct route • Use in emergencies, not used often; rate 1 mg/min Y-site compatibilities: Alfentanil, amika- cin, aminophylline, ascorbic acid injec- tion, atracurium, atropine, azaTHIOprine, aztreonam, bumetanide, buprenorphine, butorphanol, calcium chloride, gluconate, ceFAZolin, cefotaxime, cefoTEtan, cefOXi- tin, cefTAZidime, ceftizoxime, cefTRIAX- one, cefuroxime, chlorproMAZINE, cimetidine, clindamycin, cyanocobalamin, cycloSPORINE, dexamethasone, digoxin, diphenhydrAMINE, DOBUTamine, DOPa- mine, doxycycline, enalaprilat, ePHED- rine, epinephrine, epoetin alfa, erythromy- cin lactobionate, esmolol, famotidine, fentaNYL, fluconazole, folic acid (as sodium salt), gentamicin, glycopyrrolate, heparin, hydrocortisone sodium succi- nate, hydrOXYzine, imipenem-cilastatin, inamrinone, insulin (regular), isoproter- enol, ketorolac, labetalol, lactated Ring- er’s, lidocaine, magnesium sulfate, man- nitol, meperidine, metaraminol, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, midazolam, minocycline, morphine, multiple vitamins injection, nafcillin, nalbuphine, naloxone, netilmicin, nitroglycerin, nitroprusside, norepinephrine, ondansetron, oxacillin, oxytocin, papaverine, penicillin G potas- sium/sodium, pentamidine, pentazocine, PHENobarbital, phentolamine, phenyleph- rine, phytonadione, piperacillin, poly- myxin B, potassium chloride, procain- amide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, Ringer’s injection, sodium bicarbonate, succinylcholine, SUFentanil, tacrolimus, theophylline, thia- mine, ticarcillin, ticarcillin-clavulanate, tobramycin, tolazoline, urokinase, vanco- mycin, vasopressin, verapamil
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Assess: • Parkinsonism: EPS, shuffling gait, muscle rigidity, involuntary movements, loss of balance, tardive dyskinesia; may exacerbate symptoms • Monitor vital signs • I&O ratio; commonly causes decreased urinary output; urinary hesitancy, reten- tion; palpate bladder if retention occurs • Constipation: increase fluids, bulk, exer- cise if this occurs, paralytic ileus may occur • Mental status: affect, mood, CNS de- pression, worsening of mental symptoms during early therapy • Use caution during hot weather; prod- uct may increase susceptibility to heat stroke by decreasing sweating • With benztropine “buzz” or “high,” patients may imitate EPS • Hard candy, gum, frequent drinks to relieve dry mouth • Withdrawal symptoms: do not discon- tinue abruptly; taper • Beers: avoid in older adults; high risk of delirium, CNS effects, decreased urinary flow • Pregnancy/breastfeeding: Unknown
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Evaluate: • Therapeutic response: absence of invol- untary movements after 2 days of treatment
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report urinary hesitancy/retention, dysuria B • That tablets may be crushed, mixed with food; may take whole dose at bed- time if approved by prescriber • Not to discontinue product abruptly; to taper off over 1 wk or withdrawal symp- toms may occur (EPS, tremors, insom- nia, tachycardia, restlessness); to take as directed; not to double dose • To avoid driving, other hazardous ac- tivities; drowsiness/dizziness may occur • To avoid OTC medications: cough, cold preparations with alcohol, antihistamines, antacids, antidiarrheals within 2 hr unless directed by prescriber • To change positions slowly to prevent orthostatic hypotension • To use good oral hygiene, frequent sips of water, sugarless gum for dry mouth • To avoid strenuous exercise or activities in hot weather; overheating may occur • That routine exams will be needed • To separate antacids by 2 hr of this product
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PHARMACOKINETICS PO: Onset 1 hr, peak 7 hr, duration 24 hr IM/IV: Onset 15 min, duration 6-10 hr
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• Child >3 yr: IM/IV/PO 0.02-0.05 mg/ kg/dose 1-2×/day Transient EPS
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