From the Guidelines
Cogentin (benztropine) is primarily used to treat symptoms of Parkinson's disease and to manage drug-induced extrapyramidal symptoms, particularly those caused by antipsychotic medications. It works by blocking the action of acetylcholine in the central nervous system, which helps restore balance to neurotransmitters in the brain. The typical starting dose for adults is 0.5 to 1 mg daily, which may be gradually increased to 4-6 mg daily if needed, divided into multiple doses. For acute drug-induced reactions, 1-2 mg may be given intramuscularly or intravenously. Common side effects include dry mouth, blurred vision, constipation, and urinary retention due to its anticholinergic properties.
According to a study published in 2012 1, Cogentin (benztropine) has anticholinergic side effects, which can delay the usual elimination of enterotoxin by C. perfringens–induced diarrhea, causing longer exposure to the toxin. This can lead to severe intestinal damage and death, particularly in patients with impaired gastrointestinal motility.
Key points to consider when using Cogentin include:
- Use with caution in elderly patients and those with certain conditions like glaucoma, prostatic hypertrophy, or cardiovascular disease
- Monitor for common side effects such as dry mouth, blurred vision, constipation, and urinary retention
- Avoid sudden stoppage of the medication, as this could worsen the underlying condition
- Be aware of the potential for severe outcomes from C. perfringens intoxication, particularly in patients with constipation or impaired intestinal motility.
It's essential to take this medication exactly as prescribed and to follow the guidance of a healthcare professional to minimize the risk of adverse effects.
From the FDA Drug Label
INDICATIONS AND USAGE Benztropine mesylate tablets, USP are indicated for use as an adjunct in the therapy of all forms of parkinsonism. Useful also in the control of extrapyramidal disorders (except tardive dyskinesia - see PRECAUTIONS) due to neuroleptic drugs (e.g., phenothiazines).
Cogentin (benztropine) is used for:
- Parkinsonism: as an adjunct in the therapy of all forms of parkinsonism
- Extrapyramidal disorders: control of disorders due to neuroleptic drugs (e.g., phenothiazines), except for tardive dyskinesia 2
From the Research
Overview of Cogentin
- Cogentin, also known as benztropine, is an anticholinergic drug used in the treatment of Parkinson's disease 3, 4.
- It is often used in combination with other medications, such as levodopa-carbidopa (Sinemet), to enhance their effectiveness 4.
Uses of Cogentin
- Cogentin is used to treat symptoms of Parkinson's disease, including rigidity, tremors, and difficulty with movement 4.
- It has been shown to improve motor function and activities of daily living in patients with Parkinson's disease when used in combination with Sinemet 4.
- Cogentin may also be used to treat other conditions, such as drug-induced parkinsonism, although its use for this purpose is not as well established as other treatments like amantadine 5.
Pharmacokinetics of Cogentin
- Cogentin is rapidly absorbed after oral administration and has a variable oral bioavailability ranging from 30% to over 70% 3.
- It is extensively metabolized and excreted in the urine and bile, with a large volume of distribution in humans and animals 3.
- The pharmacokinetics of Cogentin in the elderly are not well understood, which may be a hindrance to its safe and effective use in this population 3.