Can Ingrezza (valbenazine) be taken with Cogentin (benztropine)?

Concomitant Use of Ingrezza (Valbenazine) with Cogentin (Benztropine)

Ingrezza (valbenazine) can be safely taken with Cogentin (benztropine), as there are no documented significant drug interactions between these medications.

Medication Overview

Ingrezza (Valbenazine)

• FDA-approved treatment specifically for tardive dyskinesia 1, 2
• Selective vesicular monoamine transporter 2 (VMAT2) inhibitor 3
• First medication approved specifically for tardive dyskinesia 4
• Typically dosed at 40-80 mg once daily 3

Cogentin (Benztropine)

• Anticholinergic medication used to treat extrapyramidal symptoms
• Often used to manage side effects of antipsychotic medications 5
• Guidelines specifically recommend avoiding benztropine with typical antipsychotics when extrapyramidal symptoms occur 5

Drug Interaction Analysis

There are no documented significant pharmacokinetic or pharmacodynamic interactions between valbenazine and benztropine in the available evidence. The medications work through different mechanisms:

• Valbenazine works by inhibiting VMAT2, which regulates monoamine storage and release
• Benztropine works through anticholinergic mechanisms

Clinical Considerations

Potential Benefits

• Benztropine has shown efficacy as an adjunctive treatment for managing Parkinson-like symptoms 6
• The combination may be beneficial in patients who have both tardive dyskinesia (treated with valbenazine) and other extrapyramidal symptoms (treated with benztropine)

Precautions

1. Anticholinergic Burden:

   • Monitor for cumulative anticholinergic effects (dry mouth, constipation, urinary retention, blurred vision)
   • Particularly important in elderly patients who may be more sensitive to these effects

2. Sedation Risk:

   • Both medications may cause sedation in some patients
   • Assess for additive sedative effects, especially when initiating therapy

3. Cognitive Effects:

   • Benztropine may cause confusion, especially in older adults 7
   • Monitor cognitive function when using these medications together

Monitoring Recommendations

When using Ingrezza with Cogentin:

• Monitor for efficacy in controlling both tardive dyskinesia and other extrapyramidal symptoms
• Assess for potential anticholinergic side effects
• Evaluate cognitive function, particularly in elderly patients
• Consider periodic reassessment of the need for continued benztropine therapy

Conclusion

Based on the available evidence, there is no contraindication to using Ingrezza (valbenazine) and Cogentin (benztropine) concurrently. While guidelines specifically advise against using benztropine with typical antipsychotics 5, this caution does not extend to VMAT2 inhibitors like valbenazine. The combination may be particularly useful in patients who have both tardive dyskinesia and other extrapyramidal symptoms requiring different pharmacological approaches.