From the Guidelines
Benztropine should be avoided in the treatment of extrapyramidal symptoms caused by antipsychotic medications, especially in elderly patients, due to its potential to cause significant side effects and interact with other medications. According to the guidelines for managing Alzheimer's disease, typical antipsychotic agents, which often require the use of benztropine to manage extrapyramidal symptoms, should be avoided if possible due to their association with significant side effects involving the cholinergic, cardiovascular, and extrapyramidal systems 1. The use of benztropine is specifically cautioned against in patients taking haloperidol, fluphenazine, or thiothixene, as it may exacerbate side effects 1.
Key Considerations
- Benztropine is an anticholinergic medication that can cause dry mouth, blurred vision, constipation, urinary retention, and confusion, particularly in elderly patients.
- It should be used cautiously in patients with glaucoma, prostatic hypertrophy, or cognitive impairment.
- The medication can interact with other anticholinergic agents, increasing the risk of adverse effects.
- Atypical antipsychotic agents, such as risperidone, olanzapine, and quetiapine, are preferred over typical antipsychotic agents due to their lower risk of extrapyramidal symptoms and tardive dyskinesia 1.
Alternative Treatments
- Atypical antipsychotic agents, such as risperidone, olanzapine, and quetiapine, are recommended for the control of problematic delusions, hallucinations, severe psychomotor agitation, and combativeness 1.
- Mood-stabilizing drugs, such as trazodone, carbamazepine, and divalproex sodium, may be useful alternatives to antipsychotic agents for controlling severe agitated, repetitive, and combative behaviors 1.
From the FDA Drug Label
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). The primary use of Benztropine is as an adjunct in the therapy of parkinsonism and in the control of extrapyramidal disorders due to neuroleptic drugs.
- Key Indications:
- All forms of parkinsonism
- Extrapyramidal disorders due to neuroleptic drugs (except tardive dyskinesia) 2
From the Research
Benztropine Overview
- Benztropine is an anticholinergic drug used in the treatment of Parkinson's disease and neuroleptic-induced parkinsonism 3, 4.
- It is rapidly absorbed after oral administration and has a variable oral bioavailability ranging from 30% to over 70% 3.
- Benztropine is extensively metabolized and excreted via the urine and bile, with a large volume of distribution in humans and animals 3.
Clinical Use
- Benztropine is used to control tremor and drooling in patients with Parkinson's disease, often in combination with levodopa 5.
- It is also used to treat neuroleptic-induced parkinsonism, although it may not be the first choice due to its potential to cause tardive dyskinesia and other side effects 4.
- In some cases, benztropine may be used to treat drug-induced parkinsonism, but its use is not recommended if the patient has tardive dyskinesia, as it can worsen the condition 6.
Side Effects and Interactions
- Benztropine can cause peripheral side effects, such as dry mouth, constipation, and urinary retention, as well as central side effects like anxiety and depression 4.
- It can also increase the risk of tardive dyskinesia, particularly when used to treat neuroleptic-induced parkinsonism 4.
- Elderly patients may tolerate benztropine less well than younger patients, and there is a lack of pharmacokinetic information for this population 3.