Benztropine

COGENTIN

Open Benztropine in the interactive console ↗

What it isCentral muscarinic and H1 antagonist with dopamine-reuptake inhibition; drug-induced parkinsonism and acute dystonia.

Why this oneIt reverses acute dystonic reactions rapidly and more reliably than oral alternatives.

What limits itCognitive and peripheral anticholinergic toxicity make long-term use poor; it does not treat and may worsen tardive dyskinesia.

FDA-approved for

Parkinson/drug-induced EPS (~1954)

FDA label

Read the full label on DailyMed ↗

FDA dosing	Population	Start	Target	Max
Idiopathic parkinsonism	Adults	0.5-1 mg QHS	1-2 mg/day	6 mg/day
Postencephalitic parkinsonism	Adults	2 mg/day in 1+ doses	1-2 mg/day (range 0.5-6)	6 mg/day

Titration Increase in 0.5 mg increments at 5- to 6-day intervals

Renal Undefined

Hepatic Undefined

Instructions

Individualize by age/weight; older and thin patients tolerate large doses poorly
May be given as single daily dose (often QHS) or 2-4 divided doses

Contraindications

Pediatric patients under 3 years of age (atropine-like effects)

Cautions

Anticholinergic toxicity: toxic psychosis (confusion, disorientation, memory impairment, hallucinations)
Use with caution in older pediatric patients
Heat stroke/hyperthermia risk
Paralytic ileus, urinary retention

Adverse reactions

Tachycardia
Anticholinergic: dry mouth, constipation, blurred vision, dilated pupils, urinary retention
Nausea, vomiting
Nervousness, depression, confusion, hallucinations

Pregnancy Undefined

Lactation Undefined

NO BOXED WARNINGS

Principal riskAnticholinergic burden and cognitive impairment

Cost, est. cash$5–$150/month

Generic entry1984

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability1 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism4 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.