Benztropine
COGENTIN
Pronunciation: BENZ-troe-peen (koe-JEN-tin)
“Benz-troping Cog gentleman”
“red as a beet” → anticholinergic
“mad as a hatter” → BBB-crossing anticholinergic
What it isCentral muscarinic and H1 antagonist with dopamine-reuptake inhibition; drug-induced parkinsonism and acute dystonia.
Why this oneReverses 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.
Benztropine prescription history
Animated chart of estimated U.S. prescriptions per year, Parkinson medicines (1948–2026). Benztropine enters in 1954 (estimated).
FDA-approved for
- Parkinson/drug-induced EPS (~1954)
Principal riskAnticholinergic burden and cognitive impairment
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| 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
Available strengths
- tab 0.5, 1, 2 mg
- inj 1 mg/mL
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
Cost
Generic entry1984
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Memory aids: interaction avatars
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Self-check
- Does benztropine treat tardive dyskinesia?
No; it may worsen it. - Which acute reaction does benztropine rapidly reverse?
Acute dystonia.