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 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
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
NO BOXED WARNINGS
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.
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