Benztropine (Cogentin® and generic forms) belongs to a group of medications called “anticholinergics.”

What is this medication used for?

Benztropine is approved by Health Canada for the treatment of movement side effects, called “extrapyramidal” side effects (EPS), caused by antipsychotic medications. This is approved for children 3 years of age or older.

It may also be used to treat symptoms of Parkinson’s disease in adults.

Learn more about off-label medication use: http://bit.ly/KMH-off-label-use

Tell your doctor or pharmacist if you:

• Have allergies or bad reactions to a medication
• Take (or plan to take) other prescription or non-prescription medications, including natural medicines. Some medications interact with benztropine. Your doctor may adjust medication doses or monitor for side effects
• Have a history of heart, kidney or liver disease, tardive dyskinesia, epilepsy or seizures, blood disorders, narrow-angle glaucoma or trouble urinating
• Have heartburn or a gastric ulcer, obstruction of the bowel or urinary system, ulcerative colitis or a bowel infection
• Have depression, bipolar disorder or other psychiatric conditions
• Miss a menstrual period, are pregnant, breast-feeding or planning a pregnancy
• Use alcohol or drugs. Taking benztropine together with certain substances may cause a bad reaction. Learn more at www.DrugCocktails.ca

When will the medication start to work?

If taken by mouth to relieve movement side effects caused by antipsychotic medications, benztropine may work within 1 hour. However, it may need to be taken for 1 to 2 days before you notice improvement in your symptoms.

If the injectable form is used, you may notice an improvement in symptoms within 15 minutes.

Talk with your doctor if you feel that benztropine has not been helpful or if side effects are too bothersome. Your doctor may recommend switching you to a different medication.

This medication is not addictive. Do not stop taking it before talking to your doctor.

How do I take this medication?

Some people may only need to take benztropine occasionally on an ‘as needed’ basis, while others may take it regularly. There are two forms of benztropine: tablets and an injection.

If you take tablets regularly, benztropine is usually taken once or twice daily, at the same time(s) each day. It can be taken with or without food. Sometimes, you will start with a low dose and slowly increase this dose over several days or weeks, based on how you tolerate it. If necessary, benztropine tablets may be broken in half, but they should not be crushed or chewed.

The injection form may be injected into a large muscle by a doctor or nurse to treat sudden or severe muscle spasms. Doses of benztropine may be given by mouth for a short time for less severe muscle spasms, or following an injection to prevent muscle spasms from returning.

Possible common or serious side effects:

Side effects may be more common when starting a medication or after a dose increase. Talk to your doctor, nurse or pharmacist if any side effect concerns you.

• Daytime drowsiness, nervousness or headache
• Low blood pressure, dizziness or lightheadedness
• Blurred vision or dry mouth
• Fast or strong heartbeat
• Stomach ache, nausea, vomiting or constipation
• Decrease in appetite

Contact your doctor immediately if you experience:

• Seizure, irritability, hyperactivity, uncontrollable behaviour or other unusual changes in mood
• Fast or irregular heartbeat
• Severe confusion, agitation, disorientation or weakness
• Seeing or hearing things that are not there (hallucinations)
• Trouble urinating
• Decreased sweating, intolerance to heat or heatstroke
• Thoughts of hurting yourself, suicide, increased hostility or worsening symptoms

What precautions should my doctor and I be aware of when taking this medication?

• Many medications may interact with benztropine, including cough and cold medications, antihistamines or sleep aides, some antidepressants, monoamine oxidase inhibitors, and several other medications. If you are (or begin) taking any other prescription, over-the-counter medication, natural health product, or supplement, check with your doctor or pharmacist to see if they are safe to use.
• While taking benztropine, if you feel dizzy, drowsy, or slowed down, do not drive a car or operate heavy machinery. Alcohol could make this worse. Try to avoid alcohol while taking benztropine.

What special instructions should I follow while using this medication?

• Keep all appointments with your doctor.
• Your doctor may order certain assessments and tests (for example, abnormal involuntary movement testing). This is to monitor your condition, check how you are responding to benztropine, and monitor for side effects.
• Do not allow anyone else to use your medication.

What should I do if I forget to take a dose of this medication?

If you are taking benztropine regularly and forget to take a dose, take the missed dose as soon as you remember.

However, if it is within 8 hours of your next scheduled dose, skip the missed dose and continue with your regular schedule. DO NOT double your next dose to try to ‘catch up’.

How do I store this medication?

Keep this medication in the original container, stored at room temperature away from moisture and heat and protected from light. Keep this medication out of reach and sight of children.

How does this medication work?

Benztropine affects the actions of the brain chemicals acetylcholine, histamine and dopamine. Benztropine restores the balance between the dopamine and acetylcholine in the parts of the brain that control the action of muscles. This improves the movement side effects caused by antipsychotic medications and Parkinson’s disease.

How well does the medication work in children and adolescents?

Benztropine has been shown to be better than placebo (an inactive pill) for the treatment of movement side effects associated with antipsychotic medications (for example, risperidone, loxapine, or haloperidol). Benztropine may relieve or prevent the following symptoms: severe physical restlessness, agitation, fidgeting and pacing (akathisia), spasms of the eyes, tongue, jaw, neck and back muscles (dystonia), muscle stiffness, rigidity, difficulty initiating movement, unstable posture, shuffling steps when walking, slowed movement, and shakiness (Parkinsonian effects).

Benztropine usually does not improve a rare movement side effect that involves involuntary muscle movements of the lips, tongue, hands, or neck (tardive dyskinesia). Talk with your doctor if you experience these movements. This condition may become permanent and irreversible if left untreated in people who take antipsychotic medications at higher doses or for long periods of time.

How long should I take the medication for?

This depends on the symptoms you have, how frequently they occur, and how long you have had them. Treatment with benztropine is only needed if you experience movement side effects from antipsychotic medications.

Some people may require benztropine for a short duration, while others continue to take this medication for as long as they are taking antipsychotic medications. Your doctor may re-assess over time the need for you to continue benztropine treatment.

Do not increase, decrease, or stop taking this medication without discussing it with your doctor. If you stop taking benztropine suddenly, it is possible that you may experience a return of muscle stiffness or uncomfortable withdrawal effects such as irritability, nausea, vomiting, headache, or difficulties sleeping.