Cogentin 1mg Tablets
It is used to treat Parkinson's disease.It is used to treat side effects caused by some other drugs.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antiparkinsonian agent
Pharmacologic Class
Anticholinergic, Antihistamine
Pregnancy Category
Category C
FDA Approved
Jan 1954
DEA Schedule
Not Controlled
Overview
What is this medicine?
Benztropine is a medication used to help control muscle stiffness, tremors, and other involuntary movements often associated with Parkinson's disease or as a side effect of certain medications (like antipsychotics). It works by balancing natural substances in the brain.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, it's essential to take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely. Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better.
To help your body absorb the medication effectively, drink plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
Storing and Disposing of Your Medication
To maintain the quality and safety of your medication, store it at room temperature in a dry place, avoiding the bathroom. Keep all medications in a secure location, out of the reach of children and pets. When your medication is no longer needed or has expired, dispose of it properly. Do not flush it down the toilet or pour it down the drain unless instructed to do so by your doctor or pharmacist. If you're unsure about the best way to dispose of your medication, consult with your pharmacist, who may be aware of drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To get the most benefit from your medication, it's essential to take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely. Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better.
To help your body absorb the medication effectively, drink plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
Storing and Disposing of Your Medication
To maintain the quality and safety of your medication, store it at room temperature in a dry place, avoiding the bathroom. Keep all medications in a secure location, out of the reach of children and pets. When your medication is no longer needed or has expired, dispose of it properly. Do not flush it down the toilet or pour it down the drain unless instructed to do so by your doctor or pharmacist. If you're unsure about the best way to dispose of your medication, consult with your pharmacist, who may be aware of drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Avoid overheating and stay hydrated, especially in hot weather or during exercise, as this medication can reduce sweating and increase body temperature.
- Avoid alcohol and other CNS depressants, as they can increase drowsiness and dizziness.
- Be cautious when driving or operating machinery until you know how this medication affects you, as it can cause blurred vision and dizziness.
- Manage constipation by increasing fiber intake, fluids, and physical activity.
- Report any difficulty urinating immediately.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
0.5 to 6 mg daily, typically divided into 1-4 doses
Dose Range:
0.5 - 6 mg
Condition-Specific Dosing:
parkinsonism:
Initial 0.5-1 mg at bedtime, then 0.5-1 mg increments every few days as needed, up to 6 mg/day. Maintenance 1-2 mg/day.
drug_induced_extrapyramidal_disorders:
Initial 1-2 mg once or twice daily. Maintenance 1-4 mg once or twice daily.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established for children under 3 years. Limited data for older children; generally not recommended due to increased sensitivity to anticholinergic effects.
Adolescent:
Not established; use with extreme caution if considered.
Dose Adjustments
Renal Impairment:
Mild:
No specific dose adjustment; monitor for increased anticholinergic effects.
Moderate:
No specific dose adjustment; monitor closely for increased anticholinergic effects; consider lower initial doses and slower titration.
Severe:
No specific dose adjustment; monitor closely for increased anticholinergic effects; consider lower initial doses and slower titration.
Dialysis:
Considerations: Not dialyzable; monitor for exaggerated anticholinergic effects.
Hepatic Impairment:
Mild:
No specific dose adjustment; monitor for increased anticholinergic effects.
Moderate:
No specific dose adjustment; monitor closely for increased anticholinergic effects; consider lower initial doses and slower titration.
Severe:
No specific dose adjustment; monitor closely for increased anticholinergic effects; consider lower initial doses and slower titration.
Pharmacology
Mechanism of Action
Benztropine is a centrally acting anticholinergic agent that selectively blocks cholinergic receptors in the central nervous system (CNS), thereby reducing the relative excess of cholinergic activity that contributes to Parkinsonian symptoms (e.g., tremor, rigidity). It also possesses antihistaminic properties, which may contribute to its therapeutic effects.
Pharmacokinetics
Absorption:
Bioavailability:
Not precisely quantified, but well absorbed orally.
Tmax:
6-8 hours (oral)
FoodEffect:
Not significantly affected by food.
Distribution:
Vd:
Not well established
ProteinBinding:
Not well established
CnssPenetration:
Yes
Elimination:
HalfLife:
Estimated 10-24 hours (variable)
Clearance:
Not precisely quantified
ExcretionRoute:
Primarily renal
Unchanged:
Not precisely quantified
Pharmacodynamics
OnsetOfAction:
Within 1 hour (oral)
PeakEffect:
Not precisely quantified, generally aligns with Tmax (6-8 hours)
DurationOfAction:
24 hours
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
New or worsening mental, mood, or behavior changes
Hallucinations (seeing or hearing things that are not there)
Feeling confused
Changes in eyesight, eye pain, or severe eye irritation
Trouble swallowing or speaking
Decreased appetite
Weight loss
Trouble passing urine
Pain when passing urine
Fast heartbeat
Larger pupils
Memory problems or loss
Severe constipation or stomach pain, which may be signs of a severe bowel problem
Weakness
Trouble moving around
Numbness of fingers
Sweating less, heat stroke, and deadly high body temperatures have occurred with this medication. Be cautious in hot weather and during physical activity. If you experience a fever or do not sweat during activities or in warm temperatures, contact your doctor right away.
Other Possible Side Effects
Like all medications, this drug may cause side effects. Many people experience no side effects or only minor ones. If you are bothered by any of the following side effects or if they do not go away, contact your doctor or seek medical help:
Constipation
Upset stomach or vomiting
Dry mouth
Feeling nervous and excitable
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
New or worsening mental, mood, or behavior changes
Hallucinations (seeing or hearing things that are not there)
Feeling confused
Changes in eyesight, eye pain, or severe eye irritation
Trouble swallowing or speaking
Decreased appetite
Weight loss
Trouble passing urine
Pain when passing urine
Fast heartbeat
Larger pupils
Memory problems or loss
Severe constipation or stomach pain, which may be signs of a severe bowel problem
Weakness
Trouble moving around
Numbness of fingers
Sweating less, heat stroke, and deadly high body temperatures have occurred with this medication. Be cautious in hot weather and during physical activity. If you experience a fever or do not sweat during activities or in warm temperatures, contact your doctor right away.
Other Possible Side Effects
Like all medications, this drug may cause side effects. Many people experience no side effects or only minor ones. If you are bothered by any of the following side effects or if they do not go away, contact your doctor or seek medical help:
Constipation
Upset stomach or vomiting
Dry mouth
Feeling nervous and excitable
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe confusion or disorientation
- Hallucinations (seeing or hearing things that are not there)
- Severe difficulty urinating or inability to urinate
- Severe constipation or abdominal pain
- Eye pain or sudden vision changes (could indicate glaucoma)
- Fever with hot, dry skin (signs of heatstroke)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you have been diagnosed with tardive dyskinesia, a severe muscle condition.
If you have glaucoma.
For Parents or Guardians:
If your child is under 3 years of age, do not administer this medication. It is not approved for use in children younger than 3 years.
Additional Considerations:
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. This will help ensure that it is safe to take this medication in conjunction with your other treatments. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you have been diagnosed with tardive dyskinesia, a severe muscle condition.
If you have glaucoma.
For Parents or Guardians:
If your child is under 3 years of age, do not administer this medication. It is not approved for use in children younger than 3 years.
Additional Considerations:
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. This will help ensure that it is safe to take this medication in conjunction with your other treatments. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Before engaging in activities that require your full attention, such as driving, wait until you understand how this drug affects you.
Combining this medication with certain other drugs can lead to severe and potentially life-threatening complications, including paralytic ileus (a condition where the bowel becomes paralyzed), fever, and heat stroke. To minimize these risks, carefully review all your medications with your doctor and pharmacist.
To manage dry mouth, a common side effect, practice good oral hygiene, and consider sucking on hard, sugar-free candy or chewing sugar-free gum. Regular dental check-ups are also recommended.
When administering this medication to children, exercise caution, as they may be more susceptible to certain side effects. Similarly, if you are 65 or older, use this medication with caution, as you may be more prone to experiencing side effects.
If you are pregnant, planning to become pregnant, or breastfeeding, consult your doctor to discuss the potential benefits and risks of this medication to both you and your baby.
Combining this medication with certain other drugs can lead to severe and potentially life-threatening complications, including paralytic ileus (a condition where the bowel becomes paralyzed), fever, and heat stroke. To minimize these risks, carefully review all your medications with your doctor and pharmacist.
To manage dry mouth, a common side effect, practice good oral hygiene, and consider sucking on hard, sugar-free candy or chewing sugar-free gum. Regular dental check-ups are also recommended.
When administering this medication to children, exercise caution, as they may be more susceptible to certain side effects. Similarly, if you are 65 or older, use this medication with caution, as you may be more prone to experiencing side effects.
If you are pregnant, planning to become pregnant, or breastfeeding, consult your doctor to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe anticholinergic effects: CNS depression (coma, respiratory depression) or CNS excitation (confusion, delirium, hallucinations, agitation, seizures)
- Hyperthermia (high body temperature)
- Tachycardia (rapid heart rate)
- Arrhythmias
- Dilated pupils (mydriasis)
- Flushed, hot, dry skin and mucous membranes
- Paralytic ileus
- Urinary retention
What to Do:
Seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Treatment is supportive and may include physostigmine for severe anticholinergic symptoms.
Drug Interactions
Contraindicated Interactions
- Narrow-angle glaucoma
- Myasthenia gravis
- Obstructive uropathy (e.g., bladder neck obstruction due to prostatic hypertrophy)
- Severe prostatic hypertrophy
- Tardive dyskinesia (relative contraindication, may exacerbate)
Major Interactions
- Other anticholinergics (e.g., atropine, scopolamine, tricyclic antidepressants, phenothiazines): Additive anticholinergic effects (e.g., dry mouth, blurred vision, urinary retention, constipation, CNS effects like confusion, hallucinations).
- Phenothiazines (e.g., chlorpromazine, thioridazine): Increased risk of tardive dyskinesia and paralytic ileus.
- Tricyclic antidepressants (TCAs): Additive anticholinergic effects, increased risk of paralytic ileus.
- Monoamine Oxidase Inhibitors (MAOIs): Additive anticholinergic effects.
Moderate Interactions
- Digoxin: May increase digoxin levels due to decreased GI motility.
- Antacids: May decrease absorption of benztropine if administered concurrently; separate administration by at least 2 hours.
- Potassium chloride (oral solid forms): Increased risk of gastrointestinal lesions due to delayed transit time.
- Alcohol and other CNS depressants: Additive CNS depression.
Minor Interactions
- Not many specific minor interactions beyond additive anticholinergic effects with other drugs possessing anticholinergic properties.
Monitoring
Baseline Monitoring
Ophthalmic examination
Rationale: To rule out narrow-angle glaucoma, a contraindication.
Timing: Prior to initiation
Prostate examination
Rationale: To assess for prostatic hypertrophy, a contraindication or caution.
Timing: Prior to initiation
Mental status assessment
Rationale: To establish baseline cognitive function, as anticholinergics can cause confusion/hallucinations.
Timing: Prior to initiation
Routine Monitoring
Anticholinergic side effects (e.g., dry mouth, blurred vision, constipation, urinary retention)
Frequency: Regularly, especially during dose titration and maintenance
Target: Minimize severity
Action Threshold: If severe or intolerable, consider dose reduction or discontinuation.
Mental status (e.g., confusion, disorientation, hallucinations)
Frequency: Regularly, especially in elderly or cognitively impaired patients
Target: Maintain baseline cognitive function
Action Threshold: If new or worsening cognitive impairment, consider dose reduction or discontinuation.
Parkinsonian symptoms (e.g., tremor, rigidity, bradykinesia)
Frequency: Regularly, to assess therapeutic efficacy
Target: Improvement in symptoms
Action Threshold: If symptoms worsen or do not improve, consider dose adjustment or alternative therapy.
Extrapyramidal symptoms (e.g., dystonia, akathisia)
Frequency: Regularly, especially if used for drug-induced EPS
Target: Resolution or reduction of symptoms
Action Threshold: If symptoms persist or worsen, re-evaluate therapy.
Symptom Monitoring
- Dry mouth
- Blurred vision
- Constipation
- Urinary hesitancy or retention
- Dizziness
- Lightheadedness
- Nausea
- Vomiting
- Tachycardia
- Nervousness
- Confusion
- Disorientation
- Hallucinations
- Memory impairment
- Heat intolerance (due to decreased sweating)
Special Patient Groups
Pregnancy
Category C. Use only if the potential benefit justifies the potential risk to the fetus. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Trimester-Specific Risks:
First Trimester:
Potential for fetal harm based on animal data; human data limited.
Second Trimester:
Potential for fetal harm based on animal data; human data limited.
Third Trimester:
Potential for fetal harm based on animal data; human data limited. Anticholinergic effects could theoretically affect fetal heart rate or GI motility.
Lactation
L3 (Moderately Safe). Benztropine is likely excreted in breast milk. It may decrease milk supply due to its anticholinergic effects. Monitor the infant for anticholinergic effects (e.g., drowsiness, constipation, urinary retention, dry mouth). Use with caution.
Infant Risk:
Potential for anticholinergic effects (e.g., sedation, constipation, urinary retention, dry mouth) and theoretical risk of reduced milk supply.
Pediatric Use
Not recommended for children under 3 years of age. Use with extreme caution in older children due to increased sensitivity to anticholinergic effects and potential for hyperthermia, especially in hot weather or during exercise. Safety and efficacy not well established.
Geriatric Use
Elderly patients are particularly susceptible to anticholinergic side effects, including confusion, hallucinations, memory impairment, urinary retention, and constipation. Start with lower doses and titrate slowly. Avoid in elderly patients with pre-existing cognitive impairment or dementia due to increased risk of exacerbating symptoms.
Clinical Information
Clinical Pearls
- Benztropine is often used as adjunctive therapy for Parkinson's disease, particularly for tremor and rigidity, but less effective for bradykinesia.
- It is highly effective in treating drug-induced extrapyramidal symptoms (EPS) caused by antipsychotics, especially acute dystonia and parkinsonism.
- Tapering benztropine slowly is crucial to avoid rebound parkinsonism or worsening of EPS.
- Due to its euphoric effects at high doses, benztropine has a potential for abuse.
- Patients should be advised to avoid activities that may lead to overheating, as benztropine can impair the body's ability to sweat.
- Monitor for signs of paralytic ileus, especially when co-administered with other anticholinergic drugs.
Alternative Therapies
- Other anticholinergics (e.g., trihexyphenidyl)
- Amantadine (for Parkinson's and drug-induced EPS)
- Dopamine agonists (e.g., pramipexole, ropinirole, rotigotine - for Parkinson's)
- Levodopa/carbidopa (for Parkinson's)
- Atypical antipsychotics (e.g., clozapine, quetiapine - for drug-induced EPS, if antipsychotic change is an option)
- Beta-blockers (e.g., propranolol - for tremor, though not primary for Parkinson's tremor)
Cost & Coverage
Average Cost:
Varies widely, typically low for generic per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (for generic formulations) on most commercial and Medicare Part D plans.
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to ensure you receive the best possible care.