Cogentin 2mg Tablets

Manufacturer MERCK HUMAN HEALTH Active Ingredient Benztropine Tablets(BENZ troe peen) Pronunciation BENZ-troe-peen
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.
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Drug Class
Antiparkinsonian agent
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Pharmacologic Class
Anticholinergic agent; Muscarinic antagonist
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Pregnancy Category
Category C
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FDA Approved
Aug 1952
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DEA Schedule
Not Controlled

Overview

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What is this medicine?

Benztropine is a medication used to treat symptoms of Parkinson's disease, such as tremors and stiffness, and also to help control muscle problems caused by certain other medications (like antipsychotics). It works by balancing natural substances in the brain.
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How to Use This Medicine

Taking Your Medication Correctly

To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel better.

It's also important to stay hydrated by drinking plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.

Storing and Disposing of Your Medication

To keep your medication effective and safe:

Store it at room temperature in a dry place, away from the bathroom.
Keep all medications in a secure location, out of the reach of children and pets.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your doctor or pharmacist.
If you're unsure about how to dispose of your medication, consult with your pharmacist. You may also want to check if there are any 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.
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Lifestyle & Tips

  • Avoid alcohol and other sedating medications, as they can increase drowsiness and dizziness.
  • Be cautious when driving or operating machinery until you know how this medication affects you.
  • To relieve dry mouth, chew sugarless gum, suck on hard candy, or use saliva substitutes.
  • To prevent constipation, increase fiber in your diet, drink plenty of fluids, and engage in regular exercise.
  • Avoid overheating and strenuous exercise in hot weather, as this medication can decrease sweating and increase the risk of heat stroke.
  • Report any vision changes, difficulty urinating, or confusion to your doctor immediately.
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Available Forms & Alternatives

Dosing & Administration

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Adult Dosing

Standard Dose: Parkinsonism: 1-2 mg/day orally, usually at bedtime or in divided doses. Drug-induced extrapyramidal symptoms: 1-4 mg once or twice daily orally.
Dose Range: 0.5 - 6 mg

Condition-Specific Dosing:

parkinsonism: Initial: 0.5-1 mg at bedtime, gradually increased to 1-2 mg/day in 1-2 divided doses. Maintenance: 1-6 mg/day. Max: 6 mg/day.
drug_induced_extrapyramidal_symptoms: 1-4 mg once or twice daily. Some patients may require 1-2 mg three times daily. Max: 6 mg/day.
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Pediatric Dosing

Neonatal: Not established
Infant: Not established
Child: Not recommended for children under 3 years of age. For children >3 years with drug-induced extrapyramidal symptoms: 0.5 mg to 1 mg once or twice daily. Max: 6 mg/day.
Adolescent: For drug-induced extrapyramidal symptoms: 0.5 mg to 1 mg once or twice daily. Max: 6 mg/day.
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Dose Adjustments

Renal Impairment:

Mild: No specific dose adjustment guidelines; use with caution, monitor for anticholinergic effects.
Moderate: No specific dose adjustment guidelines; use with caution, monitor for anticholinergic effects. Consider lower initial doses and slower titration.
Severe: No specific dose adjustment guidelines; use with caution, monitor for anticholinergic effects. Consider lower initial doses and slower titration due to potential for accumulation.
Dialysis: Not available; Benztropine is likely not dialyzable due to high protein binding and large volume of distribution.

Hepatic Impairment:

Mild: No specific dose adjustment guidelines; use with caution, monitor for anticholinergic effects.
Moderate: No specific dose adjustment guidelines; use with caution, monitor for anticholinergic effects. Consider lower initial doses and slower titration.
Severe: No specific dose adjustment guidelines; use with caution, monitor for anticholinergic effects. Consider lower initial doses and slower titration due to potential for impaired metabolism.

Pharmacology

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Mechanism of Action

Benztropine is a centrally acting anticholinergic agent that also possesses antihistaminic properties. It acts by blocking cholinergic muscarinic receptors in the central nervous system, thereby helping to restore the balance between cholinergic and dopaminergic activity in the basal ganglia, which is disrupted in Parkinson's disease. Its antihistaminic action may also contribute to its therapeutic effects.
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Pharmacokinetics

Absorption:

Bioavailability: Not precisely quantified, but well absorbed orally.
Tmax: Not well-defined, generally within hours.
FoodEffect: Food may delay absorption but does not significantly affect extent of absorption.

Distribution:

Vd: Not precisely quantified, but widely distributed.
ProteinBinding: Not precisely quantified, but likely high.
CnssPenetration: Yes

Elimination:

HalfLife: Variable and prolonged; reported ranges from 10 to 24 hours, but not consistently defined.
Clearance: Not precisely quantified.
ExcretionRoute: Primarily renal excretion of metabolites and some unchanged drug.
Unchanged: Not precisely quantified, but a small percentage.
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Pharmacodynamics

OnsetOfAction: Oral: 1-2 hours
PeakEffect: Oral: 2-4 hours
DurationOfAction: 6-10 hours, but can be up to 24 hours depending on dose and individual response.

Safety & Warnings

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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 immediately or seek emergency medical attention:

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 immediately.

Other Possible Side Effects

Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild 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 attention:

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.
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Seek Immediate Medical Attention If You Experience:

  • Severe dry mouth
  • Blurred vision or eye pain
  • Difficulty urinating or inability to urinate
  • Severe constipation or abdominal pain
  • Confusion, disorientation, memory problems
  • Hallucinations or unusual thoughts/behavior
  • Rapid heartbeat
  • Dizziness or fainting
  • Signs of heat stroke (e.g., fever, hot dry skin, confusion)
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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 Children:
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. They will help determine if it is safe to take this medication with your other drugs and health issues. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
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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 increase the risk of severe and potentially life-threatening conditions, including paralytic ileus (a type of bowel blockage), fever, and heat stroke. To minimize this risk, 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 years 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.
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Overdose Information

Overdose Symptoms:

  • Dilated pupils
  • Hot, dry skin
  • Flushed face
  • Dry mucous membranes
  • Fever
  • Tachycardia
  • Hypertension (early), hypotension (late)
  • Urinary retention
  • Paralytic ileus
  • CNS effects: confusion, disorientation, agitation, hallucinations, delirium, seizures, coma, respiratory depression.

What to Do:

Seek immediate medical attention. Call 911 or Poison Control (1-800-222-1222). Treatment is supportive and symptomatic. Physostigmine may be used as an antidote in severe cases of central anticholinergic syndrome.

Drug Interactions

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Contraindicated Interactions

  • Not specifically contraindicated with other drugs, but additive effects are a concern.
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Major Interactions

  • Other anticholinergic drugs (e.g., tricyclic antidepressants, phenothiazines, antihistamines, disopyramide): Increased risk of severe anticholinergic side effects (e.g., paralytic ileus, urinary retention, heat stroke, delirium).
  • Cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine): Benztropine may antagonize the therapeutic effects of cholinesterase inhibitors.
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Moderate Interactions

  • Dopaminergic agents (e.g., levodopa): May enhance or antagonize effects depending on the specific drug and patient response.
  • Antacids/Adsorbent antidiarrheals: May decrease absorption of benztropine if given concurrently. Separate administration by at least 2 hours.
  • Drugs that cause CNS depression (e.g., alcohol, sedatives, hypnotics, opioids): Increased risk of sedation and CNS depression.
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Minor Interactions

  • Not available

Monitoring

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Baseline Monitoring

Ophthalmic examination (especially for narrow-angle glaucoma)

Rationale: Benztropine is contraindicated in narrow-angle glaucoma due to risk of acute attack.

Timing: Prior to initiation of therapy.

Assessment for prostatic hypertrophy

Rationale: Benztropine can exacerbate urinary retention in patients with prostatic hypertrophy.

Timing: Prior to initiation of therapy.

Baseline mental status and cognitive function

Rationale: To establish a baseline for monitoring potential anticholinergic-induced cognitive impairment or delirium.

Timing: Prior to initiation of therapy.

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Routine Monitoring

Mental status and cognitive function (e.g., confusion, disorientation, memory impairment)

Frequency: Regularly, especially during dose titration and in elderly patients.

Target: Maintain baseline cognitive function or minimize decline.

Action Threshold: New onset or worsening confusion, disorientation, or memory impairment may require dose reduction or discontinuation.

Anticholinergic side effects (e.g., dry mouth, blurred vision, constipation, urinary retention, tachycardia)

Frequency: Regularly, especially during dose titration.

Target: Minimize severity of side effects.

Action Threshold: Severe or intolerable side effects may require dose reduction or discontinuation.

Intraocular pressure (in patients at risk for glaucoma)

Frequency: Periodically, as clinically indicated.

Target: Within normal limits.

Action Threshold: Significant increase in intraocular pressure.

Bowel function

Frequency: Regularly.

Target: Regular bowel movements.

Action Threshold: Severe constipation or signs of paralytic ileus.

Urinary output

Frequency: Regularly.

Target: Normal urinary flow.

Action Threshold: Urinary hesitancy or retention.

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Symptom Monitoring

  • Dry mouth
  • Blurred vision
  • Constipation
  • Urinary hesitancy or retention
  • Dizziness
  • Lightheadedness
  • Nausea
  • Nervousness
  • Confusion
  • Disorientation
  • Memory impairment
  • Hallucinations
  • Delirium
  • Tachycardia
  • Heat intolerance (reduced sweating)

Special Patient Groups

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Pregnancy

Category C. Use only if the potential benefit justifies the potential risk to the fetus. Limited human data available.

Trimester-Specific Risks:

First Trimester: Limited data; potential for developmental toxicity not well-established.
Second Trimester: Limited data.
Third Trimester: Limited data; theoretical risk of anticholinergic effects in the neonate if used close to delivery.
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Lactation

Excreted into breast milk. Potential for anticholinergic effects in the infant (e.g., sedation, constipation, dry mouth, decreased sweating). Use with caution; monitor infant for adverse effects. Consider alternative if possible, especially in preterm or jaundiced infants.

Infant Risk: L3 (Moderate risk)
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Pediatric Use

Not recommended for children under 3 years of age due to increased susceptibility to anticholinergic side effects and potential for hyperthermia. Use with caution in older children, especially for drug-induced extrapyramidal symptoms, and monitor closely for adverse effects.

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Geriatric Use

Elderly patients are highly susceptible to anticholinergic side effects, particularly cognitive impairment (confusion, delirium, memory loss), hallucinations, urinary retention, constipation, and falls. Use with extreme caution, start with lower doses, and titrate slowly. Often avoided in the elderly due to Beers Criteria recommendations.

Clinical Information

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Clinical Pearls

  • Benztropine is often used as an adjunctive therapy for Parkinson's disease or for drug-induced extrapyramidal symptoms, not typically as monotherapy for Parkinson's.
  • It is generally less effective for bradykinesia and rigidity compared to tremors.
  • Due to its anticholinergic properties, it should be used with extreme caution or avoided in patients with angle-closure glaucoma, prostatic hypertrophy, urinary retention, or gastrointestinal obstruction.
  • Educate patients about the risk of heat stroke due to decreased sweating, especially during exercise or in hot weather.
  • Withdrawal should be gradual to avoid rebound parkinsonian symptoms or cholinergic crisis.
  • Consider the anticholinergic burden when prescribing with other medications that have anticholinergic effects.
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Alternative Therapies

  • Other anticholinergic agents (e.g., trihexyphenidyl, procyclidine)
  • Amantadine (for Parkinson's and drug-induced EPS)
  • Dopaminergic agents (e.g., levodopa/carbidopa, dopamine agonists for Parkinson's)
  • Beta-blockers (e.g., propranolol for essential tremor, sometimes used off-label for parkinsonian tremor)
  • For drug-induced EPS: Dose reduction of offending agent, switching to a less EPS-inducing antipsychotic (e.g., atypical antipsychotics).
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Cost & Coverage

Average Cost: $10 - $50 per 30 tablets (generic 2mg)
Generic Available: Yes
Insurance Coverage: Tier 1 or Tier 2 (Generic)
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General Drug Facts

If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe and effective treatment, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it is a good idea to consult with your pharmacist. If you have any questions or concerns about this medication, do not hesitate to discuss them with 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 detailed information about the overdose, including the medication taken, the amount, and the time it occurred.