Oral: One tablet one to three times daily. Zonisamide: (Moderate) Zonisamide use is associated with case reports of decreased sweating, hyperthermia, heat intolerance, or heat stroke and should be used with caution in combination with other drugs that may also predispose patients to heat-related disorders like anticholinergics. A weight-based dose of 0.02 to 0.05 mg/kg/dose IV once or twice per day has been reported in children 3 to 12 years; single doses rarely exceed 1 mg/dose. The Antipsychotic Algorithms for treatment of Schizophrenia to a friend, relative, colleague or yourself. Anyone else on it? Trihexyphenidyl Symptoms in the newborn may include agitation, feeding disorder, hypertonia, hypotonia, respiratory distress, somnolence, and tremor; these effects may Benztropine Dosage Guide + Max Dose, Adjustments - Drugs.com Chlorpromazine: (Moderate) Additive anticholinergic effects may be seen when anticholinergics are used concomitantly with phenothiazines, including chlorpromazine. Concomitant use may increase the risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. 2. Antacids: (Moderate) Antacids may inhibit the oral absorption of anticholinergics. Pharmacology, adverse reactions, warnings and side effects. Drugs.com Dosage may be increased by 0.5-mg increments at 5- or 6-day intervals based on response and tolerability up to a maximum of 6 mg daily. Clinicians should note that anticholinergic effects might be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation. Trihexyphenidyl, while also a drug with limited data, has been reported in use during pregnancy in a few cases. The concomitant use of benzhydrocodone and anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Botulinum Toxins: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention). Remifentanil: (Moderate) Monitor patients for signs of urinary retention or reduced gastric motility when remifentanil is used concomitantly with an anticholinergic drug. In treating extrapyramidal disorders due to neuroleptic drugs (e.g., phenothiazines), the recommended dosage is 1 to 4 mg once or twice a day orally or A dose of benztropine can be administered orally, intravenously, or through intramuscular routes. Memantine: (Moderate) The adverse effects of anticholinergics, such as dry mouth, urinary hesitancy or blurred vision may be enhanced with use of memantine; dosage adjustments of the anticholinergic drug may be required when memantine is coadministered. Anticholinergics may decrease gastric motility and increase the transit time of solid oral dosage forms of potassium chloride leading to prolonged contact with the gastrointestinal mucosa. Potassium Bicarbonate: (Moderate) Use anticholinergics, such as benztropine, and concomitant solid oral dosage forms of potassium chloride with caution due to risk for gastrointestinal mucosal injury. The other trial evaluated intravenous benztropine at a dose of 2 mg in 6 individuals with schizophrenia or bipolar disorder. The concomitant use of oxymorphone and anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Therefore, caution should be exercised when administering benztropine to a breast-feeding woman. Benzhydrocodone; Acetaminophen: (Moderate) Monitor patients for signs of urinary retention or reduced gastric motility when benzhydrocodone is used concomitantly with an anticholinergic drug. Aluminum Hydroxide; Magnesium Hydroxide: (Moderate) Antacids may inhibit the oral absorption of anticholinergics. Aspirin, ASA; Caffeine; Orphenadrine: (Moderate) Additive anticholinergic effects may be seen when benztropine is used concomitantly with other drugs that possess anticholinergic properties, such as orphenadrine. Consider alternatives to these other medications, if available. Webdrug-induced extrapyramidal reactions. Benztropine has antimuscarinic, antihistaminic, and local anesthetic effects. Anticholinergic agents administered concurrently with procainamide may produce additive antivagal effects on AV nodal conduction, although this is not as well documented for procainamide as for quinidine. Magnesium Hydroxide: (Moderate) Antacids may inhibit the oral absorption of anticholinergics. Levodopa: (Minor) Through its central antimuscarinic actions, antimuscarinics such as benztropine can potentiate the dopaminergic effects of levodopa. In some patients, this will be adequate; in others 4 to 6 mg a day may be required. Concomitant use may increase the risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Benztropine can be administered intra venously, intramuscularly, or orally. Schizophrenia in adults: Maintenance therapy and side effect Benztropine should be generally avoided in patients with myasthenia gravis because the anticholinergic effects of the drug compete with acetylcholine and may exacerbate muscle weakness. Additive drowsiness may also occur. Some of the common selective antimuscarinic drugs for bladder problems, (such as oxybutynin, darifenacin, trospium, fesoterodine, tolerodine, or solifenacin), do not routinely cause problems with medications used for dementia, but may cause anticholinergic side effects in some patients. Opiates increase the tone and decrease the propulsive contractions of the smooth muscle of the gastrointestinal tract. Oxycodone: (Moderate) Monitor for signs of urinary retention or reduced gastric motility during concomitant oxycodone and benztropine use. Prolongation of the gastrointestinal transit time may be the mechanism of the constipating effect. Calcium Carbonate; Simethicone: (Major) Avoid concomitant use of calcium carbonate and anticholinergics. Extrapyramidal Side Effects WebThe initial dose is 40 mg once daily. benztropine, biperiden, and trihexyphenidyl) can block excitatory cholinergic pathways in the basal ganglia and restore the dopamine/Ach balance.7 The antimuscarinic, rather than antinicotinic, properties of anticholinergics are thought to be responsible for their efcacy in treating EPS. Pharmacological Management of Acute Behavioural Agitation Ambenonium Chloride: (Major) The muscarinic actions of ambenonium chloride, can antagonize the antimuscarinic actions of benztropine. Morphine; Naltrexone: (Moderate) Monitor for signs of urinary retention or reduced gastric motility during concomitant morphine and benztropine use. 2A receptor occupancy may be protective . WebAnti-EPS Starting Dose Range (daily dose) benztropine (Cogentin) 1 mg bid 2 - 6 trihexphenidyl (Artane) 2 mg bid 4 - 12 propanolol ( Inderal) 10 mg qid 20 160 benzodiazapines Starting Dose lorazepam ( Ativan) 0.5 - 1 mg t.i.d 1 8 clonazepam (Klonopin) 0.25 - 0.5 mg. bid 0.5 - 4 Extrapyramidal side effects are characterized by a triad of symptoms, including which of the following? In this narrative review we highlight the clinical significance of AIA, outline major approaches for its management and propose a practical algorithm for its treatment. Neuroleptic-induced: 2 mg orally 1 to 3 times a day. Drug class: Anticholinergic antiparkinson agents. Cogentin, Benadryl, Artane WebCategories of medications commonly used to treat dystonia include: Anticholinergics. Biperiden Dosage Solifenacin: (Moderate) Additive anticholinergic effects may be seen when drugs with antimuscarinic properties like solifenacin are used concomitantly with other antimuscarinics. Benzatropine Mesilate Concomitant use may increase the risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Chlorpheniramine; Hydrocodone: (Moderate) Monitor for signs of urinary retention or reduced gastric motility during concomitant hydrocodone and benztropine use. Trihexyphenidyl Monograph for Professionals - Drugs.com Calcium Carbonate: (Major) Avoid concomitant use of calcium carbonate and anticholinergics. Concomitant use may increase the risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Data sources include IBM Watson Micromedex (updated 3 July 2023), Cerner Multum (updated 10 July 2023), ASHP (updated 10 July 2023) and others. Medically reviewed by Drugs.com. Dystonic Reactions The usual daily dose is 1 to 2 mg, with a range of 0.5 to 6 mg parenterally. Opiates increase the tone and decrease the propulsive contractions of the smooth muscle of the gastrointestinal tract. benztropine Paralytic ileus, hyperthermia and heat stroke, all of which have sometimes been fatal, have occurred in patients taking anticholinergic-type antiparkinsonism drugs, including benztropine, in combination with phenothiazines and/or tricyclic antidepressants (TCAs). There are no adequate and well controlled studies in pediatric patients; dosage should be individualized based on severity of symptoms and patient characteristics. Separate multiple email address with a comma. They are more commonly Opiates increase the tone and decrease the propulsive contractions of the smooth muscle of the gastrointestinal tract. WebAbstract. Antacids may interfere with the absorption of anticholinergics. Clinicians should note that antimuscarinic effects may be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation. There is no clinically important difference in onset of effects between IM or IV injection, therefore, the manufacturer states that IV administration is rarely necessary.Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. WebAnti-EPS Starting Dose Range (daily dose) benztropine (Cogentin) 1 mg bid 2 - 6 trihexphenidyl (Artane) 2 mg bid 4 - 12 propanolol ( Inderal) 10 mg qid 20 160 Effects of discontinuing anticholinergic treatment on The drug is quickly effective after either route, with improvement sometimes noticeable a few minutes after injection. The concomitant use of sufentanil and anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Use caution and monitor GI symptoms during coadministration. Several case reports implicate propofol as the likely causative agent producing these symptoms, which include ballismus, dystonia, choreoathetosis, and opisthotonus. C. Cogentin D. Parlodel. Concomitant use may increase the risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. This is apparently a result of a decrease in gastrointestinal motility and rate of stomach emptying by the antimuscarinic agent. Alfentanil: (Moderate) Monitor patients for signs of urinary retention or reduced gastric motility when alfentanil is used concomitantly with an anticholinergic drug. Aclidinium; Formoterol: (Moderate) Although aclidinium is minimally absorbed into the systemic circulation after inhalation, there is the potential for aclidinium to have additive anticholinergic effects when administered with other anticholinergics or antimuscarinics. These medications act by blocking a neurotransmitter chemical called acetylcholine, which plays an important role in muscle activation. Dosage may be increased in 2-mg increments at 3- to 5-day intervals up to a maximum of 610 mg daily. Concomitant use may increase the risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Inform patients that this drug may impair mental and/or physical abilities required to perform hazardous tasks such as driving a motor vehicle. Alosetron: (Major) Concomitant use of alosetron and anticholinergics, which can decrease GI motility, may seriously worsen constipation, leading to events such as GI obstuction, impaction, or paralytic ileus. In acute dystonic reactions, 1 to 2 mL of the injection usually relieves the condition quickly. Cogentin Oral: Uses, Side Effects, Interactions, Pictures, Warnings Extrapyramidal Treatment of Antipsychotic-Induced Akathisia: Role of Nalbuphine: (Moderate) Monitor patients for signs of urinary retention or reduced gastric motility when nalbuphine is used concomitantly with an anticholinergic drug. Usual dose: 1 to 2 mg orally per day How is Data not available. For oral dosage form (tablets): For Idiopathic parkinsonism: AdultsAt first, 0.5 to 1 milligram (mg) at bedtime. Blurred vision and dry mouth would be common effects. If the other agents are to be reduced or discontinued, it must be done gradually. Lubiprostone: (Moderate) Antimuscarinic drugs can promote constipation and pharmacodynamically oppose the action of drugs used for the treatment of constipation, such as lubiprostone. The dosage is individualized and may be increased to a maximum of 8 tablets (16 mg) per 24 hours. Hydromorphone: (Moderate) Monitor patients for signs of urinary retention or reduced gastric motility when hydromorphone is used concomitantly with an anticholinergic drug. Revisiting amantadine as a treatment for drug-induced Loperamide: (Moderate) Both antidiarrheals and anticholinergics, such as benztropine, decrease GI motility. Clinicians should be aware that urinary retention, particularly in males, and aggravation of glaucoma are realistic possibilities of using disopyramide with other anticholinergic agents. Additive drowsiness may also occur, depending on the anticholinergic agent used. 43. Concomitant use may increase the risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. DIMDs are less frequently associated with the atypical antipsychotics, but dose-related EPS occurs with olanzapine and risperidone (especially at dosages greater than 6 mg/day). According to the treatment guidelines of the American Academy of Neurology, there is insufficient evidence to determine the effectiveness of anticholinergic drugs in treating extrapyramidal symptoms such as tardive dyskinesia. WebCogentin (benztropine) is an oral and injectable anticholinergic medication used to manage drug-induced extrapyramidal disorders (except tardive dyskinesia) and to treat Parkinsons disease.. Aluminum Hydroxide: (Moderate) Antacids may inhibit the oral absorption of anticholinergics. His BP fluctuated wildly, and he was mildly tachycardic, with a pulse There are 339 drugs known to interact with Cogentin (benztropine), along with 12 disease interactions, and 2 alcohol/food interactions. Benztropine (Cogentin) - Side Effects, Interactions, Uses, Dosage, WebNK-02; Pharmacology Indication. The Extrapyramidal Rating Scale has been extensively deployed and has established inter-rater reliability. Olanzapine; Fluoxetine: (Moderate) Additive anticholinergic effects may be seen when olanzapine and anticholinergics are used concomitantly; use with caution. For example, I have a schizophrenic patient on Haldol 10mg BID (anything less leads to really distressing psychosis), yet he experiences significant EPS at this dose. Crofelemer: (Moderate) Pharmacodynamic interactions between crofelemer and antimuscarinics are theoretically possible. Codeine; Promethazine: (Moderate) Monitor for signs of urinary retention or reduced gastric motility during concomitant codeine and benztropine use. Dosage Extrapyramidal Symptoms: A Review of Symptoms and Extrapyramidal symptoms that may develop after initiation of treatment with antipsychotics are often transient and usually respond to a dose of 1 or 2 mg PO twice daily or 3 times daily, within 1 or 2 days. The dosage should be individualized with the dose titrated upward to a maximum of 8 tablets (16 mg) per 24 hours. Usual Adult Dose for Extrapyramidal Reaction. Methadone: (Moderate) Monitor patients for signs of urinary retention or reduced gastric motility when methadone is used concomitantly with an anticholinergic drug. Acetaminophen; Oxycodone: (Moderate) Monitor for signs of urinary retention or reduced gastric motility during concomitant oxycodone and benztropine use. Calcium Carbonate; Risedronate: (Major) Avoid concomitant use of calcium carbonate and anticholinergics. Routine therapeutic monitoring should be continued when an antimuscarinic agent is prescribed with digoxin until the effects of combined use are known. Concomitant use may increase the risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. In idiopathic parkinsonism, therapy may be initiated with a single daily dose of 0.5 to 1 mg at bedtime. Curr Ther Res. Last updated on Feb 15, 2023. Concomitant use may increase the risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Benztropine: Generic, Uses, Side Effects, Dosages, Interactions, The clinical significance of these potential interactions is uncertain. WebMovement disorders, including extrapyramidal symptoms (EPS; parkinsonism, dystonia, akathisia and tardive dyskinesia), are very common adverse effects in patients taking antipsychotics [Margolese et al. Benzatropine Mesilate Additive drowsiness or other additive CNS effects may also occur. Acute dystonic reactions generally respond to 1 or 2 mg IV or IM, followed by an oral dose to prevent recurrence. Cetirizine: (Moderate) Monitor for signs or symptoms of anticholinergic toxicity during concomitant cetirizine and benztropine use. Clinicians should note that antimuscarinic effects might be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation. ocular hypertension / Delayed / Incidence not knowntoxic megacolon / Delayed / Incidence not knownileus / Delayed / Incidence not known, constipation / Delayed / 10.0confusion / Early / Incidence not knownhallucinations / Early / Incidence not knowndelirium / Early / Incidence not knownpsychosis / Early / Incidence not knowndepression / Delayed / Incidence not knownmemory impairment / Delayed / Incidence not knowncycloplegia / Early / Incidence not knownblurred vision / Early / Incidence not knownparotitis / Delayed / Incidence not knownhyperthermia / Delayed / Incidence not knownheat intolerance / Early / Incidence not knownanhidrosis / Delayed / Incidence not knownurinary retention / Early / Incidence not knowndysuria / Early / Incidence not knownsinus tachycardia / Rapid / Incidence not knownmyasthenia / Delayed / Incidence not known, xerostomia / Early / 10.0nausea / Early / 10.0drowsiness / Early / Incidence not knownheadache / Early / Incidence not knownanxiety / Delayed / Incidence not knowndizziness / Early / Incidence not knowninsomnia / Early / Incidence not knownparesthesias / Delayed / Incidence not knownmydriasis / Early / Incidence not knownvomiting / Early / Incidence not knownfever / Early / Incidence not knownrash / Early / Incidence not knownweakness / Early / Incidence not knownasthenia / Delayed / Incidence not known. Symptoms of extrapyramidal effects include an inability to sit still, involuntary muscle contraction, tremors, stiff muscles, and involuntary facial movements. Initial dose: 1 to 2 mg orally or IM/IV 2 to 3 times a day. Additive drowsiness may also occur, depending on the anticholinergic agent used. Olanzapine exhibits anticholinergic activity. Prolongation of the gastrointestinal transit time may be the mechanism of the constipating effect. Strive to find the lowest effective dose and periodically attempt to remove the anticholinergics to avoid using anticholinergics long-term. Macimorelin: (Major) Avoid use of macimorelin with drugs that may blunt the growth hormone response to macimorelin, such as antimuscarinic anticholinergic agents. Ingrezza Tiotropium; Olodaterol: (Major) Avoid concomitant use of anticholinergic medications and tiotropium due to increased risk for anticholinergic adverse effects. Concomitant use is not recommended. The concomitant use of nalbuphine and anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Calcium Carbonate; Magnesium Hydroxide: (Major) Avoid concomitant use of calcium carbonate and anticholinergics. Categorized as an extrapyramidal system side effect (EPS), akathisia can result in substantial noncompliance with antipsychotic medication. Blurred vision, constipation, and dry mouth may be more prominent additive effects. Dystonia, akathisia (motor restlessness), and Parkinsonism are commonly subsumed under this heading as phenomena that usually emerge acutely. The usual daily dose is 1 to 2 mg, with a range of 0.5 to 6 mg parenterally. US-based MDs, DOs, NPs and PAs in full-time patient practice can register for free on PDR.net. Concomitant use may result in additive anticholinergic adverse effects. WebThe treatment of choice for this poorly understood phenomenon is to lower the dosage of the antipsychotic. Benztropine is indicated to be used as an adjunct in the therapy of all forms of parkinsonism. While some patients may benefit from this interaction, clinicians should be ready to decrease doses of levodopa if benztropine is added. Very few pregnancies are reported to have exposure to benztropine. Concomitant use may result in additive anticholinergic adverse effects. blurry vision. Akathisia, also spelled acathisia, is a neuropsychiatric syndrome or movement disorder characterized by inner restlessness and the inability to sit or stand still for a reasonable period of time. Nurserachet888. Postencephalitic and Idiopathic Parkinsonism: We comply with the HONcode standard for trustworthy health information. Carbidopa; Levodopa; Entacapone: (Minor) Through its central antimuscarinic actions, antimuscarinics such as benztropine can potentiate the dopaminergic effects of levodopa. Donepezil: (Moderate) The therapeutic benefits of donepezil, a cholinesterase inhibitor, may be diminished during chronic co-administration with antimuscarinics or medications with potent anticholinergic activity. With many of the listed agents, additive drowsiness may also occur when combined with trospium. If you are unclear why benztropine is being Stomach upset, nausea, vomiting (try taking the benztropine dose with food) Concurrent use of lurasidone and medications with anticholinergic activity may contribute to heat-related disorders. The manufacturer has not conducted specific studies to determine the rate of administration or dilution requirements prior to IV administration. It is not intended to be a substitute for the exercise of professional judgment. Clinical experience has not identified differences in efficacy or safety relevant to younger adults; however, because geriatric patients may be more sensitive to anticholinergic effects, the dose should be started at the low end of the dosage range and increased only as needed and with close monitoring for adverse events. Prolongation of the gastrointestinal transit time may be the mechanism of the constipating effect. Per the manufaturer, avoid concomitant administration of umeclidinium with other anticholinergic medications when possible. local exposure to high potassium concentration) Beyond anxiety and agitation: A clinical approach The oral route is preferred when addressing initial or acute symptoms of drug-induced parkinsonism. Lurasidone: (Moderate) Antipsychotic agents may disrupt core temperature regulation; therefore, caution is recommended during concurrent use of lurasidone and medications with anticholinergic activity such as antimuscarinics. Side effects, drug interactions, dosage, and pregnancy safety should be reviewed prior to taking this medication. Cogentin is less sedating and more targeted toward EPS. Use of these medications together may impact the accuracy of the macimorelin growth hormone test. Data not available. Initially, 1 mg on first day. Drugs.com
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