benztropine

Adjunctive therapy

Brands: Cogentin

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

What is benztropine?
Benztropine (brand Cogentin; generics) is an anticholinergic antiparkinson agent. In psychiatry it is commonly used to treat antipsychotic-induced Parkinsonism and acute Dystonia, and it is sometimes used for other medication-induced extrapyramidal reactions (label/clinical).
What is Cogentin?
Cogentin is a brand name for benztropine.
What is Cogentin (benztropine) used for?
Label indications include: Parkinsonism; control of extrapyramidal disorders due to neuroleptic drugs (except tardive dyskinesia) (label).
What drug class is Cogentin (benztropine)?
Anticholinergic (antimuscarinic) antiparkinson agent used for parkinsonism and to control extrapyramidal reactions caused by neuroleptic drugs (except tardive dyskinesia). In psychiatric practice it is often used short term for drug-induced parkinsonism or acute dystonia, balancing symptomatic benefit against anticholinergic adverse effects (confusion, constipation, urinary retention).
What strengths does Cogentin (benztropine) come in?
Tablets: 0.5 mg, 1 mg, 2 mg (label/manufacturer-dependent).

Snapshot

Class: Adjunctive therapy
Common US brands: Cogentin
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-30

Label indications

Parkinsonism; control of extrapyramidal disorders due to neuroleptic drugs (except tardive dyskinesia) (label).

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Clinical Highlights

Benztropine (brand Cogentin; generics) is an anticholinergic antiparkinson agent. In psychiatry it is commonly used to treat antipsychotic-induced Parkinsonism and acute Dystonia, and it is sometimes used for other medication-induced extrapyramidal reactions (label/clinical). Benztropine does not treat tardive dyskinesia (TD) and may worsen it; labels and clinical reviews emphasize not using anticholinergics as TD treatment (label/clinical).

The main limitation is anticholinergic adverse effects (dry mouth, constipation, urinary retention, blurry vision, confusion), which can be particularly problematic in older adults or in patients with cognitive vulnerability (label/clinical).
In antipsychotic-induced parkinsonism, addressing the underlying driver (dose reduction, switching antipsychotic, or minimizing anticholinergic burden) is often considered alongside symptomatic medications (review).
The compare view, benztropine evidence feed, and benztropine print page support EPS counseling and shared decision-making.

Dosing & Formulations

Tablets: 0.5 mg, 1 mg, 2 mg (label/manufacturer-dependent). Label dosing for parkinsonism and neuroleptic-induced EPS is typically individualized: initiate low and increase gradually in 0.5 mg increments every 5–6 days, with a usual daily dose around 1–2 mg/day and a range up to 6 mg/day (label).

For acute Dystonia in urgent settings, parenteral anticholinergics are commonly used in practice; oral benztropine may be used for short-term continuation to prevent recurrence once symptoms resolve (clinical).
Because cumulative anticholinergic effects can build over days, the lowest effective dose and shortest effective duration are common goals (label/clinical).

Monitoring & Risks

Anticholinergic adverse effects: monitor bowel function, urinary retention, blurry vision, dry mouth, tachycardia, and confusion, especially in older adults (label/clinical). Cognitive and delirium risk increases with higher anticholinergic burden and polypharmacy; reassess need if attention, memory, or agitation worsens (review/clinical).

Heat intolerance and decreased sweating can occur; counsel about overheating risk during hot weather or strenuous activity (label).
In patients with Glaucoma risk or urinary obstruction symptoms, the risk–benefit calculation often shifts away from anticholinergics (label/clinical).

Drug Interactions

Additive anticholinergic burden occurs with TCAs, first-generation antihistamines, many antipsychotics (notably clozapine), and other anticholinergic agents; regimen review is often higher yield than “stacking” anticholinergics (clinical). Sedatives and alcohol can worsen dizziness and falls risk when anticholinergic load is high (clinical).

Anticholinergics can counteract cholinesterase inhibitors; co-use is typically avoided when dementia medications are present (clinical).

Practice Notes

For antipsychotic-induced parkinsonism, many frameworks emphasize first assessing whether antipsychotic dose reduction or switching is feasible before adding chronic anticholinergic therapy (Wisidagama 2021/clinical). When anticholinergic cognitive burden is a concern, amantadine is sometimes considered as an alternative symptomatic option (clinical).

Avoid “automatic prophylaxis” (routine benztropine with every antipsychotic) unless there is a clear indication and follow-up plan, because unnecessary anticholinergic exposure can worsen cognition and constipation (review/clinical).

References

Benztropine mesylate tablets prescribing information — DailyMed (2025)
Recognition AND Management OF Antipsychotic Induced Parkinsonism IN Older Adults A Narrative Review — Medicines (2021)
Managing Antipsychotic Induced Acute AND Tardive Dystonia — Drug Safety (1998)
Anticholinergic Burden and Cognitive Performance in Patients With Schizophrenia A Systematic Literature Review — Frontiers in Psychiatry (2021)
AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)