Benztropine (Cogentin) is an older anticholinergic agent primarily used for movement-type disorders and adverse effects. I’ll share some of my most important benztropine clinical pearls in this article.

Benztropine can be used in the management of acute dystonia. Dystonia is defined as “a state of abnormal muscle tone resulting in muscular spasm and abnormal posture, typically due to neurological disease or a side effect of drug therapy.” If it is an emergency situation, benztropine has an injectable formulation to be given IM or IV.

One way to tackle polypharmacy is to pay attention to why benztropine was added in the first place. I have seen numerous patients on benztropine and not receiving concomitant antipsychotic therapy. When I see this, it always prompts me to look at the past history of the patient and figure out what was the original indication for the benztropine was. There have been a significant number of times in my career where we have been able to taper down and off the benztropine.

Benztropine is highly anticholinergic. You are likely to see adverse effects because of its pharmacologic action. Dry mouth, dry eyes, and constipation are highly prevalent. More significantly, the risk of confusion, falls, and urinary retention exists as well. Here are some classic examples of the prescribing cascade caused by anticholinergic activity.

Patients with schizophrenia who are treated with long antipsychotics may have been placed on benztropine many years prior to the first time you interact with the patient. As patients age, benztropine may need to be reduced as the likelihood of experiencing anticholinergic side effects may go up. In addition to pharmacokinetic alterations due to natural aging, we need to remember that patients may be getting placed on other medications that can have additive anticholinergic effects. Continually assess if the benztropine dose remains appropriate and ensure that we are at the minimum effective dose. Hopefully these benztropine clinical pearls help you in your practice!

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