Benzatropine

Benzatropine
Clinical data
Routes of; administration	Oral, IM, IV
ATC code	N04AC01 (WHO) ;
Pharmacokinetic data
Elimination half-life	36 hours
Identifiers
	IUPAC name (3-endo)-3-(diphenylmethoxy)-8-methyl-8-azabicyclo[3.2.1]octane;
CAS Number	86-13-5;
PubChem CID	1201549;
DrugBank	APRD00748;
CompTox Dashboard (EPA)	DTXSID9022659 ;
Chemical and physical data
Formula	C21H25NO
Molar mass	307.429 g/mol g·mol−1
3D model (JSmol)	Interactive image;
	SMILES CN4[C@@H]1CC[C@H]4C[C@H](C1)OC(c2ccccc2)c3ccccc3;

Benzatropine mesilate (INN), benztropine mesylate, or benztropine (USAN) marketed as Cogentin, is an anticholinergic drug principally used for the treatment of:

Drug-induced parkinsonism, akathisia and acute dystonia;
Parkinson disease; and
Idiopathic or secondary dystonia.

Benzatropine is a centrally acting anticholinergic agent resulting from the combination of the tropine portion of the atropine molecule and the benzohydryl portion of diphenhydramine. Animal studies have indicated that anticholinergic activity of benzatropine is approximately one-half that of atropine, while antihistaminic activity approaches that of pyrilamine. Its anticholinergic effects have been established as therapeutically significant in the management of parkinsonism. Benzatropine antagonises the effect of acetylcholine, decreasing the imbalance between the neurotransmitters acetylcholine and dopamine, which may improve the symptoms of early Parkinson's disease. ^[1]

Indications

It is used in patients to reduce the side effects of antipsychotic treatment, such as parkinsonism and akathisia.

Benzatropine is also a second-line drug for the treatment of Parkinson's disease. It improves tremor but not rigidity. Benzatropine is also sometimes used for the treatment of dystonia, a rare disorder that causes abnormal muscle contraction, resulting in twisting postures of limbs, trunk, or face.

Side effects

These are principally anticholinergic:

Dry mouth
Blurred vision
Cognitive changes
Constipation
Urinary retention
Tachycardia
Anorexia
Psychosis (an overdose situation)

Some studies suggest that use of anticholinergics increases the risk of tardive dyskinesia, a long-term side effect of antipsychotics.^[2]^[3]

Other studies have found no association between anticholinergic exposure and risk of developing tardive dyskinesia.^[4]

References

^ MIMS Australia Pty Ltd. MIMS.
^ "Arch Gen Psychiatry -- Abstract: Tardive dyskinesia: prevalence and risk factors, 1959 to 1979, April 1982, Kane and Smith 39 (4): 473". Retrieved 2007-08-14.
^ Wszola BA, Newell KM, Sprague RL (2001). "Risk factors for tardive dyskinesia in a large population of youths and adults". Experimental and clinical psychopharmacology. 9 (3): 285–96. doi:10.1037/1064-1297.9.3.285. PMID 11534539.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ van Harten PN, Hoek HW, Matroos GE, Koeter M, Kahn RS (1998). "Intermittent neuroleptic treatment and risk for tardive dyskinesia: Curaçao Extrapyramidal Syndromes Study III". The American journal of psychiatry. 155 (4): 565–7. PMID 9546009.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[1] MIMS Australia Pty Ltd. MIMS.

[2] "Arch Gen Psychiatry -- Abstract: Tardive dyskinesia: prevalence and risk factors, 1959 to 1979, April 1982, Kane and Smith 39 (4): 473". Retrieved 2007-08-14.

[pmid11534539-3] Wszola BA, Newell KM, Sprague RL (2001). "Risk factors for tardive dyskinesia in a large population of youths and adults". Experimental and clinical psychopharmacology. 9 (3): 285–96. doi:10.1037/1064-1297.9.3.285. PMID 11534539.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[pmid9546009-4] van Harten PN, Hoek HW, Matroos GE, Koeter M, Kahn RS (1998). "Intermittent neuroleptic treatment and risk for tardive dyskinesia: Curaçao Extrapyramidal Syndromes Study III". The American journal of psychiatry. 155 (4): 565–7. PMID 9546009.{{cite journal}}: CS1 maint: multiple names: authors list (link)

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