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| {{DrugProjectFormSinglePage
| | #REDIRECT [[Benztropine]] |
| |authorTag={{AJ}}
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| |aOrAn=an
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| |drugClass=[[anticholinergic]]
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| |indicationType=treatment
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| |indication=[[Postencephalitic parkinsonism|postencephalitic]] and [[parkinsonism|idiopathic parkinsonism]] and [[Extrapyramidal side effect|drug-induced|extrapyramidal disorders]]
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| |adverseReactions=[[tachycardia]], [[constipation]], [[nausea]], [[xerostomia]], [[blurred vision]], [[dysuria]], and [[urinary retention]]
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| <!--Black Box Warning-->
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| |blackBoxWarningTitle=Title
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| |blackBoxWarningBody=<i><span style="color:#FF0000;">ConditionName: </span></i>
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| * Content
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| <!--Adult Indications and Dosage-->
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| <!--FDA-Labeled Indications and Dosage (Adult)-->
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| |fdaLIADAdult======Postencephalitic and Idiopathic Parkinsonism=====
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| *The usual daily dose is 1 to 2 mg, with a range of 0.5 to 6 mg orally.
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| *As with any agent used in [[parkinsonism]], dosage must be individualized accordingto age and weight. and the type of [[parkinsonism]] being treated. Generally, older patients, and thin patients cannot tolerate large doses. Most patients with [[parkinsonism|postencephalitic parkinsonism]] need fairly large doses and tolerate them well. Patients with a poor mental outlook are usually poor candidates for therapy.
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| *In [[parkinsonism|idiopathic parkinsonism]], therapy may be initiated with a single daily dose of 0.5 to 1 mg at bedtime. In some patients, this will be adequate; in others 4 to 6 mg a day may be required.
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| *In [[parkinsonism|postencephalitic parkinsonism]], therapy may be initiated in most patients with 2 mg a day in one or more doses. In highly sensitive patients, therapy may be initiated with 0.5 mg at bedtime, and increased as necessary.
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| *Some patients experience greatest relief by taking the entire dose at bedtime; others react more favorably to divided doses, two to four times a day. Frequently, one dose a day is sufficient, and divided doses may be unnecessary or undesirable.
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| *The long duration of action of this drug makes it particularly suitable for bedtime medication when its effects may last throughout the night, enabling patients to turn in bed during the night more easily, and to rise in the morning.
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| *When benztropine mesylate is started, do not terminate therapy with other [[antiparkinsonian]] agents abruptly. If the other agents are to be reduced or discontinued, it must be done gradually. Many patients obtain greatest relief with combination therapy.
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| *Benztropine mesylate may be used concomitantly with [[Carbidopa]]-[[Levodopa]], or with [[levodopa]], in which case periodic dosage adjustment may be required in order to maintain optimum response.
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| =====Drug-Induced Extrapyramidal Disorders=====
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| *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. Dosage must be individualized according to the need of the patient. Some patients require more than recommended; others do not need as much.
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| *In [[Dystonic reaction|acute dystonic reactions]], 1 to 2 mL of the injection usually relieves the condition quickly. After that, the tablets 1 to 2 mg twice a day, usually prevents recurrence.
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| *When [[Extrapyramidal disorder|extrapyramidal disorders]] develop soon after initiation of treatment with [[Neuroleptics|neuroleptic drugs]] (e.g., [[phenothiazines]]), they are likely to be transient. One to 2 mgof benztropine mesylate tablets two or three times a day usually provides relief within one or two days. After one or two weeks the drug should be withdrawn to determine the continued need for it. If such disorders recur, benztropine mesylate can be reinstituted.
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| *Certain [[Extrapyramidal disorder|drug-induced extrapyramidal disorders]] that develop slowly may not respond to benztropine mesylate.
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| <!--Off-Label Use and Dosage (Adult)-->
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| <!--Guideline-Supported Use (Adult)-->
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| |offLabelAdultGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
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| <!--Non–Guideline-Supported Use (Adult)-->
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| |offLabelAdultNoGuideSupport======Excessive salivation, Medical condition-associated; Prophylaxis=====
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| *Benztropine daily doses of 3.8 mg.
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| <!--Pediatric Indications and Dosage-->
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| <!--FDA-Labeled Indications and Dosage (Pediatric)-->
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| |fdaLIADPed======Condition1=====
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| * Dosing Information
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| :* Dosage
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| =====Condition2=====
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| There is limited information regarding <i>FDA-Labeled Use</i> of {{PAGENAME}} in pediatric patients.
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| <!--Off-Label Use and Dosage (Pediatric)-->
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| <!--Guideline-Supported Use (Pediatric)-->
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| |offLabelPedGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
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| <!--Non–Guideline-Supported Use (Pediatric)-->
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| |offLabelPedNoGuideSupport======Excessive [[salivation]], Medical condition-associated; Prophylaxis=====
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| *Benztropine daily doses of 3.8 mg.
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| <!--Contraindications-->
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| |contraindications=*[[Hypersensitivity]] to benztropine mesylate tablets.
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| *Because of its atropine-like side effects, this drug is contraindicated in [[pediatric]] patients under three years of age, and should be used with caution in older [[pediatric]] patients.
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| <!--Warnings-->
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| |warnings=* Safe use in pregnancy has not been established.
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| *Benztropine mesylate may impair mental and/or physical abilities required for performance of hazardous tasks, such as operating machinery or driving a motorvehicle.
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| *When benztropine mesylate is given concomitantly with [[phenothiazines]], [[haloperidol]],or other drugs with [[anticholinergic]] or [[antidopaminergic]] activity, patients should be advised to report [[gastrointestinal]] complaints, [[fever]] or [[hyperthermia|heat intolerance]] promptly. [[Paralytic ileus]], [[hyperthermia]] and [[heat stroke]], all of which have sometimes been fatal, have occurred in patients taking [[anticholinergic]]-type [[antiparkinsonism]] drugs, including benztropine mesylate, in combination with phenothiazines and/or [[tricyclic antidepressants]].
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| *Since benztropine mesylate contains structural features of [[atropine]], it may produce [[anhidrosis]]. For this reason, it should be administered with caution during hot weather, especially when given concomitantly with other [[atropine]]-like drugs to thechronically ill, the alcoholic, those who have [[central nervous system]] disease, and those who do manual labor in a hot environment. [[Anhidrosis]] may occur more readily when some disturbance of [[sweating]] already exists. If there is evidence of [[anhidrosis]], the possibility of [[hyperthermia]] should be considered.Dosage should be decreased at the discretion of the physician so that the ability to maintain body [[heat]] equilibrium by [[perspiration]] is not impaired. Severe [[anhidrosis]] and fatal [[hyperthermia]] have occurred.
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| ====Precautions====
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| *Since benztropine mesylate has cumulative action, continued supervision is advisable. Patients with a tendency to [[tachycardia]] and patients with [[prostatic hypertrophy]] should be observed closely during treatment.
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| *[[Dysuria]] may occur, but rarely becomes a problem. Urinary retention has been reported with benztropine mesylate.
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| *The drug may cause complaints of weakness and inability to move particular muscle groups, especially in large doses. For example, if the neck has been [[rigid]] and suddenly [[relaxes]], it may feel weak, causing some concern. In this event, dosage adjustment is required.
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| *Mental [[confusion]] and excitement may occur with large doses, or in susceptible patients. [[Visual hallucinations]] have been reported occasionally. Furthermore, in the treatment of [[Extrapyramidal disorder|extrapyramidal disorders]] due to [[neuroleptic]] drugs (e.g.,[[phenothiazines]]), in patients with [[mental disorders]], occasionally there may be intensification of mental symptoms. In such cases, [[antiparkinsonian]] drugs can precipitate a toxic [[psychosis]]. Patients with [[mental disorders]] should be kept under careful observation, especially at the beginning of treatment or if dosage is increased.
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| *[[Tardive dyskinesia]] may appear in some patients on long-term therapy with [[phenothiazines]] and related agents, or may occur after therapy with these drugs has been discontinued. [[Antiparkinsonism]] agents do not alleviate the symptoms of [[tardive dyskinesia]], and in some instances may aggravate them. Benztropine mesylate is not recommended for use in patients with [[tardive dyskinesia]].
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| *The physician should be aware of the possible occurrence of [[glaucoma]]. Although the drug does not appear to have any adverse effect on simple [[glaucoma]], it probably should not be used in [[angle-closure glaucoma]].
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| <!--Adverse Reactions-->
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| <!--Clinical Trials Experience-->
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| |clinicalTrials=*The adverse reactions below, most of which are [[Anticholinergic|antichlolinergic]] in nature, have been reported and within each category are listed in order of decreasing severity.
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| =====Cardiovascular=====
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| [[Tachycardia]].
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| =====Digestive=====
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| [[Paralytic ileus]], [[constipation]], [[vomiting]], [[nausea]], [[dry mouth]].
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| If [[dry mouth]] is so severe that there is difficulty in [[swallowing]] or speaking, or [[loss of appetite]] and weight, reduce dosage, or discontinue the drug temporarily.
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| Slight reduction in dosage may control [[nausea]] and still give sufficient relief of symptoms. [[Vomiting]] may be controlled by temporary discontinuation, followed by resumption at a lower dosage.
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| =====Nervous System=====
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| Toxic [[psychosis]], including [[confusion]], [[disorientation]], [[memory impairment]], [[visual hallucinations]]; exacerbation of pre-existing [[psychotic]] symptoms; [[nervousness]]; [[depression]]; [[listlessness]]; [[numbness]] of fingers.
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| =====Special Senses=====
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| [[Blurred vision]], [[dilated pupils]].
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| =====Urogenital=====
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| [[Urinary retention]], [[dysuria]].
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| =====Metabolic/Immune or Skin=====
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| Occasionally, an [[allergic reaction]], e.g., [[skin rash]], develops. If this cannot be controlled by dosage reduction, the medication should be discontinued.
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| =====Other=====
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| [[Heat stroke]], [[hyperthermia]], [[fever]].
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| <!--Postmarketing Experience-->
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| |postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} in the drug label.
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| <!--Drug Interactions-->
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| |drugInteractions=<!--Use in Specific Populations-->
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| |useInPregnancyFDA=* '''Pregnancy Category'''
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| |useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
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| There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
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| |useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
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| |useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
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| |useInPed=*Because of the atropine-like side effects, benztropine mesylate should be used with caution in pediatric patients over three years of age.
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| |useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
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| |useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
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| |useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
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| |useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
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| |useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
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| |useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
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| |useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
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| <!--Administration and Monitoring-->
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| |administration=* Oral
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| * Intravenous
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| |monitoring=There is limited information regarding <i>Monitoring</i> of {{PAGENAME}} in the drug label.
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| <!--IV Compatibility-->
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| |IVCompat=There is limited information regarding <i>IV Compatibility</i> of {{PAGENAME}} in the drug label.
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| <!--Overdosage-->
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| |overdose====Acute Overdose===
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| ====Signs and Symptoms====
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| *May be any of those seen in [[atropine]] [[poisoning]] or [[antihistamine]] [[overdosage]]: [[CNS depression]], preceded or followed by stimulation; [[confusion]]; [[nervousness]]; [[listlessness]]; intensification of mental symptoms or toxic [[psychosis]] in patients with mental illness being treated with [[neuroleptic]] drugs (e.g.,[[phenothiazines]]); [[hallucinations]] (especially visual); [[dizziness]]; [[muscle weakness]]; [[ataxia]]; [[dry mouth]]; [[mydriasis]]; [[blurred vision]]; [[palpitations]]; [[tachycardia]]; [[elevated blood pressure]]; [[nausea]]; [[vomiting]]; [[dysuria]]; [[numbness]] of fingers; [[dysphagia]]; [[allergic reactions]], e.g., [[skin rash]]; [[headache]]; hot, [[dry skin|dry]], [[flushing|flushed skin]]; [[delirium]]; [[coma]]; [[shock]]; [[convulsions]]; [[respiratory arrest]]; [[anhidrosis]]; [[hyperthermia]]; [[glaucoma]]; [[constipation]].
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| ====Management====
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| *[[Physostigmine]] salicylate, 1 to 2 mg, SC or IV, reportedly will reverse symptoms of [[anticholinergic]] intoxication.* A second injection may be given after 2 hours if required. Otherwise treatment is symptomatic and supportive. Induce [[emesis]] or perform [[gastric lavage]] (contraindicated in [[coma|precomatose]] convulsive, or [[psychotic]] states). Maintain [[respiration]]. A short-acting [[barbiturate]] may be used for [[CNS]] excitement, but with caution to avoid subsequent [[depression]]; supportive care for [[depression]] (avoid [[convulsant]] stimulants such as [[picrotoxin]], [[pentylenetetrazol]],or [[bemegride]]); artificial [[respiration]] for severe [[respiratory depression]]; a local [[miotic]] for [[mydriasis]] and [[cycloplegia]]; ice bags or other cold applications and [[alcohol]] sponges for [[hyperpyrexia]], a [[vasopressor]] and [[fluids]] for [[collapse|circulatory collapse]]. Darken room for [[photophobia]].
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| ===Chronic Overdose===
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| There is limited information regarding <i>Chronic Overdose</i> of {{PAGENAME}} in the drug label.
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| <!--Pharmacology-->
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| <!--Drug box 2-->
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| |drugBox={{drugbox2
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| | Verifiedfields = changed
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| | Watchedfields = changed
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| | verifiedrevid = 456483119
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| | IUPAC_name = (3-''endo'')-3-(Diphenylmethoxy)-8-methyl-8-azabicyclo[3.2.1]octane
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| | image = Benzatropine00.png
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| | drug_name = Benzatropine
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| <!--Clinical data-->
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| | tradename = Cogentin
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| | Drugs.com = {{drugs.com|monograph|cogentin}}
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| | pregnancy_US = C
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| | pregnancy_category =
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| | legal_US = Rx-only
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| | routes_of_administration = Oral, [[Intramuscular injection|IM]], [[Intravenous therapy|IV]]
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| <!--Pharmacokinetic data-->
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| | bioavailability =
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| | metabolism = Hepatic
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| | elimination_half-life = 12-24 hours
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| | excretion = Urine
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| <!--Identifiers-->
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| | synonyms = Benztropine
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| | CASNo_Ref = {{cascite|correct|CAS}}
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| | CAS_number_Ref = {{cascite|correct|??}}
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| | CAS_number = 86-13-5
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| | ATC_prefix = N04
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| | ATC_suffix = AC01
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| | PubChem = 1201549
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| | DrugBank_Ref = {{drugbankcite|changed|drugbank}}
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| | DrugBank = DB00245
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| | ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
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| | ChemSpiderID = 16736541
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| | UNII_Ref = {{fdacite|correct|FDA}}
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| | UNII = 1NHL2J4X8K
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| | ChEBI_Ref = {{ebicite|correct|EBI}}
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| | ChEBI = 3048
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| | ChEMBL_Ref = {{ebicite|changed|EBI}}
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| | ChEMBL = 1201203
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| <!--Chemical data-->
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| | C=21 | H=25 | N=1 | O=1
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| | molecular_weight = 307.429 g/mol
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| | smiles = CN4[C@@H]1CC[C@H]4C[C@H](C1)OC(c2ccccc2)c3ccccc3
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| | InChI = 1/C21H25NO/c1-22-18-12-13-19(22)15-20(14-18)23-21(16-8-4-2-5-9-16)17-10-6-3-7-11-17/h2-11,18-21H,12-15H2,1H3/t18-,19+,20+
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| | StdInChI_Ref = {{stdinchicite|correct|chemspider}}
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| | StdInChI = 1S/C21H25NO/c1-22-18-12-13-19(22)15-20(14-18)23-21(16-8-4-2-5-9-16)17-10-6-3-7-11-17/h2-11,18-21H,12-15H2,1H3/t18-,19+,20+
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| | StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
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| | StdInChIKey = GIJXKZJWITVLHI-PMOLBWCYSA-N
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| }}
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| <!--Mechanism of Action-->
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| |mechAction=* Benztropine mesylate possesses both [[anticholinergic]] and [[antihistaminic]] effects,although only the former have been established as therapeutically significant in the management of [[parkinsonism]].
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| <!--Structure-->
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| |structure=*Benztropine Mesylate is a synthetic compound containing structural features found in atropine and diphenhydramine.
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| *It is a crystalline white powder, very soluble in water, designated as 3α-(Diphenylmethoxy)-1αH, 5αH-tropane methanesulfonate, with the following structural formula:
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| : [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
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| *Each tablet, for oral administration, contains 0.5 mg, 1 mg or 2 mg of benztropine mesylate.
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| *Each tablet contains the following inactive ingredients: dibasic calcium phosphate lactose monohydrate, lactose anhydrous, microcrystalline cellulose, cornstarch,talc and hydrogenated vegetable oil.
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| <!--Pharmacodynamics-->
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| |PD=There is limited information regarding <i>Pharmacodynamics</i> of {{PAGENAME}} in the drug label.
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| <!--Pharmacokinetics-->
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| |PK=There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.
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| <!--Nonclinical Toxicology-->
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| |nonClinToxic=There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.
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| <!--Clinical Studies-->
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| |clinicalStudies=There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.
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| <!--How Supplied-->
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| |howSupplied=* Benztropine Mesylate Tablets, USP are available as follows:
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| :*0.5 mg white, round, bisected, compressed tablets, debossed “EP 136”, in bottles of 100 (NDC 64125-136-01) and 1000 (NDC 64125-136-10) tablets.
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| :*1 mg white, oval, bisected, compressed tablets debossed “EP 137”, in bottles of 100 (NDC 64125-137-01) and 1000 (NDC 64125-137-10) tablets.
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| :*2 mg white, round, bisected, compressed tablets, debossed “EP 138”, in bottles of100 (NDC 64125-138-01) and 1000 (NDC 64125-138-10) tablets.
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| *Dispense in a well-closed container as defined in the USP, with a child-resistant closure.
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| *Store at 20°-25°C (68°-77°F).
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| <!--Patient Counseling Information-->
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| |fdaPatientInfo=There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.
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| <!--Precautions with Alcohol-->
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| |alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
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| <!--Brand Names-->
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| |brandNames=* BENZTROPINE MESYLATE®<ref>{{Cite web | title = BENZTROPINE MESYLATE- benztropine mesylate tablet | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=37eef247-c418-4cbe-aff2-d74d032ede1c }}</ref>
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| <!--Look-Alike Drug Names-->
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| |lookAlike=<!--Drug Shortage Status-->
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| |drugShortage=
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| }}
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| {{PillImage
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| |fileName=No image.jpg
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| }}
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| <!--Pill Image-->
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| <!--Label Display Image-->
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| {{LabelImage
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| |fileName={{PAGENAME}}11.png|This image is provided by the National Library of Medicine.
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| }}
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| {{LabelImage
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| |fileName={{PAGENAME}}11.png|This image is provided by the National Library of Medicine.
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| }}
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| <!--Category-->
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| [[Category:Drug]]
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