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Cogentin (benztropine) Disease Interactions

There are 12 disease interactions with Cogentin (benztropine):

Major

Antiperistaltic Agents (Includes Cogentin) ↔ Infectious Diarrhea

Severe Potential Hazard, High plausibility

Applies to: Infectious Diarrhea/Enterocolitis/Gastroenteritis

The use of drugs with antiperistaltic activity (primarily antidiarrheal and antimuscarinic agents, but also antispasmodic agents such as dicyclomine or oxybutynin at high dosages) is contraindicated in patients with diarrhea due to pseudomembranous enterocolitis or enterotoxin-producing bacteria. These drugs may prolong and/or worsen diarrhea associated with organisms that invade the intestinal mucosa, such as toxigenic E. coli, Salmonella and Shigella, and pseudomembranous colitis due to broad-spectrum antibiotics. Other symptoms and complications such as fever, shedding of organisms and extraintestinal illness may also be increased or prolonged. In general, because antiperistaltic agents decrease gastrointestinal motility, they may delay the excretion of infective gastroenteric organisms or toxins and should be used cautiously in patients with any infectious diarrhea, particularly if accompanied by high fever or pus or blood in the stool. Some cough and cold and other combination products may occasionally include antimuscarinic agents for their drying effects and may, therefore, require careful selection when necessary.

References

  1. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  2. Brown JW "Toxic megacolon associated with loperamide therapy." JAMA 241 (1979): 501-2
  3. Walley T, Milson D "Loperamide related toxic megacolon in Clostridium difficile colitis." Postgrad Med J 66 (1990): 582
  4. Marshall WF Jr, Rosenthal P, Merritt RJ "Atropine therapy and paralytic ileus in an infant." J Pediatr Gastroenterol Nutr 9 (1989): 532-4
  5. "Lomotil for diarrhea in children." Med Lett Drugs Ther 17 (1975): 104
  6. "Product Information. Imodium (loperamide)." Janssen Pharmaceutica, Titusville, NJ.
View all 6 references
Moderate

Antimuscarinics (Includes Cogentin) ↔ Psychoses

Moderate Potential Hazard, Moderate plausibility

Applies to: Psychosis

Toxic psychosis manifested as confusion, disorientation, agitation, excitation, memory impairment, delusions and hallucinations may develop at toxic and therapeutic dosages of antimuscarinic agents. Therapy with these agents should be administered cautiously in patients with mental disorders receiving antimuscarinic agents for control of drug-induced extrapyramidal effects, especially at the beginning of therapy or during dosage adjustment. Psychiatric deterioration and psychotic flare-ups have also been reported following withdrawal of therapy. Symptoms include delusions, hallucinations, aggression or violent behavior, and suicidal tendencies. In high dosages, antimuscarinic agents may sometimes produce euphorigenic effects. For this reason, it can be a drug of abuse.

References

  1. Goggin DA, Solomon GF "Trihexyphenidyl abuse for euphorigenic effect." Am J Psychiatry 136 (1979): 459-60
  2. Baker LA, Cheng LY, Amara IB "The withdrawal of benztropine mesylate in chronic schizophrenic patients." Br J Psychiatry 143 (1983): 584-90
  3. Kulik AV, Wilbur R "Delirium and stereotypy from anticholinergic antiparkinson drugs." Prog Neuropsychopharmacol Biol Psychiatry 6 (1982): 75-82
  4. Jellinek T, Gardos G, Cole JO "Adverse effects of antiparkinson drug withdrawal." Am J Psychiatry 138 (1981): 1567-71
  5. McInnis M, Petursson H "Trihexyphenidyl dependence." Acta Psychiatr Scand 69 (1984): 538-42
  6. Craig DH, Rosen P "Abuse of antiparkinsonian drugs." Ann Emerg Med 10 (1981): 98-100
  7. Kaminer Y, Munitz H, Wijsenbeek H "Trihexyphenidyl (Artane) abuse: euphoriant and anxiolytic." Br J Psychiatry 140 (1982): 473-4
  8. Warnes H "Toxic psychosis due to antiparkinsonian drugs." Can Psychiatr Assoc J 12 (1967): 323-6
  9. Yassa R "Antiparkinsonian medication withdrawal in the treatment of tardive dyskinesia: a report of three cases." Can J Psychiatry 30 (1985): 440-2
  10. Woody GE, O'Brien CP "Anticholinergic toxic psychosis in drug abusers treated with benztropine." Compr Psychiatry 15 (1974): 439-42
  11. Pullen GP, Best NR, Maguire J "Anticholinergic drug abuse: a common problem?" Br Med J (Clin Res Ed) 289 (1984): 612-3
  12. Laski E, Taleporos E "Anticholinergic psychosis in a bilingual: a case study." Am J Psychiatry 134 (1977): 1038-40
  13. Mohan D, Mohandas E, Dube S "Trihexyphenidyl abuse." Br J Addict 76 (1981): 195-7
  14. Wilcox JA "Psychoactive properties of benztropine and trihexyphenidyl." J Psychoactive Drugs 15 (1983): 319-21
  15. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ.
  16. Brower KJ "Smoking of prescription anticholinergic drugs." Am J Psychiatry 144 (1987): 383
  17. Rubinstein JS "Abuse of antiparkinsonism drugs. Feigning of extrapyramidal symptoms to obtain trihexyphenidyl." JAMA 239 (1978): 2365-6
  18. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
  19. Hidalgo HA, Mowers RM "Anticholinergic drug abuse." DICP 24 (1990): 40-1
  20. Ananth JV, Jain RC "Benztropine psychosis." Can Psychiatr Assoc J 18 (1973): 409-14
  21. Moreau A, Jones BD, Banno V "Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia." Can J Psychiatry 31 (1986): 339-41
  22. Macvicar K "Abuse of antiparkinsonian drugs by psychiatric patients." Am J Psychiatry 134 (1977): 809-11
View all 22 references
Moderate

Benztropine (Includes Cogentin) ↔ Angle-Closure Glaucoma.

Moderate Potential Hazard, High plausibility

Applies to: Glaucoma/Intraocular Hypertension

Benztropine should not be used in angle-closure glaucoma. Although benztropine does not appear to have any adverse effect on simple glaucoma, it probably should not be used in angle-closure glaucoma as anticholinergics cause mydriasis and they may exacerbate this condition.

Moderate

Benztropine (Includes Cogentin) ↔ Anhydrosis

Moderate Potential Hazard, Moderate plausibility

Applies to: Alcoholism, CNS Disorder

Since benztropine contains structural features of atropine, it may produce anhidrosis. Benztropine should be administered with caution during hot weather, especially when given concomitantly with other atropine-like drugs to the chronically 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. Severe anhidrosis and fatal hyperthermia have occurred with the use of benztropine. Caution is recommended when prescribing benztropine to patients with inability to sweat normally.

Moderate

Benztropine (Includes Cogentin) ↔ Bph

Moderate Potential Hazard, Moderate plausibility

Applies to: Benign Prostatic Hyperplasia

Therapy with benztropine should be administered cautiously in patients with prostatic hypertrophy. Close monitoring is recommended when benztropine is prescribed to these patients.

Moderate

Benztropine (Includes Cogentin) ↔ Cns Disorders

Moderate Potential Hazard, Moderate plausibility

Applies to: CNS Disorder

The use of benztropine may cause mental confusion and excitement may occur with large doses, or in susceptible patients. In addition, visual hallucinations have been reported. Furthermore, in the treatment of 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.

Moderate

Benztropine (Includes Cogentin) ↔ Dysuria

Moderate Potential Hazard, Moderate plausibility

Applies to: Urinary Retention

Dysuria may occur with the use of benztropine, but it rarely becomes a problem. Also, urinary retention has been reported. Caution is advised even when using benztropine in patients with urinary blockage, particularly in elderly patients.

Moderate

Benztropine (Includes Cogentin) ↔ Gi Obstruction

Moderate Potential Hazard, High plausibility

Applies to: Gastrointestinal Obstruction, Esophageal Obstruction

Benztropine should be used with caution in patients with obstructive diseases such as achalasia, esophageal stricture or stenosis, pyloroduodenal stenosis, stenosing peptic ulcer, pyloric obstruction, and paralytic ileus. Anticholinergics may further suppress intestinal motility with resultant precipitation or aggravation of toxic megacolon. Caution is recommended when prescribing benztropine to these patients.

Moderate

Benztropine (Includes Cogentin) ↔ Hypertension

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypertension

Cardiovascular effects of anticholinergic agents may exacerbate hypertension. Therapy with benztropine should be administered cautiously in patients with hypertension.

Moderate

Benztropine (Includes Cogentin) ↔ Tachycardia

Moderate Potential Hazard, Moderate plausibility

Applies to: Arrhythmias, Congestive Heart Failure

Therapy with benztropine should be administered cautiously in patients with tachycardia, or congestive heart failure. Close monitoring is recommended when this agent is prescribed to these patients.

Moderate

Benztropine (Includes Cogentin) ↔ Tardive Dyskinesia

Moderate Potential Hazard, High plausibility

Applies to: Tardive Dyskinesia

Benztropine may precipitate symptoms of tardive dyskinesia (TD), a syndrome consisting of rhythmic involuntary movements variously involving the tongue, face, mouth, lips, jaw, and/or trunk and extremities, following chronic use of at least several months but often years. Elderly patients, particularly women, are most susceptible. Antiparkinsonism agents do not alleviate the symptoms of tardive dyskinesia, and in some instances may aggravate them. Benztropine is not recommended for use in patients with tardive dyskinesia.

Moderate

Atropine-Like Agents (Includes Cogentin) ↔ Fever

Minor Potential Hazard, Moderate plausibility

Applies to: Fever

Atropine-like agents may increase the risk of hyperthermia in patients with fever by producing anhidrosis. Therapy with atropine-like agents should be administered cautiously in febrile patients.

References

  1. Sarnquist F, Larson CP Jr "Drug-induced heat stroke." Anesthesiology 39 (1973): 348-50
  2. Lee BS "Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs." J Clin Psychiatry 47 (1986): 571
  3. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
  4. Stadnyk AN, Glezos JD "Drug-induced heat stroke." Can Med Assoc J 128 (1983): 957-9
  5. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  6. Forester D "Fatal drug-induced heat stroke." JACEP 7 (1978): 243-4
View all 6 references

Cogentin (benztropine) drug Interactions

There are 781 drug interactions with Cogentin (benztropine)

Cogentin (benztropine) alcohol/food Interactions

There are 2 alcohol/food interactions with Cogentin (benztropine)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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