(FDA approved in bold)

• Extrapyramidal disorders
  
• Parkinsonism
  
• Acute dystonic reactions
  
• Idiopathic generalized dystonia
  
• Focal dystonias
  
• Dopa-responsive dystonia

• In PD, there is a relative excess of cholinergic input. Benztropine is a synthetic anticholinergic with relatively greater CNS activity than most other anticholinergics. May also inhibit the reuptake and storage of dopamine at central dopamine receptors, prolonging dopamine action

• PD/extrapyramidal disorders – minutes-hours

• PD – do not abruptly discontinue or change doses of other PD treatments. Usually most effective in combination with other medications

• PD – Generally benztropine is an adjunctive medication for common PD symptoms, such as tremor, rigidity, and drooling. Other cardinal PD symptoms, such as bradykinesia and gait difficulties, are most likely to improve with other PD treatments, such as levodopa, dopamine agonists, amantadine, or MAO-B inhibitors
  
• Acute dystonic reactions – diphenhydramine is another option, if not effective consider benzodiazepines. If possible, discontinue the agent that precipitated the extrapyramidal AE

• For bradykinesia or gait disturbances causing significant functional disturbance, levodopa is most effective. For idiopathic PD patients, especially younger patients with normal cognition and milder disability, dopamine agonists are a good first choice. Amantadine and MAO-B inhibitors may also be useful
  
• Depression is common in PD and may respond to low dose SSRIs

• None