Benzatropine

Indications: 

• Acute dystonic reaction – extrapyramidal: this is generally a side effect of  medications received – e.g. antipsychotics, metoclopramide (usually within hrs or up  to 5 days of starting) 

Formulation: 

• Injectable 1mg/ml – (2ml ampoule)
• Tablet form – 2mg PO 

Dosage and Administration 

Intravenous 

• Adult – 1-2mg IV – slow IV injection – if no IV IM (takes longer).
• Paediatric – 0.02mg/kg to max 1mg IV.
• Usually responds within 5-20mins – if persists can give second dose.  

Oral

• 2mg bd as necessary (given to take home if symptoms return) 

Side Effects 

Anticholinergic side effects  

• Dry mouth
• blurred vision
• Tachycardia
• delirium
• urinary retention 

Pit Falls 

• Remember good supportive care for acute dystonic reaction
• May need airway support
• May need benzos – e.g. midazolam 1-2mg IV/IM
• If no benztropine – Can try promethazine 

Caution if on other meds with anticholinergic effects