benztropine and Drug-Overdose

Today, anticholinergic antiparkinsonian drugs are primarily used to ameliorate extrapyramidal side-effects induced by neuroleptic agents. Orphenadrine dominates quantitatively among these drugs in Norway, presumably because it is assumed to carry a lower risk of abuse. There are numerous reports of deaths following orphenadrine overdoses. Orphenadrine has complex pharmacokinetic properties and a narrow therapeutic index. After an overdose, it confers toxic effects of rapid onset to several organ systems. No specific and effective therapy for orphenadrine intoxication has been established. For the two other drugs in this class which are marketed in Norway, biperiden and benztropine, toxicity is mainly connected to their anticholinergic properties. Notably, no reports of lethalities after overdoses of biperiden seem to be available. A small number of accounts of deaths following benztropine intoxication have been published. Neither of these two agents, and benztropine in particular, has been subjected to comprehensive pharmacokinetic evaluations. The relatively extensive use of orphenadrine should be discouraged.

Topics: Antiparkinson Agents; Benztropine; Biperiden; Drug Overdose; Humans; Muscle Relaxants, Central; Orphenadrine; Risk Factors

The abuse and overdose of anti-cholinergic agents such as benztropine is well reported in the psychiatric and emergency medicine journals. However, despite almost 40 years since the first modern report, physicians in general remain poorly aware of anti-cholinergic abuse. A case report of recreational overdose of benztropine in a 19 year old schizophrenic patient is presented. Delirium and anti-cholinergic manifestations persisted for five days necessitating prolonged hospitalization. The literature on benztropine abuse and overdose is reviewed.

Topics: Adult; Benztropine; Drug Overdose; Humans; Male; Muscarinic Antagonists; Substance-Related Disorders

Benztropine is an anticholinergic agent used in the treatment of Parkinson's disease and drug induced extrapyramidal disorders. We report a case of fatal benztropine toxicity. This drug is regarded as relatively safe and reports of isolated toxicity are scarce. In ascribing a particular death to fatal drug toxicity the forensic pathologist must take into account the circumstances surrounding the death, the presence and significance of any co-existent natural disease and the potential contribution of any other detected therapeutic or illicit agents. This interpretation will occur in the knowledge that certain drugs will not be detected and that with respect to quantification of postmortem drug levels, the notion of postmortem redistribution should always be considered.

Topics: Antiparkinson Agents; Autopsy; Benztropine; Drug Overdose; Female; Humans; Middle Aged; Muscarinic Antagonists

Topics: Antiparkinson Agents; Benztropine; Bipolar Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Overdose; Humans; Infusions, Intravenous; Male; Middle Aged; Parasympathomimetics; Physostigmine; Veterans

The case history presented illustrates that, following an overdose of 'Whizz' and alcohol, a protracted dystonic syndrome can develop, clinically indistinguishable from tetanus. A prolonged period of ventilation may be necessary, but, in this case, complete recovery eventually occurred.

Topics: Adult; Alcoholic Intoxication; Amphetamines; Benztropine; Diagnosis, Differential; Drug Overdose; Dystonia; Ethanol; Humans; Male; Procyclidine; Syndrome; Tetanus