ll, 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.

oxic psychosis. patients with mental disorders should be kept under careful observation, especially at the beginning of treatment or if dosage is increased. tardive dyskinesia may appear in some patients on long-term therapy with phenothiazines and related agents, or may occur after therapy with these drugs have 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. 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.

onism, dosage must be individualized according to age and weight, and the type of parkinsonism being treated. generally, older patients, and thin patients cannot tolerate large doses. most patients with postencephalitic parkinsonism need fairly large doses and tolerate them well. patients with a poor mental outlook are usually poor candidates for therapy. in 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. in 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. some patients experience greatest relief when given 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. 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. 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. benztropine mesylate may be used concomitantly with sinemet ® (carbidopa-levodopa), or with levodopa, in which case dosage adjustment may be required in order to maintain optimum response. drug-induced extrapyramidal disorders in treating extrapyramidal disorders due to neuroleptic drugs (e.g., phenothiazines), the recommended dosage is 1 to 4 mg once or twice a day parenterally. dosage must be individualized according to the need of the patient. some patients require more than recommended; others do not need as much. in acute dystonic reactions, 1 to 2 ml of the injection usually relieves the condition quickly. when extrapyramidal disorders develop soon after initiation of treatment with neuroleptic drugs (e.g., phenothiazines), they are likely to be transient. one to 2 mg of benztropine mesylate two or three times a day usually provides relief within one or two days. if such disorders recur, benztropine mesylate can be reinstituted. certain drug-induced extrapyramidal disorders that develop slowly may not respond to benztropine mesylate. parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.

.g., skin rash, develops. if this cannot be controlled by dosage reduction, the medication should be discontinued. other heat stroke, hyperthermia, fever. to report suspected adverse reactions, contact fresenius kabi, vigilance & medical affairs at 1-800-551-7176 or fda at 1-800-fda-1088 or www.fda.gov/medwatch .