Q&A: When should benztropine be prescribed for patients with movement disorders?
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Neurocrine Biosciences Inc. recently presented data on comorbidities, polypharmacy and treatment patterns of patients prescribed benztropine who also were being treated with antipsychotic medications.
According to a company press release, analysis of a retrospective, 24-month observational study of claims found that patients who received at least one new benztropine prescription often had multiple comorbidities and substantial polypharmacy, as well as mild, moderate or severe anticholinergic burden associated with medication use before initiation of benztropine.
Healio spoke with Neurocrine Chief Medical Officer Eiry W. Roberts, MD, to learn more about benztropine, how it should be prescribed to patients with specific movement disorders and findings from the study.
Healio: Please describe the clinical significance of the study results.
Roberts: This study demonstrates that patients often had substantial comorbidity profiles and polypharmacy at baseline, and 38% of patients were on benztropine for up to 6 months, exceeding recommendations for acute use. These results show that research and education of evidence-based treatment algorithms and assessment of anticholinergic burden and consequences is needed within this population.
Healio: Benztropine is currently approved for all forms of parkinsonism, as well as some antipsychotic-induced movement disorders. Can you elaborate on its use for movement disorders?
Roberts: Benztropine may be useful in control of antipsychotic-induced movement disorders. Parkinsonism is a general term that refers to a group of neurological disorders that cause movement problems similar to those seen in Parkinson’s disease such as tremors, slow movement and stiffness.
Drug-induced parkinsonism can be difficult to distinguish from PD though the tremors and postural instability may be less severe. It is usually the side effect of drugs that affect dopamine levels in the brain, such as antipsychotics, some calcium channel blockers and stimulants like amphetamines and cocaine.
Parkinsonism associated with use of such dopaminergic drugs is usually dose-related and reversible with withdrawal of the offending drug, hence supporting the responsiveness to benztropine and why benztropine can — and should — be used only acutely.
Healio: Are there any movement disorders that benztropine should NOT be used to treat?
Roberts: Tardive dyskinesia (TD) should not be treated with benztropine. This is important, because benztropine does not alleviate the symptoms of TD and may even aggravate them.
TD is a movement disorder characterized by abnormal, involuntary movements of the tongue, jaw, trunk or extremities, which may be disruptive and negatively impact those living with the condition. TD is associated with prolonged use of certain kinds of mental health medicines, such as antipsychotics, which help control dopamine receptors in the brain.
TD is generally an irreversible, drug-induced movement disorder that requires long-term treatment in many patients. As such, benztropine is not an effective solution due to the poor tolerability and side effect profile observed in many patients taking benztropine long term.