antiparkinsonian drugs can precipitate toxic psychosis
Cogentin advertisement, 1972.
Hospital & Community Psychiatry, Vol. 23, No. 4, pp. 50-51.

for the triple threats of extrapyramidal symptoms caused by phenothiazines   akathisia ~ dystonia ~ akinesia
The patient on phenothiazines lives in the shadow of many possible extrapyramidal side effects. Among those which may appear are the motor disturbances -- akathisia, dystonia, or akinesia. Should they become serious or bothersome, Cogentin Mesylate added to the patient's regimen may relieve these and other troublesome extrapyramidal side effects such as thickened or slurred speech, fine tremor, or slight drooling. In patients with mental disorders, occasionally there may be intensification of mental symptoms when Cogentin Mesylate is used to treat side effects of phenothiazine derivatives and reserpine. In such cases, at times, increased doses of antiparkinsonian drugs can precipitate a toxic psychosis. Since Cogentin Mesylate has cumulative action, continued supervision is advisable.
for extrapyramidal symptoms caused by phenothiazines   COGENTIN® Mesylate (benztropine mesylate ~ MSD)
[Precautions include:] Mental confusion and excitement may occur with large doses, or in susceptible patients; visual hallucinations reported occasionally. May intensify mental symptoms when used to treat extrapyramidal disorders due to CNS drugs, such as reserpine and phenothiazines, in patients with mental disorders; in such patients, increased doses of antiparkinsonian drugs can precipitate toxic psychosis; observe patients carefully, especially at the beginning of treatment or if dosage is increased. Masking action on possible development of permanent extrapyramidal symptoms with prolonged phenothiazine therapy has not been investigated. Patients with a poor mental outlook are usually poor candidates for therapy.
For more detailed information, consult your MSD representative or see the Direction Circular. Merck Sharp & Dohme, Division of Merck & Co., Inc. West Point, Pa. 19486     MSD ~ Merck Sharp & Dohme

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