Benztropine is used with other medicines to treat symptoms of Parkinson’s disease, such as stiffness or tremors.

Benztropine is also used to treat Parkinson-like symptoms caused by using certain medicines.

Benztropine may also be used for purposes not listed in this medication guide.

Benztropine side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Benztropine may cause serious side effects. Call your doctor at once if you have:

• dry mouth that causes trouble talking or swallowing;
• little or no urination;
• uncontrolled muscle movements;
• vomiting, severe constipation;
• fast heartbeats;
• muscle weakness;
• blurred vision, tunnel vision, eye pain, or seeing halos around lights;
• confusion, hallucinations; or
• severe skin rash.

Common side effects of benztropine may include:

• dry mouth;
• blurred vision;
• constipation; or
• nausea.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Use only as directed. Tell your doctor if you use other medicines or have other medical conditions or allergies.

Before taking this medicine

You should not use benztropine if you are allergic to it.

Not approved for use by anyone younger than 3 years old.

Tell your doctor if you have ever had:

• an enlarged prostate;
• urination problems;
• glaucoma; or
• muscle problems.

Older adults may be more sensitive to the effects of benztropine.

It is not known if benztropine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Tell your doctor if you are breastfeeding.

How should I take benztropine?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Benztropine oral is taken by mouth.

Benztropine is usually taken at bedtime.

Benztropine injection is given in a muscle or vein if you are unable to take the medicine by mouth.

Drink plenty of water to prevent dry mouth while taking benztropine.

Dry mouth may lead to gum disease or cavities. Brush and floss your teeth regularly and visit your dentist for routine dental care.

Call your doctor if your symptoms do not improve, or if they get worse.

Your symptoms may get worse if you stop using benztropine suddenly. Ask your doctor before stopping any of your anti-Parkinson medications.

Store at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose may cause drowsiness, confusion, nervousness, hallucinations, fast heart rate, vomiting, numbness in your fingers, hot or dry skin, or fainting.

What should I avoid while taking benztropine?

Avoid driving or hazardous activity until you know how benztropine will affect you. Your reactions could be impaired.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Benztropine can decrease sweating and you may be more prone to heat stroke.

What other drugs will affect benztropine?

Tell your doctor about all your other medicines, especially:

• other medicine to treat Parkinson’s disease;
• medicine to treat depression, anxiety, mood disorders, or mental illness;
• cold or allergy medicine (Benadryl and others);
• medicine to treat stomach problems, motion sickness, or irritable bowel syndrome;
• medicine to treat overactive bladder; or
• bronchodilator asthma medication.

Azilect works by increasing the levels of certain chemicals in the brain.

Azilect is used to treat symptoms of Parkinson’s disease (stiffness, tremors, spasms, poor muscle control).

Azilect is sometimes used with another medicine called levodopa.

Warnings

Do not Azilect if you have used a MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, selegiline, or tranylcypromine.

Tell your doctor about all medicines you have used in the 2-week period before you start taking Azilect. Many drugs can interact with rasagiline, and some drugs should not be used together.

Before you take this medicine, tell your doctor if you have liver disease.

There are many other drugs that can cause serious medical problems if you take them together with Azilect. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

While you are taking this medicine and for 2 weeks after you stop taking it, you may not be able to eat certain types of cheese. Follow your doctor’s instructions. Rasagiline may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Before taking this medicine

You should not take Azilect if you are allergic to rasagiline.

Do not use Azilect if you have used any other MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, selegiline, tranylcypromine, and others.

Many drugs can interact and cause dangerous effects. Some drugs should not be used together with Azilect. Your doctor may change your treatment plan if you also use:

• cyclobenzaprine (a muscle relaxer);
• dextromethorphan (contained in many over-the-counter cough medicines);
• meperidine (Demerol);
• methadone;
• St. John’s wort; or
• tramadol (Ultram, Ultracet).

Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, migraine headaches, serious infections, or prevention of nausea and vomiting. These medicines may interact with rasagiline and cause a serious condition called serotonin syndrome.

To make sure Azilect is safe for you, tell your doctor if you have ever had:

• high or low blood pressure;
• liver or kidney disease; or
• if you take ciprofloxacin (an antibiotic).

People with Parkinson’s disease may have a higher risk of skin cancer (melanoma). Ask your doctor about skin symptoms to watch for.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It may not be safe to breast-feed while using this medicine. Ask your doctor about any risk.

How should I take Azilect?

Take Azilect exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

If you take Azilect alone, your dose may be different than if you take it with other Parkinson’s medications. Follow your doctor’s dosing instructions very carefully.

Azilect may be only part of a complete program of treatment that also includes a special diet. Follow the diet plan created for you by your doctor or nutrition counselor.

Get familiar with the list of foods you should avoid to help prevent certain side effects of rasagiline.

Call your doctor if your Parkinson’s symptoms do not improve, or if they get worse while using Azilect.

Store at room temperature away from moisture and heat.

Do not stop using Azilect suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.

Dosing information

Usual Adult Dose for Parkinson’s Disease:

Monotherapy:
Recommended dose: 1 mg orally once a day

Adjunct therapy:
Initial dose (in patients on concomitant levodopa): 0.5 mg orally once a day
Initial dose (in patients not on concomitant levodopa): 1 mg orally once a day
Maintenance dose: 0.5 mg to 1 mg orally once a day

Maximum dose: 1 mg orally once a day

Comments: May be used as adjunct therapy in patients on levodopa therapy, with or without other drugs used in the treatment of Parkinson’s disease.

What happens if I miss a dose?

Skip the missed dose and use your next dose at the regular time. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . An overdose of rasagiline can be fatal.

Overdose symptoms may include drowsiness, dizziness, severe headache, rapid pulse, feeling agitated or irritable, muscle spasms in your neck or jaw, sweating, cold or clammy skin, shallow breathing, fainting, or seizure (convulsions). These symptoms may be delayed for 12 to 24 hours after an overdose.

What to avoid

Avoid driving or hazardous activity until you know how this medicine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Avoid drinking alcohol, especially red wine, vermouth, and tap beers or ale.

Also avoid eating foods that are high in tyramine, such as aged cheeses, fava beans, soy sauce, herring, pickled or processed meats and fish, and meats that are aged, dried, smoked, or fermented. Eating tyramine while you are taking Azilect can raise your blood pressure to dangerous levels which could cause life-threatening side effects.

Azilect side effects

Get emergency medical help if you have signs of an allergic reaction to Azilect: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• severe headache, blurred vision, pounding in your neck or ears;
• extreme drowsiness or falling asleep suddenly, even after feeling alert;
• unusual changes in mood or behavior;
• hallucinations;
• a light-headed feeling, like you might pass out; or
• worsening symptoms of Parkinson’s disease (especially uncontrolled muscle movements).

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Some people taking Azilect with levodopa have fallen asleep during normal daytime activities such as working, talking, eating, or driving. Tell your doctor if you have any problems with daytime sleepiness or drowsiness.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medicine. Talk with your doctor if this occurs.

Common Azilect side effects may include:

• depressed mood;
• sleep problems (insomnia), strange dreams;
• involuntary muscle movements;
• loss of appetite, weight loss;
• indigestion, stomach pain, nausea, vomiting, constipation;
• joint pain or stiffness;
• rash;
• cough or other flu symptoms;
• dry mouth; or
• swelling in your hands or feet.

Austedo (deutetrabenazine) is a prescription medicine used to treat chorea associated with Huntington’s disease and tardive dyskinesia (TD), which are involuntary movement disorders. Austedo helps reduce uncontrolled movements and improve the quality of life for patients; however, it does not cure the underlying condition causing the movement disorder. 

Austedo works by regulating the storage and release of natural chemical messengers (neurotransmitters) from nerves, to help control symptoms such as twitching, jerking, or facial tics. It does this by targeting and blocking a protein in the brain called VMAT2, which is responsible for moving neurotransmitters (chemical messengers) into nerve cell storage areas.

Austedo’s drug class is a VMAT2 inhibitor (vesicular monoamine transporter 2 inhibitor).

Austedo tablets are taken twice daily, and the Austedo XR (extended-release) tablets are taken once daily.

What is Tardive dyskinesia (TD) and chorea associated with Huntington’s disease 

Tardive dyskinesia (TD) is a nervous system disorder that causes repetitive, uncontrolled muscle movements, usually in the face (chewing, lip smacking, frowning, tongue movement, blinking, or eye movement). Tardive dyskinesia can develop due to using certain medicines.

Chorea associated with Huntington’s disease is sudden, involuntary movements usually of the arms, legs, face, and tongue. It is an inherited disease that causes the progressive breakdown of nerve cells in the brain. Austedo is not a cure for Huntington’s disease and will only treat the symptom of chorea; it does not treat other symptoms of this condition.

Austedo side effects

Common Austedo side effects may include:

• drowsiness;
• tiredness;
• dry mouth;
• runny or stuffy nose, sore throat;
• sleep problems (insomnia); or
• diarrhea.

Serious Austedo side effects

Get emergency medical help if you have signs of an allergic reaction to Austedo: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Some people have thoughts about suicide while taking Austedo for Huntington’s disease. Stay alert to changes in your mood or symptoms. Your family or caregivers should also watch for sudden changes in your behavior.

Some side effects may actually be signs that your Huntington’s disease is progressing. Your doctor will need to check your progress on a regular basis.

Deutetrabenazine may cause other serious side effects. Call your doctor at once if you have:

• fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
• severe restlessness or agitation;
• tremors, shaking;
• muscle stiffness;
• problems with balance or coordination; or
• severe nervous system reaction – very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What is the cost of Austedo tablets?

The cost of prescription drugs varies depending on your insurance plan and which pharmacy you use. Refer to our Austedo price guide or Austedo XR price guide pages for more information about the cost of this medicine.

Who is eligible for the Austedo Coupon or Copay Card?

You are eligible for the Austedo Copay Card if you have commercial or private insurance, a valid prescription, and are a resident of the United States or the United States territories. 

You are not eligible for an Austedo Copay Card if you are enrolled in Medicare, Medigap, Medicaid, VA, DOD, TRICARE, Puerto Rico Government Health Insurance Plan, and Medicare-eligible patient enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees.

How can I apply for the AustedoCopay Card?

You can apply for the Austedo Copay Card or Coupon online; there is a link on the Austedo Price Guide page. 

Check the terms and conditions for the Austedo Savings Card online.

Warnings 

QTc Prolongation. This medicine may prolong the QT interval, but the degree of QT prolongation is not clinically significant when administered within the recommended dosage range.  Austedo tablets and XR tablets should be avoided in patients with congenital long QT syndrome and in patients with a history of cardiac arrhythmias associated with a prolonged QT interval. 

Certain circumstances may increase the risk of the occurrence of torsade de pointes and/or sudden death in association with the use of drugs that prolong the QTc interval, including: 

• slow heart rate (bradycardia),
• low potassium levels (hypokalemia), 
• low magnesium blood levels (hypomagnesemia), 
• having a congenital prolongation of the QT interval, and
• concomitant use of other drugs that prolong the QTc interval.

Depression and Suicide. Some people have thoughts about suicide while taking Austedo tablets and extended-release tablets; stay alert to changes in your mood, feelings, thoughts, or behaviors. Tell your doctor right away if you have any sudden changes in mood or behavior or thoughts about suicide.

You should not use this medicine if you have Huntington’s disease and you have untreated or uncontrolled depression, or if you have thoughts about suicide.

Other medicines. Do not use this medicine if you have taken reserpine (Serpalan, Renese-R) in the past 20 days, or if you have used an MAO inhibitor (isocarboxazid, linezolid, rasagiline, selegiline, and others) in the past 14 days. See the Interactions section for more interactions with this medicine.

Before taking this medicine

You should not use Austedo if you are allergic to the active ingredient, deutetrabenazine, inactive ingredients, or if you have:

• untreated or uncontrolled depression;
• thoughts about suicide or hurting yourself;
• if you have recently taken tetrabenazine or valbenazine; or
• liver impairment.

Do not use this medicine if you have taken reserpine in the past 20 days, or if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, and tranylcypromine.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• depression, anxiety, nervousness, or agitation;
• mental illness or psychosis;
• suicidal thoughts or actions;
• breast cancer;
• a heart rhythm disorder;
• long QT syndrome (in you or a family member);
• an electrolyte imbalance (such as low blood levels of potassium or magnesium); or
• liver disease.

People with Huntington’s disease may have a higher risk of depression and suicidal thoughts or behaviors. Taking this medicine may further increase this risk. However, the benefits of taking this medicine (improvement in daily living) may outweigh any suicidal risks.

Taking this medicine may cause symptoms similar to Parkinson’s disease (resting tremor, stiff muscles, slow movements, difficulty maintaining balance, and walking). Ask your doctor about your risk.

Your doctor will need to check your progress on a regular basis. Your family or caregivers should also watch for sudden changes in your behavior.

Tell your doctor if you are pregnant or breastfeeding.

How should I take this medicine?

Take Austedo as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

If you are switching from a similar medicine called tetrabenazine, take your first dose of Austedo one day after your last dose of tetrabenazine.

Austedo tablets are usually taken twice daily with food and a whole glass of water. Swallow the tablet whole and do not crush, chew, or break it. Tell your doctor if you have trouble swallowing the tablet whole.

You may need medical tests to check your heart function using an electrocardiograph or ECG (sometimes called an EKG).

Do not stop the medicine without your doctor’s advice. If you stop taking Austedo for longer than 1 week, do not start taking it again without your doctor’s advice.

Store at room temperature away from moisture and heat. Keep the medicine in the original container, along with the packet or canister of moisture-absorbing preservative.

Austedo dose information

Austedo dose

Initial dose: 6 mg twice daily (12 mg per day).
Dose titration: May increase dose in increments of 6 mg/day at weekly intervals, based on reduction of chorea or tardive dyskinesia, and tolerability up to a maximum of 48 mg/day in divided doses.
Maximum Dose: 48 mg/day in divided doses.
Important Administration Instructions: 

• Take Austedo tablets with food
• Swallow whole. Do not chew, crush, or break tablets
• Take total daily dosages of 12 mg or above in two divided doses.

Austedo XR dose

Initial Dose: 12 mg once daily (12 mg per day).
Dose titration: May increase dose in increments of 6 mg/day at weekly intervals, based on reduction of chorea or tardive dyskinesia, and tolerability up to a maximum of 48 mg/day.
Maximum Dose:  48 mg/day
Important Administration Instructions:

• Take XR tablets with or without food 
• Swallow whole. Do not chew, crush, or break tablets.
• Take Austedo XR once daily. 

General dosing information

Switching Between Austedo and Austedo XR When switching between Austedo tablets (twice daily) and Austedo XR extended-release tablets (once daily), switch to the same total daily dosage.

Dose modifications: Dose modifications may be required when taking other medications due to drug interactions.

Discontinuation and Interruption of Treatment: Treatment with this medicine can be discontinued without tapering. Following treatment interruption of greater than one week, this therapy should be re-titrated when resumed. For treatment interruption of less than one week, treatment can be resumed at the previous maintenance dose without titration.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line ,

Overdose symptoms may include involuntary muscle movements, tremors, rapid eye movements, nausea, vomiting, diarrhea, flushing, sweating, severe drowsiness, confusion, hallucinations, or feeling light-headed.

What should I avoid while taking this medicine?

Avoid driving or hazardous activity until you know how this medicine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Drinking alcohol with this medicine can cause side effects.

What other drugs will affect this medicine?

Austedo can cause a serious heart problem. Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

Using Austedo with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Many drugs can interact with the active ingredient deutetrabenazine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all other medicines you use.