The page was published on February 24, 2022
Anticholinergic medications are prescribed by mental health clinicians to treat (or prevent) some extrapyramidal side effects of antipsychotic medications—acute dystonia and parkinsonism.
Note: It is very important for us to know that anticholinergic medications do NOT work for akathisia or tardive dyskinesia. In fact, they may make tardive dyskinesia worse.
The anticholinergic medications most commonly used, in the US and elsewhere, are:
1. Benztropine (0.5 mg, 1 mg, and 2 mg tablets).
Generic; it was previously available as brand name Cogentin®)
2. Trihexyphenidyl (2 mg, and 5 mg tablets).
Generic; it was previously available as brand name Artane®)
3. Biperiden: As of February 2022, biperiden is no longer available in the United States. It is available in Europe under the brand name Akineton®.
4. Procyclidine: As of February 2022, procyclidine is no longer available in the United States. It is available in Europe under the brand name Kemadrin®.
5. Diphenhydramine: (25 mg tablets or capsules)
Generic and brand name (Benadryl®).
Diphenhydramine is not simply an anticholinergic medication. It is an antihistamine that also has anticholinergic activity. But, it is included here because it is often used to treat extrapyramidal side effects of antipsychotics.
Trihexyphenidyl oral solution (generic, 2 mg/5mL)
Benztropine 2mg/2mL (ampule or vial)
Next, for clinically-important differences between the available anticholinergic medications and tips on prescribing them, please see the following article on this website:
Clinically-important differences between the available anticholinergic medications
Anticholinergic medications in mental health: Menu of options
Clinically important differences between the available anticholinergic medications
Antipsychotic-induced parkinsonism clinical features
Can we prevent neuroleptic-induced parkinsonism?
Does dose reduction work for neuroleptic-induced parkinsonism?
Tips on treating antipsychotic-induced parkinsonism
For how long should anticholinergics be given for antipsychotic-induced parkinsonism?
Amantadine for antipsychotic-induced parkinsonism
What we know about VMAT2-inhibitor-induced parkinsonism
Can valproate cause parkinsonism?
Can buspirone cause dyskinesia or parkinsonism?
Can lithium cause parkinsonism?
Side effects: Main menu (index and links)
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