Sam is on fluphenazine (Prolixin) with benztropine (Cogentin). Why is benztropine prescribed?

• A. To prevent extrapyramidal symptoms.
• B. To treat depression.
• C. To increase antipsychotic efficacy.
• D. To reduce insomnia.

Answer: (A)

Benztropine is used with a high-potency antipsychotic to prevent extrapyramidal symptoms caused by dopamine blockade in the nigrostriatal pathway. As fluphenazine reduces dopamine activity, cholinergic activity in the basal ganglia becomes relatively dominant, leading to movement disorders such as dystonia, rigidity, tremor, and restlessness. Benztropine, an anticholinergic, dampens those cholinergic effects, helping to maintain motor function and reduce EPS. It’s not for treating depression, not to boost antipsychotic efficacy, and not to reduce insomnia, so its role here is specifically to prevent EPS.