Biperiden

Brand name: Akineton
Drug class: Anticholinergic Agents
VA class: AU350
CAS number: 1235-82-1

Introduction

Antimuscarinic antiparkinsonian agent.

Uses for Biperiden

Parkinsonian Syndrome

Adjunctive treatment of all forms of parkinsonian syndrome; more efficacious in postencephalic and idiopathic cases than in arteriosclerotic types.

Relieves muscle rigidity, reduces sweating and salivation, improves gait, and to a lesser extent, tremor.

Drug-Induced Extrapyramidal Reactions

Control of extrapyramidal reactions induced by neuroleptic agents (e.g., phenothiazines).

Biperiden Dosage and Administration

Administration

Oral Administration

Administer orally 1–3 times daily.

Dosage

Available as biperiden hydrochloride, dosage expressed in terms of the salt.

Adjust dosage carefully according to individual requirements and response.

Adults

Parkinsonian Syndrome

Oral

Initially, 2 mg 3–4 times daily; if tolerance develops, or dosage is inadequate, titrate dose to maximum of 16 mg daily in 3–4 divided doses.

Drug-Induced Extrapyramidal Reactions

Oral

Usual dosage: 2 mg 1–3 times daily.

Prescribing Limits

Adults

Oral

Maximum 16 mg daily.

Special Populations

No special population dosage recommendations at this time.

Cautions for Biperiden

Contraindications

Narrow angle glaucoma.
Bowel obstruction or megacolon.
Known hypersensitivity to biperiden or any ingredient in the formulation.

Warnings/Precautions

Warnings

CNS Effects

Large or toxic doses or usual doses in patients with excess susceptibility may produce marked CNS disturbances (e.g., mental confusion, euphoria, agitation, disturbed behavior).

Use with caution in patients with epilepsy.

Ophthalmic Effects

Increased ocular tension associated with antimuscarinic use; however, such effect not reported with biperiden. Use with caution in patients with glaucoma.

Cardiovascular Effects

Possible tachycardia; use with caution in patients with cardiac arrhythmias.

GU Effects

Possible urinary retention; use with caution in patients with prostatic hypertrophy.

Specific Populations

Pregnancy

Category C.

Lactation

Not known whether biperiden is distributed into milk. Caution advised if biperiden is used.

Pediatric Use

Safety and efficacy not established.

Common Adverse Effects

Dry mouth, blurred vision, drowsiness, dizziness, constipation, agitation, mental confusion.

Interactions for Biperiden

Specific Drugs

Drug	Interaction	Comments
Alcohol	Possible additive CNS effects	Avoid concomitant use
Anticholinergic agents	Increased risk of adverse anticholinergic effects

Stability

Storage

Oral

Tablets

25°C (may be exposed to 15–30°C). Protect from light.

Actions

Exhibits atropine-like blocking action on parasympathetic-innervated peripheral structures, including smooth muscle.
Competitively inhibits acetylcholine or other cholinergic stimuli at autonomic effectors innervated by postganglionic nerves.
Weak peripheral anticholinergic agent with antisecretory, antispasmodic, and mydriatic effects.
Exhibits nicotinolytic effects. Nicotinolytic effects >6 times that of atropine.

Advice to Patients

Potential for drug to impair mental alertness or physical coordination; use caution when driving or operating machinery until effects on individual are known.
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as concomitant illnesses.
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.
Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.