Biperiden (Systemic)

AHFS Class: Anticholinergic Agents (28:36.08)

VA Class: AU350

View the associated AHFS monograph.

Brands: Akineton^®

Introduction

Antimuscarinic antiparkinsonian agent.^{a b}

Uses

Parkinsonian Syndrome

Adjunctive treatment of all forms of parkinsonian syndrome;^{a b} more efficacious in postencephalic and idiopathic cases than in arteriosclerotic types.^b

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

Drug-Induced Extrapyramidal Reactions

Control of extrapyramidal reactions induced by neuroleptic agents (e.g., phenothiazines).^{a b}

Dosage and Administration

Administration

Administer orally 1–3 times daily.^{a b}

Dosage

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

Adjust dosage carefully according to individual requirements and response.^b

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.^b

Drug-Induced Extrapyramidal Reactions.

> Oral— Usual dosage: 2 mg 1–3 times daily.^{a b}

Prescribing Limits

Oral— Maximum 16 mg daily.^{a b}

Special Populations

No special population dosage recommendations at this time.^a

Cautions

Contraindications

• Narrow angle glaucoma.^{a b}

• Bowel obstruction or megacolon.^{a b}

• Known hypersensitivity to biperiden or any ingredient in the formulation.^{a b}

Warnings/Precautions

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).^a

Use with caution in patients with epilepsy.^a

Ophthalmic Effects. Increased ocular tension associated with antimuscarinic use; however, such effect not reported with biperiden.^{a c} Use with caution in patients with glaucoma.^a

Cardiovascular Effects. Possible tachycardia; use with caution in patients with cardiac arrhythmias.^{a c}

GU Effects. Possible urinary retention; use with caution in patients with prostatic hypertrophy.^{a c}

Pregnancy.

Category C.^{a b}

Lactation. Not known whether biperiden is distributed into milk.^{a b} Caution advised if biperiden is used.^{a b}

Pediatric Use. Safety and efficacy not established.^a

Common Adverse Effects

Dry mouth, blurred vision, drowsiness, dizziness, constipation, agitation, mental confusion.^{a b}

Interactions

Specific Drugs

Stability

Storage

Tablets. 25°C (may be exposed to 15–30°C).^a Protect from light.^{a b}

Actions

• Exhibits atropine-like blocking action on parasympathetic-innervated peripheral structures, including smooth muscle.^a

• Competitively inhibits acetylcholine or other cholinergic stimuli at autonomic effectors innervated by postganglionic nerves.^{a c}

• Weak peripheral anticholinergic agent with antisecretory, antispasmodic, and mydriatic effects.^b

• Exhibits nicotinolytic effects.^{a b} Nicotinolytic effects >6 times that of atropine.^b

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.^a

• 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.^a

• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.^a

• Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Biperiden Hydrochloride

Routes	Forms	Strengths	Brand Names	Manufacturer
Oral	Tablets	2 mg	Akineton® (scored)	Abbott

© Copyright, October 2007, American Society of Health-System Pharmacists, Inc. 7272 Wisconsin Avenue, Bethesda, MD 20814.

References

a. Par Pharmaceutical, Inc. Akineton^® (biperiden hydrochloride) tablets prescribing information. Spring Valley, NY; 2001 Nov.

b. AHFS drug information 2006. McEvoy GK, ed. Biperiden. Bethesda, MD: American Society of Health-System Pharmacists; 2006:1255.

c. AHFS drug information 2006. McEvoy GK, ed. Antimuscarinics/Antispasmodics General Statement. Bethesda, MD: American Society of Health-System Pharmacists; 2006:1257-64].