Biperiden

Oral
Drug-induced extrapyramidal symptoms

Oral
Parkinsonism

Should be taken with food.

Narrow-angle glaucoma, megacolon, bowel obstruction, paralytic ileus.

Patient with cardiac failure, tachycardia or cardiac arrhythmias, history of seizure disorder; hyperthyroidism, prostatic hyperplasia and/or urinary stricture or retention, myasthenia gravis. Not recommended for use in patients with tardive dyskinesia. Renal and hepatic impairment. Pregnancy and lactation.

Significant: Anhidrosis, hyperthermia; anticholinergic effects (e.g. blurred vision, constipation, xerostomia, urinary retention); CNS depression; confusion, hallucinations, delirium, anxiety, amnesia (usually at higher doses).
Cardiac disorders: Bradycardia.
Nervous system disorders: Drowsiness.
Psychiatric disorders: Sleep disorder (decreased rapid eye movement [REM] sleep and increased REM latency), agitation, disorientation, euphoria.
Vascular disorders: Postural hypotension.

PO: C

This drug may cause CNS depression which may impair physical or mental abilities, if affected, do not drive or operate machinery.

Monitor IOP.

Symptoms: Mydriasis, dryness of mucous membranes, flushing, increased heart rate, decreased bowel motility, decreased ureter and bladder tone, increased temperature, excitation, confusion, clouding of consciousness and/or hallucinations. In severe cases, cardiac and respiratory depression may occur. Management: Supportive treatment. Gastric lavage or emesis may be considered. Acetylcholinesterase inhibitors may be given as antidote. Closely monitor vital signs. Fever reduction, application of catheter, and artificial ventilation may be needed. Cardiac stimulant (e.g. dobutamine) may be considered in case of cardiac depression.

Enhanced CNS and peripheral adverse effects with other anticholinergic psychotropic drugs, antihistamines, antispasmodics, and other antiparkinsonian agents. May potentiate anticholinergic effect (especially AV conduction) with quinidine. May enhance dyskinesia with levodopa. Reduced effect of metoclopramide and other compounds with similar activity on the gastrointestinal tract.

Alcohol may enhance the adverse effects of biperiden.

Description:
Mechanism of Action: Biperiden is a predominantly central anticholinergic agent that helps balance cholinergic transmission in the basal ganglia. It has weak peripheral anticholinergic activity.
Pharmacokinetics:
Absorption: Readily absorbed from the gastrointestinal tract. Bioavailability: Approx 30%. Time to peak plasma concentration: 0.8-1.6 hours.
Distribution: Plasma protein binding: 90-95%.
Metabolism: Undergoes extensive first-pass metabolism; metabolised via hydroxylation of bicycloheptene ring and piperidine ring.
Excretion: Elimination half-life: Approx 20 hours.

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 2381, Biperiden. https://pubchem.ncbi.nlm.nih.gov/compound/Biperiden. Accessed Nov. 22, 2023.

Store below 30°C. Protect from light.

Antiparkinsonian Drugs

N04AA02 - biperiden ; Belongs to the class of tertiary amines anticholinergic agents. Used in the management of Parkinson's disease.

Anon. Biperiden. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/10/2023.

Apiden 2 mg Tablet (JF Draf Pharmaceuticals Corp.). MIMS Philippines. http://www.mims.com/philippines. Accessed 06/10/2023.

Biperiden. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases. https://www.ncbi.nlm.nih.gov/books/ NBK548257. Accessed 06/10/2023.

Buckingham R (ed). Biperiden. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/10/2023.