Chemical formula: C₂₁H₂₉NO Molecular mass: 311.461 g/mol PubChem compound: 2381
Biperiden interacts in the following cases:
An increase in the effects of alcohol under biperiden may occur (avoid alcohol).
Combination with other anti-cholinergic drugs, e.g. psycho-pharmaceuticals, antihistamines, antiParkinson drugs and spasmolytics, can lead to an increase in central and peripheral side-effects.
Tardive dyskinesia induced by neuroleptics may be enhanced by biperiden. Occasionally, Parkinson symptoms in existing delayed dyskinesia may be so serious, that anti-cholinergic treatment becomes necessary.
Levodopa and the concomitant administration of biperiden can enhance dyskinesia. Generalised νchoreiform disturbances of movement have been observed with the concomitant use of biperiden and Levodopa/Carbidopa preparations in patients with Parkinson’s disease.
The effect of metoclopramide and compounds with similar effects on the gastro-intestinal tract is antagonised by anti-cholinergic drugs such as biperiden.
Anti-cholinergics can increase the central-nervous side-effects of pethidine.
Taking quinidine concomitantly with biperiden can lead to an enhancement of anti-cholinergic cardio-vascular effects (in particular to AV-conduction).
Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucosegalactose malabsorption should not take this medicine.
In the case of urinary retention, patients should empty the bladder before taking the respective dose of biperiden.
In patients who suffer from diseases which can lead to tachycardia, biperiden should be used with caution.
Biperiden can lead sporadically to difficulties in micturition, in particular in patients with prostate hypertrophy, more seldom to urinary retention.
Anti-cholinergic drugs, such as biperiden, with a central mode of action can lead to an increased tendency to cerebral seizures. In patients with an increased tendency to convulsions, biperiden is to be dosed carefully.
Biperiden may only be used with particular caution in patients with Myasthenia gravis.
Biperiden should be administered during pregnancy only after a careful risk-benefit analysis, as no experience is available with its use in pregnancy.
Anti-cholinergic drugs can inhibit lactation. Due to the chemical structure of the active substance, it can be assumed that biperiden passes into breast milk. For this reason, weaning is recommended.
No data are available on the effects of biperiden on fertility.
Due to central nervous and peripheral side-effects, such as e.g. tiredness, dizziness and drowsiness, even when used correctly this drug can also change the ability to react to such an extent that – independent of the limitation due to the underlying disease to be treated – the ability to actively participate in road traffic or operate electrically or motor-driven tools and machines is further impaired. This is particularly true with the concomitant use of other centrally active drugs, anticholingeric drugs and especially in connection with alcohol.
Side-effects may occur particularly at the beginning of treatment and if the dosage is increased too quickly.
Central excitation effects are frequently seen in patients with symptoms of a cerebral deficiency and can necessitate a decrease in the dosage.
The following frequencies are used as the basis in the evaluation of side-effects:
Very common (≥1/10)
Common (≥1/100 to <1/10)
Uncommon (≥1/1,000 to <1/100)
Rare (≥1/10,000 to <1/1,000)
Very rare (<1/10,000)
Not known (cannot be estimated from the available data
Not known: Parotitis.
Very rare: Hypersensitivity.
Rare: In higher doses excitement, agitation, fear, confusion, delirious syndromes, hallucinations, sleeplessness.
Very rare: Nervousness, euphoria.
Rare: Fatigue, dizziness and disturbance of memory.
Very rare: Headache, dyskinesia, ataxia and speaking disorder, increased disposition to cerebral seizures and convulsions.
Very rare: Disturbance of accommodation, mydriasis, photosensitivity. Closed-angle glaucoma might occur (controlling of intraocular pressure).
Rare: Tachycardia.
Very rare: Bradycardia. A fall in blood pressure may occur following parenteral administration.
Rare: Dryness of mouth, nausea, gastric disorder.
Very rare: Constipation.
Very rare: Reduced perspiration, allergic rash.
Rare: Muscle twitching.
Very rare: Voiding disorders, especially in patients with prostate adenoma (dose reduction), more seldom: urinary retention.
Rare: Drowsiness.
There have been reports of temporarily reduced REM sleep (sleeping phase with rapid eye movements), characterised by an increase in the time needed to reach this stage and a percentage decrease in the length of this phase in the total sleep.
The safety profile in the Paediatric population is similar to that in adults.
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