Biperiden is an oral anticholinergic agent used predominantly in the symptomatic therapy of Parkinson disease and movement disorders. Biperiden has not been associated with serum enzyme elevations during treatment and must be a very rare cause of clinically apparent acute liver injury, if it occurs at all.
Biperiden (bye per' i den) is an anticholinergic agent that blocks the central cholinergic receptors, helping to balance cholinergic transmission in the basal ganglia. Biperiden may also block dopamine reuptake and storage in central sites thus increasing dopaminergic activity. The exact mechanism(s) by which the anticholinergic agents are beneficial for symptoms of Parkinson disease is unknown. They are used largely in early Parkinsonism and as adjunctive therapy with levodopa or more potent antiParkinson disease agents. Biperiden was approved for use in the United States in 1959 and has been in use since. Current indications include therapy of symptomatic Parkinson disease as well as spastic disorders and extrapyramidal disorders due to medications. Biperiden is available in tablets of 2 mg in generic forms and under the brand name of Akineton. The recommended dose is 2 mg three to four times daily. Common side effects are due to its anticholinergic activity and include nervousness, drowsiness, confusion, tachycardia, blurred vision, constipation, dry mouth, nausea and urinary retention.
Biperiden has not been reported to cause serum aminotransferase elevations, but it has not been evaluated for effects on serum enzyme levels in a prospective manner. Despite its use for more than 50 years, there have been no reports of biperiden liver injury in the literature and it must be a very rare cause of liver injury, if it occurs at all.
Likelihood score: E (unlikely cause of clinically apparent liver injury).
REPRESENTATIVE TRADE NAMES
Biperiden – Akineton®
Product labeling at DailyMed, National Library of Medicine, NIH
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updated: 20 July 2017
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