Clinical data
AHFS/ Monograph
MedlinePlus a699058
  • AU: B2
  • US: C (Risk not ruled out)
Routes of
Oral, IM, IV
ATC code N04AA02 (WHO)
Legal status
Legal status
Pharmacokinetic data
Bioavailability 33 ± 5% (oral)
Protein binding 60%
Metabolism Hepatic hydroxylation
Biological half-life 18 to 24 hours
Excretion Renal
CAS Number 514-65-8 YesY
PubChem (CID) 2381
DrugBank DB00810 YesY
ChemSpider 2289 YesY
KEGG D00779 YesY
Chemical and physical data
Formula C21H29NO
Molar mass 311.461 g/mol
3D model (Jmol) Interactive image

Biperiden, sold under the brandname Akineton among others, is a medication used to treat Parkinson disease.[1] It is of the anticholinergic type.[2] It is on the WHO Model List of Essential Medicines, the most important medications needed in a basic health system.[3] It is available as a generic medication.

Medical uses

Biperiden is used for the adjunctive treatment of all forms of Parkinson's disease and for reduced sweating in methadone users (postencephalitic, idiopathic, and arteriosclerotic). It seems to exert better effects in the postencephalitic and idiopathic than in the arteriosclerotic type.

Biperiden is also commonly used to improve parkinsonian signs and symptoms related to antipsychotic drug therapy, such as akathisia.

It relieves muscle rigidity, reduces abnormal sweating related with clozapine and methadone use[4][5] and salivation, improves abnormal gait, and to lesser extent, tremor.

In its role as a synthetic acetylcholine antagonist, biperiden has been analyzed as an alternative anticonvulsant for usage in the treatment of intoxication by organophosphorus nerve agents, such as sarin.[6]

Pregnancy and lactation


Children and adolescents aged 1 year and older may be treated. The clinical experience is mainly on the shortterm treatment of acute drug induced dystonic reactions. Doses should be reduced according to the weight of the patients.


Side effects

Dose-dependent side effects are frequent. Particularly geriatric patients may react with confusional states or develop delirium.



Biperiden mimics an atropine intoxication with mydriasis, dryness of mucous membranes, red face, atonic states of bowels and bladder, and hyperthermia in high doses. Central consequences are agitation, confusion, and hallucinations. An untreated overdose may be fatal, particular in children. Premortal signs are respiratory depression and cardiac arrest. A specific antagonist is physostigmine which combines a peripheral and a central action. Carbachol can be used to treat atonic bowels and bladder. The vital functions should be monitored and stabilized. It may be necessary to treat hyperthermia with cooling blankets.


The oral bioavailability is only 33 ± 5% due to extensive first-pass metabolism. In young, healthy volunteers, peak plasma concentrations following a single oral 4 mg immediate-release dose are reached after 1.5 hours. The elimination half-life has been determined as 18.4 hours, and may be prolonged in geriatric patients. After a 4 mg intravenous dose, the elimination half-life is approximately 24 hours.


Biperiden has an atropine-like blocking effect on all peripheral structures which are parasympathetic-innervated (e.g. cardiovascular and visceral organs). It also has a prominent central blocking effect on M1 receptors. Biperiden does also act as FIASMA (functional inhibitor of acid sphingomyelinase).[8]


Biperiden was synthesized by the German chemist W. Klavehn from Knoll AG, Germany. In March 1953 a patent was applied for in Germany[9] and subsequently in many other countries. A US patent application was filed in March 1954 and granted in April 1957.[10]

See also


  1. Jackisch R, Kruchen A, Sauermann W, Hertting G, Feuerstein TJ (October 1994). "The antiparkinsonian drugs budipine and biperiden are use-dependent (uncompetitive) NMDA receptor antagonists". Eur. J. Pharmacol. 264 (2): 207–11. doi:10.1016/0014-2999(94)00528-1. PMID 7851484.
  2. Pehl C, Wendl B, Kaess H, Pfeiffer A (October 1998). "Effects of two anticholinergic drugs, trospium chloride and biperiden, on motility and evoked potentials of the oesophagus". Aliment. Pharmacol. Ther. 12 (10): 979–84. doi:10.1046/j.1365-2036.1998.00398.x. PMID 9798802.
  3. "19th WHO Model List of Essential Medicines (April 2015)" (PDF). WHO. April 2015. Retrieved May 10, 2015.
  4. Richardson C, Kelly DL, Conley RR (August 2001). "Biperiden for excessive sweating from clozapine". Am J Psychiatry. 158 (8): 1329–30. doi:10.1176/appi.ajp.158.8.1329-a. PMID 11481174.
  5. Caflisch C, Figner B, Eich D (February 2003). "Biperiden for excessive sweating from methadone". Am J Psychiatry. 160 (2): 386–7. doi:10.1176/appi.ajp.160.2.386. PMID 12562595.
  6. Shim, TM; McDonough JH (May 2000). "Efficacy of biperiden and atropine as anticonvulsant treatment for organophosphorus nerve agent intoxication". Archives of Toxicology. 74 (3): 165–172. doi:10.1007/s002040050670. PMID 10877003.
  7. Nishiyama K, Mizuno T, Sakuta M, Kurisaki H (1993). "Chronic dementia in Parkinson's disease treated by anticholinergic agents. Neuropsychological and neuroradiological examination.". Adv Neurol. 60: 47983. PMID 8420174.
  8. Kornhuber J, Muehlbacher M, Trapp S, Pechmann S, Friedl A, Reichel M, Mühle C, Terfloth L, Groemer T, Spitzer G, Liedl K, Gulbins E, Tripal P (2011). "Identification of novel functional inhibitors of acid sphingomyelinase". PLoS ONE. 6 (8): e23852. doi:10.1371/journal.pone.0023852. PMC 3166082Freely accessible. PMID 21909365.
  9. Espacenet - Bibliographic data
  10. United States Patent: 2789110
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