Pronunciation:

bye-PER-i-den

Brand Names:

• Akineton

Classifications:

Pharmacologic—

Anticholinergic

Uses of This Medicine:

Biperiden is used alone or together with other medicines (e.g., levodopa) to treat Parkinson's disease. By improving muscle control and reducing stiffness, this medicine allows more normal movements of the body as the disease symptoms are reduced.

Biperiden is also used to control severe muscle reactions and other side effects from certain medicines that are used to treat severe nausea or nervous, mental, or emotional conditions (e.g., chlorpromazine [Thorazine®], perphenazine [Trilafon®], prochlorperazine [Compazine®], promethazine [Phenergan®], thioridazine [Mellaril®]).

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of biperiden in the pediatric population. Safety and efficacy have not been established.

Older adults—

No information is available on the relationship of age to the effects of biperiden in geriatric patients. However, elderly men are more likely to have age-related prostate problems, which may require caution for patients receiving biperiden.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Potassium Citrate

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Amantadine
• Buprenorphine
• Clozapine
• Codeine
• Glucagon
• Glycopyrrolate
• Glycopyrronium Tosylate
• Methacholine
• Metoclopramide
• Oxycodone
• Quetiapine
• Revefenacin
• Scopolamine
• Secretin Human
• Tapentadol
• Tiotropium

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Betel Nut

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Bowel blockage or
• Glaucoma, narrow-angle or
• Megacolon (colon is enlarged)—Should not be used in patients with these conditions.

• Enlarged prostate or
• Epilepsy (seizures) or
• Glaucoma or
• Heart rhythm problems—Use with caution. May make these conditions worse.

Proper Use of This Medicine:

Take this medicine every day exactly as ordered by your doctor in order to improve your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

You may take this medicine with food to reduce stomach irritation.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (tablets):
  • For side effects caused by other medicines:
    • Adults—2 milligrams (mg) one to three times per day.
    • Children—Use and dose must be determined by your doctor.
  • For Parkinson's disease:
    • Adults—At first, 2 milligrams (mg) three or four times per day. Your doctor may increase your dose as needed. However, the dose is usually not more than 16 mg per day.
    • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine:

It is important that your doctor check your progress at regular visits to allow changes in your dose and to check for any unwanted effects.

If you develop any unusual or strange thoughts and behavior while receiving biperiden, be sure to discuss it with your doctor. Some changes that have occurred in people receiving this medicine are like those seen in people who drink too much alcohol. Other changes might be confusion, worsening of depression, visual hallucinations (seeing things that are not there), suicidal thoughts, and unusual excitement, nervousness, or irritability.

Biperiden may cause drowsiness, trouble with controlling movements, or trouble with thinking or seeing clearly. Make sure you know how you react to this medicine before you drive, use machines, or do other jobs that require you to be alert, well-coordinated, or able to think or see well.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates or medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are taking this medicine.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known

Anxiety

chest pain or discomfort

chills

cold sweats

confusion

confusion about identity, place, and time

decrease in frequency of urination

decrease in urine volume

difficulty in passing urine (dribbling)

disturbed behavior

dizziness, faintness, or lightheadedness when getting up from a lying or sitting position

dry mouth

false or unusual sense of well-being

hyperventilation

irregular heartbeats

irregular, twisting uncontrolled movement of the face, hands, arms, or legs

irritability

nervousness

painful urination

restlessness

shaking

shortness of breath

slow or irregular heartbeat

trouble sleeping

unusual tiredness

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Change in consciousness

chest pain or discomfort

convulsions

decreased awareness or responsiveness

decreased secretions of the mouth, pharynx, nose, or bronchi

delusions of persecution, mistrust, suspiciousness, or combativeness

dizziness

dry mouth

enlarged pupils

face is warm or hot to touch

fainting

fast, slow, pounding, or irregular heartbeat or pulse

foul-smelling breath

holding false beliefs that cannot be changed by fact

lightheadedness

loss of consciousness

loss of memory

no breathing

redness to face

seeing, hearing, or feeling things that are not there

severe sleepiness

shakiness and unsteady walk

trouble sitting still

unsteadiness, trembling, or other problems with muscle control or coordination

unusual excitement, nervousness, or restlessness

warm, dry skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

Blurred vision

difficulty having a bowel movement (stool)

drowsiness

nausea

vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.