For resistant seizure activity observed on EEG in a paralyzed patient, some synthetic anticholinergics, such as
biperiden, (11) may be useful because of its better blood-brain barrier penetration.
Most reported cases of M/A to date have occurred among patients with psychiatric illness because anticholinergic medications, including trihexyphenidyl, benztropine,
biperiden, procyclidine, and orphenadrine, were commonly prescribed for the management of first-generation and high dopamine D2-affinity antipsychotic-induced extrapyramidal symptoms (EPS).
The affinities of atropine, scopolamine,
biperiden and pirenzepine, the main muscarinic receptor antagonists are shown in Table 2.
The irritability and hypersexuality were improved with treatment but hyperoralism persisted and after consulting with psychiatry, amisulpride 200 mg/d and
biperiden hydrochloride 2 mg/d were added.
(42) looked at 24 elderly PD subjects that used at least one antiparkinsonian drug (either levodopa, pramipexole, amantadine or
biperiden).
His treatment included 30 mg/day aripiprazole, 1000 mg/day valproic acid, 200 mg/day quetiapine, 4 mg/day
biperiden, and 100 mg/month paliperidone palmitate.
Biperiden and clonazepam were prescribed without response.
Levodopa, dopamine agonists (apomorphine, bromocriptine, cabergoline), monoamine oxidase B inhibitors (selegiline, amantadine), anticholinergics (
biperiden, bornaprine), peripheral dopamine blockers (domperidone) and catecholamine methyltransferase inhibitors are used in the medical treatment of the disease to maintain the balance between the cholinergic and dopaminergic activity (5).
After admission to the clinic, risperidone 2 mg per day,
biperiden 2 mg per day, olanzapine 5 mg per day were added to his treatment.
Upon an increase in his excitation, haloperidol 10 mg and
biperiden HCl 2 mg IM were administered, and quetiapine 500 mg/day and risperidone 2 mg/day were added to his treatment.
Prestudy antiparkinsonian therapies (1 month before study drug start) continuing on-study in >[greater than or equal to] 2 patients were levodopa or derivatives in 13 patients total (carbidopa/levodopa, 3/121 pramipexole, 2.5%; 10/125 ropinirole, 8.0%), monoamine oxidase inhibitors in 32 patients (15/121 pramipexole, 12.4%; 17/125 ropinirole, 13.6%), amantadine in 18 patients (6/121 pramipexole, 5.0%; 12/125 ropinirole, 9.6%), tertiary amines (trihexyphenidyl HCl or
biperiden HCl) in 7 patients (4/121 pramipexole, 3.3%; 3/125 ropinirole, 2.4%), and benzatropine in 2 patients (1 each [0.8%] per group).
