Isolated instances of mental confusion, euphoria, agitation and disturbed behavior have been reported in susceptible patients. Also, the central anticholinergic syndrome can occur as an adverse reaction to properly prescribed anticholinergic medication, although it is more frequently due to overdosage. It may also result from concomitant administration of an anticholinergic agent and a drug that has secondary anticholinergic actions. Caution should be observed in patients with manifest glaucoma, though no prohibitive rise in intraocular pressure has been noted following either oral parenteral administration. Patients with prostatism, epilepsy or cardiac arrhythmia should be given this drug with caution.
Occasionally, drowsiness may occur, and patients who drive a car or operate any other potentially dangerous machinery should be warned of this possibility. As with other drugs action on the central nervous system, the consumption of alcohol should be avoided during biperiden therapy.
Should be used with caution in children and the elderly, who may be more susceptible to its adverse effects.
Biperiden should not be given to patients with angle-closure glaucoma or with a narrow angle between the iris and the cornea, since it may raise intra-ocular pressure and precipitate an acute attack.
Biperiden need to be used with caution in conditions characterised by tachycardia such as thyrotoxicosis, heart failure, and in cardiac surgery, where they may further accelerate the heart rate. Care is required in patients with acute myocardial infarction, as ischaemia and infarction may be made worse, and in patients with hypertension.
Biperiden may cause confusion, especially in the elderly. Reduced bronchial secretion caused by systemic administration of biperiden may be associated with the formation of mucous plugs.
In the treatment of parkinsonism, increases in dosage and transfer to other forms of treatment should be gradual should not be withdrawn abruptly.
Use in Children: Safety and effectiveness in children have not been established.