Akineton (biperiden) / Endo, AbbVie - LARVOL DELTA

Retrospective study for correlation with reducing antiparkinsonian anticholinergic drugs and adverse effects (CINP-AsCNP 2025) - "The dosage of antipsychotic drugs was 423.6±320.3 mg of chlorpromazine equivalent, and that of biperiden equivalent was 3.3±2.0 mg. Adverse events occurred at a rate of 64.5% when the anticholinergic dose was reduced by 0.85 mg/week in biperiden equivalents. There was no correlation with antipsychotic dosage. Various adverse events appeared at higher doses before reduction."

Adverse events • Retrospective data • CNS Disorders • Cognitive Disorders • Constipation • Gastroenterology • Gastrointestinal Disorder • Insomnia • Mood Disorders • Movement Disorders • Parkinson's Disease • Psychiatry • Schizophrenia • Sleep Disorder

When ondansetron hits different: a rare extrapyramidal reaction (Euroanaesthesia 2025) - "Extrapyramidal reactions are rare and mostly associated with metoclopramide...Severe hyponatremia complicated the case, but symptoms resolved minutes after biperiden administration, implicating ondansetron despite other confounding factors...Oncologic patients are often fragile, with multiple comorbidities and aggressive treatments. Every administered drug must be carefully assessed to minimize risks."

Fatigue • Heart Failure • Lung Cancer • Oncology • Pain • Small Cell Lung Cancer • Solid Tumor

The effect of biperiden on episodic memory: Testing the serial position effect. (PubMed, Neurobiol Learn Mem) - "Although BIP treatment has an overall impairing effect on episodic memory, it does not model primacy effect deficits in MCI and AD. However, M1 receptors appear to modulate the memory for weakly encoded/stored information suggesting that M1 agonist could improve verbal episodic memory."

Journal • Alzheimer's Disease • CNS Disorders • Cognitive Disorders

Evaluation of the effect of biperiden (cholinergic muscarinic receptor antagonist) on ethanol self-administration in rats. (PubMed, Neurosci Lett) - "Treatment with biperiden at doses of 1, 5, and 10 mg/kg also attenuated alcohol-seeking behavior after re-exposure to the context associated with ethanol self-administration. These findings suggest that biperiden may have therapeutic potential in the treatment of alcohol use disorder, indicating that modulation of the cholinergic system could be a promising avenue for further investigation."

Journal • Preclinical • Addiction (Opioid and Alcohol)

Uncommon Extrapyramidal Reaction to Ondansetron. (PubMed, Cureus) - "On the first day post-admission, the patient developed altered mental status and right-sided weakness after premedication with ondansetron and dexamethasone...Bloodwork revealed significant hyponatremia (116 mEq/L), suggesting Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), despite this suspicion, there was no further investigation to confirm this diagnosis due to rapid symptom reversal after biperiden administration, implicating an adverse reaction to ondansetron. Ondansetron and metoclopramide were discontinued, hyponatremia was corrected, and no further episodes occurred during the hospital stay. This case highlights the necessity of awareness for adverse reactions of ondansetron that can mimic cerebrovascular events and the need for a thorough revision of medication in complex cases."

Journal • Cardiovascular • Heart Failure • Lung Cancer • Movement Disorders • Oncology • Small Cell Lung Cancer • Solid Tumor

INTRAVENOUS BIPERIDEN PHARMACOLOGICAL CHALLENGE MODEL IN HEALTHY ELDERLY AS PROOF - OF-MECHANISM TOOL FOR COGNITION: A RANDOMIZED, PLACEBO -CONTROLLED CLINICAL TRIAL (ADPD 2025) - "The findings support that IV biperiden is likely a more reliable pharmacological challenge than oral biperiden for application in proof -of-mechanism studies with novel selective M1 -AChR agonists."

Clinical • CNS Disorders

Network based approach for drug target identification in early onset Parkinson's disease. (PubMed, Sci Rep) - "Notably, shared pathway analysis shows that prioritized drugs such as Amantadine, Apomorphine, Atropine, Benztropine, Biperiden, Bromocriptine, Cabergoline, Carbidopa, and Citalopram, currently used for other conditions, interact with key EOPD-associated diagnostic markers, suggesting their potential for drug repurposing. The constructed functional network's validity is reinforced by statistically significant drug-target pairs. The findings provide new insights into EOPD drug mechanisms and identify promising therapeutic candidates, potentially leading to more effective, personalized treatment approaches for EOPD patients."

Biomarker • Journal • CNS Disorders • Movement Disorders • Parkinson's Disease • APOA1 • BDNF • PTK2B

Prolonged extrapyramidal syndrome due to metoclopramide overdose: a rare case report. (PubMed, Oxf Med Case Reports) - "With the diagnosis of the extrapyramidal syndrome and intramuscular administration of biperiden 5 mg ampoule twice at 12-h intervals, unfortunately, the symptoms did not improve and finally he was referred to our hospital. Dystonic reactions caused by metoclopramide can be misdiagnosed and it is necessary to be monitored and treated appropriately to reduce the family's concern about its unpleasant side effects."

Journal • CNS Disorders • Dystonia • Movement Disorders

Unveiling the Therapeutic Potential of Small Molecule of SVAK-12: A Comprehensive In Silico, In Vitro, and In Vivo Studies on its Neuroprotective Effects and Molecular Interactions in Parkinson's Disease. (PubMed, Curr Med Chem) - "Overall, the study suggests that SVAK-12's neuro-biocompatibility, ability to reduce free radicals, and enhanced neurotrophic factors make it a promising candidate as a neuroprotective drug."

Journal • Preclinical • CNS Disorders • Depression • Movement Disorders • Parkinson's Disease • Psychiatry • BDNF • GFRA1 • NR4A2 • NTRK2 • SORT1

Exploring the efficacy of cholinergic agents for the treatment of psychostimulant use disorder: a systematic review. (PubMed, Psychopharmacology (Berl)) - "This review does not support the current prescription of cholinergic agents to treat PUD. Replication clinical trials notably on galantamine or other AChEI, and proof-of-concept trials on comedown symptoms will be necessary to identify a potential therapeutic indication for cholinergic agents in PUD."

Clinical • Journal • Review

Involvement of muscarinic acetylcholine receptor-mediated cholinergic neurotransmission in TMS-EEG responses. (PubMed, Prog Neuropsychopharmacol Biol Psychiatry) - "TEPs and TIOs were measured before and after administering a single oral dose of scopolamine (a non-selective mAChR antagonist), biperiden (an M1 mAChR antagonist), or placebo, with TMS targeting the left medial prefrontal cortex (mPFC), angular gyrus (AG), and supplementary motor area (SMA). Importantly, the effects of these mAChR antagonists on TEPs were independent of those on sensory-evoked EEG potentials caused by TMS-associated sensory stimulation. These findings expand our understanding of TMS-EEG physiology, providing insights for its application in physiological and clinical research."

Journal • CNS Disorders

Parkinsonism induced by paliperidone palmitate treatment (ECNP 2024) - "After the examination oral paliperidone therapy was initiated which was well tolerated, prompting a transition to monthly paliperidone palmitate depot therapy within a few months...At our hospital, after intramuscular treatment with 5 mg of biperiden for 5 days, her rigidity improved, but her complaints of bradykinesia and hypomimia persisted.Discussion and Maintenance therapy with antipsychotic drugs is effective in reducing relapse rates in schizophrenia [1]... Maintenance therapy with antipsychotic drugs is effective in reducing relapse rates in schizophrenia [1]. However, it is estimated that the compliance rate for patients taking oral antipsychotics for schizophrenia is less than 60%. Medication non-compliance for an important subgroup of patients leads to relapse of the illnesses and hospitalization [2]."

Bipolar Disorder • CNS Disorders • Mood Disorders • Parkinson's Disease • Psychiatry • Schizophrenia

Major depression with psychotic features after covid-19 infection: a case report (ECNP 2024) - "On examination, she exhibited reduced self-care, depressive mood, inappropriate affect and disorganized associations.Treatment initiated upon admission included haloperidol 10 mg IM 2x1, biperiden 5 mg IM 2x1, sertraline 100 mg/day, and buspirone 15 mg/day...Due to persistent psychotic symptoms and development of extrapyramidal symptoms (EPS), amisulpride was discontinued, and aripiprazole 5 mg/day was initiated...The patient responded well to treatment and was discharged on day 42 with sertraline 150 mg/day, buspirone 30 mg/day, and aripiprazole 5 mg/day...Two separate studies have found that depressive symptoms negatively affect neurocognitive performance in COVID-19 survivors[2].Furthermore, patients with higher life threat, lower emotional support, lower severity of illness at admission and longer hospital stays have shown stronger associations with PTSD, anxiety, and depression symptoms[3]. Therefore, priority should be given to these at-risk individuals, warranting..."

Case report • Clinical • CNS Disorders • Depression • Major Depressive Disorder • Mood Disorders • Post-traumatic Stress Disorder • Psychiatry • Sleep Disorder • Suicidal Ideation

A patient developed side effects after a paliperidone palmitate 3-monthly depot injection without proper tolerability assessment (ECNP 2024) - "It is recommended that patients be treated with once-monthly paliperidon palmitate (PP1M) for at least 4 months before switching to PP3M[4].A 44-year-old male patient, with atypical psychosis since 2013, was admitted to the emergency department in February 2024 with symptoms of dystonia and dysphagia. In his last visit, biperiden was decreased to 6 mg/day and 400 mg/day of carbamazepine, 75 mg/day of venlafaxine, and 3 mg/day of clonazepam were continued. His last BPRS score was 6 and UKU-SERS score was 2.With this case report, we would like to draw attention to inconvenience of switching to long-acting forms of antipsychotics in the patient before the tolerability of the antipsychotic dose is not evaluated, and the tolerability can not be evaluated correctly with the active use of diazepam and biperiden, and the use of multiple antipsychotics such as olanzapine and paliperidone combination could not be suitable for a patient."

Adverse events • Clinical • CNS Disorders • Dystonia • Mood Disorders • Pain • Psychiatry

Clinical profile of early-onset Parkinson's disease (MDS Congress 2024) - "All patients responded positively to Levodopa/Carbidopa (250/25 mg), used 5,5+-3,6 years, mean dose 845+-246 mg...Other medication were biperiden (65%) and amantadine sulfate (61%)... The incidence of EOPD aligns with previous reports (5-10%). In this series, all patients developed classic motor features and showed levodopa response. A third of the patients developed motor fluctuations and dyskinesias."

Clinical • Alzheimer's Disease • CNS Disorders • Cognitive Disorders • Depression • Dystonia • Insomnia • Mood Disorders • Pain • Parkinson's Disease • Psychiatry • Sleep Disorder

Psychotic symptoms in patients with systemic lupus erythematosus: a case study of two cases (ECNP 2024) - "Treatment with haloperidol and biperiden intramuscular injections was initiated, and then gradually switched to olanzapine. Combining antipsychotic and immunomodulatory therapies is effective, but more research is required to understand treatment responses better. Sharing more case studies and clinical experiences will improve our understanding and treatment strategies for this important complication."

Case study • Clinical • CNS Disorders • Psychiatry

Delirium by hyponatremia, manic episode with psychotic features, both or none? a case report (ECNP 2024) - "Her last treatment was fluoxetine 40mg/day and quetiapine 100mg/day...%20 NaCl in 1000cc/8 hours slow intravenous sodium replacement was administered, together with intramuscular haloperidol 5 mg with biperiden 2.5 mg...Also, she was experiencing a medical emergency but because she had had a psychiatric diagnosis, she was immediately referred to psychiatry without a thorough examination. Stigmatization towards psychiatric patients can easily cause an emergency to be underdiagnosed."

Case report • Clinical • Addiction (Opioid and Alcohol) • Bipolar Disorder • CNS Disorders • Depression • Insomnia • Mental Retardation • Mood Disorders • Psychiatry • Sleep Disorder

Manic Episode with Psychotic Features After Gastric Bypass Surgery: A Case Report (ECNP 2024) - "Treatment with haloperidol 10 mg IM 2x1, biperiden 5 mg IM 2x1 and valproic acid 1000 mg/day was started since the patient was hospitalized in our ward. Recent studies have demonstrated that mood disorders are common psychiatric presentations in the population. The manic episode that we observed in our patient after gastric bypass surgery may be a result of the natural course of bipolar affective disorder that occurs randomly or due to a mechanism that has not been elucidated to date after surgery, or on the other hand, it may be due to the effect of a psychosocial stress factor that occurs due to surgery and weight loss. As a result, it is important to evaluate the patient psychiatrically after major surgeries such as gastric bypass, taking into account such complications, in order to recognize the disease early and to provide the patient with treatment in a short time."

Bariatric surgery • Case report • Clinical • Surgery • Bipolar Disorder • CNS Disorders • Psychiatry

The importance of individualizing psychopharmacological treatments. A clinical case of antipsychotic side effects (ECNP 2024) - "For more than 10 years, she has been on the same pharmacological treatment: Haloperidol 10mg p.o/8h, Olanzapine 10mg p.o 1-1-0.5, Biperiden 2mg/24h.No history of alcohol or substance abuse. This clinical case prompts us to reflect on the importance of individualizing psychopharmacological treatments, especially in the elderly population, as they are much more sensitive to side effects of treatments. At times, it is important to thoroughly study our patients' cases and review treatments, even if they seem like good options at first glance, in order to be prepared to move forward into the future."

Adverse events • Clinical • Addiction (Opioid and Alcohol) • CNS Disorders • Psychiatry • Schizophrenia • Substance Abuse

Psychotic episode with paranoid delusions following reboxetine use: a case report (ECNP 2024) - "He was diagnosed with panic disorder and treated with paroxetine 30 mg/day and sertraline 50 mg/day at different times until one year ago when his treatment was changed to reboxetine 4 mg/day and risperidone 1 mg/day due to sedation side effects. His treatment was adjusted to reboxetine 8 mg/day and trifluoperazine 1 mg/day due to no improvement in symptoms and increased sleep duration...He received a single intramuscular injection of zuclopenthixol acuphase 50 mg during admission. Treatment was initiated with intramuscular haloperidol 10 mg twice daily and biperiden 5 mg twice daily...Discharged on the 14th day of hospitalization with olanzapine at 10 mg/day. The literature on the association between antidepressants and psychosis is growing...Further research is warranted on the effects of SNRIs like reboxetine on psychotic symptoms. Therefore, careful use of antidepressants and monitoring of symptoms are necessary."

Case report • Clinical • ADHD (Impulsive Aggression) • Attention Deficit Hyperactivity Disorder • CNS Disorders • Depression • Major Depressive Disorder • Mood Disorders • Narcolepsy • Parkinson's Disease • Psychiatry • Sleep Disorder

A case of Fahr's disease followed by psychotic symptoms (ECNP 2024) - "She sought psychiatric help a year ago due to ongoing symptoms, and olanzapine 5 mg/day was initiated...Currently, she is taking levetiracetam 500 mg/day...The patient was started on haloperidol 10 mg/day and biperiden 5 mg/day injections, along with valproic acid 750 mg/day... Fahr's syndrome, characterized by symmetric bilateral basal ganglia calcifications, is predominantly autosomal dominant but may have sporadic etiology. [1] It presents with both neurological and psychiatric symptoms, with approximately %40 of patients experiencing psychiatric manifestations such as mania, apathy, or psychosis. [1]Clinicians should consider both psychiatric and medical causes of acute mental status changes in middle-aged patients, requiring comprehensive evaluation with laboratory and neuroimaging studies."

Clinical • Bipolar Disorder • CNS Disorders • Epilepsy • Mental Retardation • Psychiatry

Joubert syndrome diagnosed in forty-seven years old in a patient with psychosis, a rare case report (ECNP 2024) - "The patient's attitude towards other patients and the treatment equip in the ward was angry and her sensitivity towards the side effects of antipsychotics was remarkable.Confusion developed with Chlorpromazine 300 mg/day, and rigidity developed in both upper extremities with Risperidone 4 mg/day (despite taking oral Biperiden 4 mg/day). Due to their tendency to extrapyramidal symptoms, the patient was treated with Olanzapine 5 mg/day and was referred for genetic examination.DiscussionIn this case, it should be concluded that the presentation of psychiatric findings should not overshadow the multisystemic approach. It was intended to emphasize that clinical observation, neuroimaging and spending time on a detailed history from the patient and his/her caregiver, dating back to the patient's childhood are integral parts of the diagnosis process and the main aim should be not only the treatment of symptoms but also a integrative and multidisciplinary approach is..."

Case report • Clinical • CNS Disorders • Insomnia • Mental Retardation • Psychiatry • Sleep Apnea • Sleep Disorder

A case report: valerian extract induced mania (ECNP 2024) - "The herbal medication was discontinued, and the patient's initial treatment was planned as intramuscular haloperidol 20mg/day and intramuscular biperiden 10mg/day...Following, the treatment was planned with olanzapine 5mg/day...There is a case report in the literature of a hypomanic episode developing after the use of Valerian extract in Turkey. [3],With this case presentation, we aim to emphasize the importance of being cautious about possible side effect profiles of herbal medicines whose mechanisms of action are not fully explained, and whose usage frequency is increasing nowadays."

Case report • Clinical • Bipolar Disorder • CNS Disorders • Depression • Insomnia • Mental Retardation • Mood Disorders • Psychiatry • Sleep Disorder

Sialorrhea induced by antipsychotics other than clozapine - why does it happen and how do we treat it? (ECNP 2024) - " A research was conducted on Pubmed's database using the following keywords and their combinations: "antipsychotics", "risperidone", "paliperidone", "aripiprazole", "quetiapine", "olanzapine", "sialorrhea", "hypersalivation", screening for relevance...Regarding treatment, management of AIS should involve the administration of α2-adrenergic receptor agonists, such as clonidine or even β-adrenergic receptor antagonists such as propranolol. There are reports showing response to biperiden and diphenhydramine in patients using risperidone, and also to diphenhydramine, trihexyphenidyl and amitriptyline in patients using aripiprazole... The underlying mechanisms of AIS differ between antipsychotics, therefore, different treatment options should be considered in each case, given the complexity and variability of this adverse effect. Future research should aim to further delineate these pathways..."

CNS Disorders

Initial clinical evidence on biperiden as antiepileptogenic after traumatic brain injury-a randomized clinical trial. (PubMed, Front Neurol) - P3 | "The present study suggests that there was insufficient evidence regarding the effect of biperiden in preventing PTE after TBI, which underpins the need for larger studies. Clinical trial registration: ClinicalTrials.gov, identifier: NCT01048138."

Clinical • Journal • CNS Disorders • Epilepsy • Infectious Disease • Novel Coronavirus Disease • Vascular Neurology