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[Pharmacology](https://durgical.com/en/pharmacology/) · [Antiparkinson anticholinergics](https://durgical.com/en/pharmacology/classes/antiparkinson-anticholinergics/)

# Biperiden

A central anticholinergic on the WHO essential list, given by mouth or injection for parkinsonism and acute dystonia from antipsychotics.

Updated 2026-11-01

- Class: [Antiparkinson anticholinergics](https://durgical.com/en/pharmacology/classes/antiparkinson-anticholinergics/)
- Receptor: Muscarinic acetylcholine receptors (M1 shown)
- ATC code: N04AA02
- WHO Model List of Essential Medicines

◎**Muscarinic acetylcholine receptors (M1 shown)**Biperiden

ⓘ The figure shows tiotropium, another muscarinic antagonist, in the human M1 receptor; biperiden blocks the same acetylcholine binding site.

**Target in 3D:** Muscarinic acetylcholine receptors (M1 shown). PDB structure 5CXV (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/5CXV) · Drag to rotate · pinch to zoom

## Mechanism of action

Biperiden is a tertiary-amine antimuscarinic that enters the brain and blocks muscarinic receptors in the striatum, restoring part of the dopamine-acetylcholine balance. Its injectable form acts quickly in acute dystonic reactions.

- A dopamine blocker or Parkinson leaves acetylcholine unopposed
- Biperiden blocks muscarinic receptors in the striatum
- Dystonic spasms, tremor and rigidity ease

## Pharmacokinetics

**Absorption**
Given by mouth, or intravenously or intramuscularly for acute dystonia

**Distribution**
Lipid-soluble; enters the brain

## Indications

- Parkinson disease (WHO essential medicine) [Parkinson disease →](https://durgical.com/en/conditions/parkinson-disease/)
- Acute dystonia and parkinsonism caused by antipsychotics [Antipsychotic-induced movement disorders (dystonia, akathisia, parkinsonism, tardive dyskinesia) →](https://durgical.com/en/conditions/antipsychotic-induced-movement-disorders/)

## Adverse effects

### Common

- Dry mouth, blurred vision, constipation
- Urinary hesitancy
- Drowsiness and dizziness

### Serious (rare, important)

- Confusion and delirium, especially in older adults or with cognitive impairment
- Urinary retention
- Acute angle-closure glaucoma

## Contraindications

- Angle-closure glaucoma
- Caution: prostate enlargement, bowel obstruction, older adults, dementia
- Not used for tardive dyskinesia (may worsen it)

## Key interactions

**Other anticholinergics (tricyclics, antihistamines, some antipsychotics)**
Additive anticholinergic burden

**Alcohol and sedatives**
More sedation

## What is monitored

- Response of the dystonia after an injection
- Mental state and cognition
- Urination and bowel habit

## Administration and safety

- For acute dystonia it is given by intravenous or intramuscular injection
- Oral treatment is withdrawn gradually

## Nursing care

- After injection, check blood pressure, pulse and sedation
- Watch older patients for confusion and urinary retention
- Explain that dystonia from antipsychotics is frightening but treatable

## Pregnancy and breastfeeding

Human data are limited; it is used only if clearly needed.

## Memory aid

«BIPERIDEN: BIte, Pull, twist… then the injection releases» – the antidote for acute dystonia (torticollis, oculogyric crisis).

## Test yourself

Think of the answer, then tap the question to see it.

## Which acute antipsychotic reaction is treated with parenteral biperiden?

Acute dystonia (for example torticollis or oculogyric crisis).

## Which anticholinergic antiparkinson drug is on the WHO essential list?

Biperiden (tablets and injection).

## Which eye condition contraindicates biperiden?

Angle-closure glaucoma.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/biperiden/)

## Related drugs

- [Benzatropine](https://durgical.com/en/pharmacology/benzatropine/)
- [Trihexyphenidyl](https://durgical.com/en/pharmacology/trihexyphenidyl/)

## Related conditions

- [Parkinson disease](https://durgical.com/en/conditions/parkinson-disease/)
- [Antipsychotic-induced movement disorders (dystonia, akathisia, parkinsonism, tardive dyskinesia)](https://durgical.com/en/conditions/antipsychotic-induced-movement-disorders/)

[← Back to the class: Antiparkinson anticholinergics](https://durgical.com/en/pharmacology/classes/antiparkinson-anticholinergics/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025); Farmacología básica y clínica (Katzung), 16.ª ed., cap. 28 (McGraw Hill, 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 21 (McGraw Hill, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N04AA02) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/biperiden/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/biperiden/