Akineton (biperiden) for Parkinson’s disease

Last updated Feb. 23, 2024, by Marisa Wexler, MS
Fact-checked by Ana de Barros, PhD

What is Akineton for Parkinson’s disease?

Akineton (biperiden) was an approved add-on therapy to help manage symptoms of Parkinson’s disease. It was also used to prevent or treat similar muscular conditions caused by certain antipsychotic therapies.

The medication, which has been discontinued in the U.S., was sold by Abbott.

Therapy snapshot

How does Akineton work?

Parkinson’s disease is caused by the death and dysfunction of the brain cells responsible for making dopamine, which is an important neurotransmitter — a chemical that nerve cells use to communicate with each other and with the rest of the body.

Dopamine signaling normally helps to control movement in concert with another neurotransmitter called acetylcholine. Within the brain, acetylcholine signaling activates certain nerve cells while dopamine signaling reduces the activity of other cells, and this balance helps to coordinate movements. In Parkinson’s, this signaling system becomes imbalanced with too much acetylcholine and not enough dopamine.

Akineton is thought to work by reducing the activity of acetylcholine signaling in the brain, which helps to restore the balance between dopamine and acetylcholine, thereby easing Parkinson’s symptoms.

Who could take Akineton?

Akineton was approved by the U.S. Food and Drug Administration (FDA) in September 1959 as an adjunct (add-on) treatment for all forms of parkinsonism, which includes Parkinson’s disease and other disorders marked by similar motor symptoms like tremor, rigidity, slowed movements, and balance problems.

It was also approved to manage movement abnormalities called extrapyramidal disorders, which can occur as side effects of certain medications for psychosis, known as neuroleptics or antipsychotics.

Who should not take Akineton?

Akineton was not recommended for anyone with:

• an allergy to the medication or any of its ingredients
• narrow angle glaucoma, a disorder characterized by a buildup of fluid in the eyes
• a blockage or obstruction in the bowel
• megacolon, a condition marked by swelling and inflammation in the colon
• benign prostatic hyperplasia, a non-cancerous enlargement of the prostate gland
• diseases that can result in dangerously increased heartbeat (tachycardia).

How was Akineton administered in Parkinson’s?

Akineton was available in the form of oral tablets, each containing 2 mg of biperiden, the medication’s active ingredient. The usual dose for Parkinson’s disease was one tablet, taken three or four times daily.

The dosage could be adjusted based on the individual’s response, up to a maximum of eight tablets (16 mg) per 24 hours. Changes in dose, including when starting or stopping the therapy, were to be made gradually.

The total daily dose was to be spread evenly throughout the day. The tablets were best taken during a meal with water, and in case of a very dry mouth, they could be taken after a meal.

People taking Akineton were advised to avoid consuming alcohol.

Akineton in clinical trials

Akineton was approved before the FDA’s modern standards for drug approval, which were implemented in the 1960s and require clinical trial evidence of a drug’s safety and effectiveness.

Several studies published in the 1950s reported Akineton treatment helped to ease the severity of Parkinson’s symptoms, especially rigidity and tremor. More recent research also suggested it had similar effects to other anticholinergic compounds.

Common side effects of Akineton

Common side effects of Akineton may include:

• dry mouth
• blurred vision
• drowsiness
• euphoria, disorientation, agitation, and other behavioral changes
• difficult or painful urination, or urinary retention (an inability to empty the bladder)
• postural hypotension (reduced blood pressure upon standing, which can cause dizziness or lightheadedness)
• constipation
• slow heart rate
• a reduction in rapid eye movement sleep, which is the phase where dreaming occurs.

Behavioral changes and co-occurring health conditions

Behavioral changes, such as confusion, euphoria, or agitation, have occurred in some patients given Akineton. Patients may require a dose reduction to ease those side effects.

Akineton was to be used with caution in patients with any of the following health issues:

• glaucoma
• prostatism
• epilepsy
• cardiac arrhythmia
• excess thyroid hormone activity
• tendency to convulsions.

Effects on ability to drive and use machines

Akineton had the potential to induce drowsiness. Patients undergoing treatment were advised against driving or operating machinery unless it had been demonstrated their physical or mental abilities remained unaffected.

Drug interactions

Akineton could interact with other medications, including some antidepressants, antipsychotics, antihistamines, pain relievers, and medicines used to regulate heart rhythm (antiarrhythmics). Patients were advised to tell their prescribers all the medications they were taking.

Overdose and central anticholinergic syndrome

Overdose of Akineton could cause a condition called central anticholinergic syndrome, which is marked by changes in thinking and behavior alongside symptoms such as dry mouth and skin, increased heart rate, and visual disturbances. This could progress to coma or death in some cases.

Central anticholinergic syndrome could also occur in people taking Akineton at approved doses, though in most cases, it was the result of an overdose.

If an overdose and/or central anticholinergic syndrome occurred, symptomatic treatments could help manage the complications until the effects of the drug had worn off.

Use in pregnancy and breastfeeding

Akineton has not been rigorously studied in people who are pregnant or breastfeeding. It was recommended the medication be used in these situations only if there was a clear need, with potential benefits outweighing possible risks.

Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.