Akineton (biperiden)

Akineton (biperiden) is an oral anticholinergic agent used as an add-on therapy for all forms of Parkinson’s disease to treat side effects, such as involuntary movements, caused by other Parkinson’s medicines.

Developed by Abbott, it was approved for use in the U.S. in 1959, but is no longer available in the U.S. market. Generics are available worldwide.

How Akineton works

Parkinson’s disease is thought to result from an imbalance between dopamine and acetylcholine, two neurotransmitters, or substances produced in response to nerve signals that act as chemical messengers.

This imbalance probably results from reduced dopamine levels caused by the loss of dopamine-producing motor neurons, which may increase acetylcholine levels.

Acetylcholine is found in the junctions between muscle cells and nerve cells as well as other sites of the central nervous system that carry signals between cells. Higher levels of this neurotransmitter are thought to cause uncontrolled, involuntary movements, known as dyskinesia, observed in Parkinson’s patients under long-term dopamine therapy.

Akineton competes with acetylcholine — it’s called a competitive antagonist — resetting this imbalance.

Akineton in trials for Parkinson’s disease

Some studies involving Parkinson’s patients have shown that Akineton helped to considerably reduce rigidity, tremor, eye spasms, excessive salivation, and sweating.

An open-label study enrolled 100 patients being treated with Akineton, which was replaced by previous medications, such as trihexyphenidyl and procyclidine. The main objective was to assess whether the patients preferred to continue taking Akineton or not. Researchers found that 53 patients wanted to stay on Akineton, 22 had more side effects, and the remaining 25 found it not as good or equal to the other drugs. Based on these results, the researchers noted that Akineton was as effective and safe as similar medicines.

The same researchers also conducted a controlled double-blind trial among 23 patients with Parkinson’s disease. The study compared the effectiveness of Akineton to procyclidine and found that rigidity and tremor decreased by half among those taking Akineton, compared with one-third of those taking procyclidine. This difference was not statistically significant, however.

The study also showed that the optimum dose of Akineton for improving rigidity and tremor ranged from 8 to 24 mg/day, while procyclidine’s optimum dose varied from 15 to 55 mg/day. The type and frequency of side effects were similar with both treatments.

Another study compared the clinical effectiveness of Akineton and Artane (trihexyphenidyl) to treat neuroleptic-induced parkinsonism. Both medicines were highly effective and all patients responded favorably to the medication. No significant differences were found between the two treatments when individual symptoms were assessed.

Other information

Akineton treatment usually begins with small incremental doses, starting at 1 mg (half a tablet) twice daily. The dose can be increased by 2 mg (one tablet) per day up to a maximum of 16 mg (eight tablets) daily.

Common side effects include agitation, blurred vision, constipation, dizziness, or lightheadedness when sitting up or standing. Other symptoms include drowsiness, dry mouth, nausea, nervousness, and/or upset stomach.

“It may cause allergic reactions to its active substance, biperiden, or to any of the therapy’s components, such as lactose.”

People with narrow-angle glaucoma should avoid Akineton. It’s also contraindicated, or should not be prescribed, for those with gastrointestinal problems, prostate tumors, and certain conditions that can lead to a fast heart rate.

People with excessive levels of thyroid hormone, heart failure, those who have an increased tendency to convulsions, and the elderly should use Akineton with caution.

Taking Akineton in combination with other anticholinergic medications, medicines used to treat allergy symptoms, or other Parkinson’s therapies may increase their effects in the central nervous system or aggravate their side effects. Taking levodopa with Akineton may worsen dyskinesia, for example.

Chorea, a condition that causes involuntary and unpredictable body movements, was observed in Parkinson’s patients who took carbidopa/levodopa together with Akineton.

As with all other therapies that target the central nervous system, alcohol should be avoided when taking Akineton.

Additional information can found at the therapy’s label.


Last updated: Feb. 23, 2022, by Teresa Carvalho MS


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