PubMed · 13573928
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W STEINBRECHER. 1958-08-15. [Akineton psychoses].. https://doi.org/10.1055/s-0028-1113795
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A case of contact dermatitis to biperiden, an anti-Parkinson agent, and photocontact dermatitis to phenothiazines in a pharmacist was reported. The patient developed eczematous lesions on exposed area after she had worked at a psychiatric hospital for 6 months. She showed positive patch test reaction to biperiden. In addition, she reacted positively to photopatch testing with ultraviolet A and phenothiazines such as chlorpromazine and perphenazine. To our knowledge, contact dermatitis to biperiden has not been previously reported in the English literature.
A 54-year-old woman with acute schizoaffective psychosis was treated with lithium carbonate (1,350 mg daily) and zuclopenthixol. On admission, clozapine was added (250 mg daily). Because extrapyramidal symptoms (rigor, akinesia) developed, she was additionally given biperiden retard (4 mg daily) from the fourth hospital day onwards. Eleven days after admission she began to complain of "unsteadiness" and "tremors" in her arms and she had asterixis (flapping tremor) on holding up her arms. The electromyogram showed electrical pauses of 60-120 ms, typical for asterixis. There were no significant metabolic or organic cerebral changes that could have accounted for the symptoms which presumably had been induced by the drugs even though their dosage was not unusual. The symptoms in fact regressed completely after the clozapine dose had been reduced, at first to 125 mg then to 50 mg. Previous experience has suggested that the risk of asterixis is particularly high when lithium and clozapine are taken together.
The authors report the case of a female patient with parkinsonism induced by flunarizine, and refer the tremor to be of parkinsonian and also of wilsonian type. Cure was observed within three months, after withdrawal of flunarizine, and the use of L-dopa and biperiden.