Bradycardia due to biperiden

Area of Science:

• Neurology
• Pharmacology

Background:

• Trigeminal neuralgia is a debilitating neuropathic pain condition.
• Biperiden lactate, an anticholinergic agent, is sometimes used off-label for certain neurological symptoms.

Observation:

• A 38-year-old male with severe postzosteric trigeminal neuralgia received intravenous biperiden lactate (10 mg).
• The patient experienced a prolonged paradoxical reaction, including significant bradycardia, dysarthria, and dysphagia.

Findings:

• Bradycardia, a slowed heart rate, was a prominent adverse effect.
• The reaction was attributed to the rapid intravenous injection and a dose-dependent dual effect of biperiden on muscarinic receptors.
• Orciprenaline administration successfully normalized the heart rate within 12 hours under intensive care monitoring.

Implications:

• This case highlights a rare but serious adverse effect of biperiden lactate.
• Clinicians should be aware of potential paradoxical reactions, especially with rapid intravenous administration.
• Careful cardiac monitoring and prompt management are crucial when administering anticholinergic drugs like biperiden.