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Exacerbation of Extrapyramidal Symptoms Associated with Drug-induced Akathisia after Intramuscular Administration of Biperiden in a Patient with End-stage Gastric Cancer A Case Report

Ryo Sakamoto, Hiromichi Matsuoka, Emi Gomi, Akinori Kawaguchi, Shiho Takehisa and Atsuko Koyama

Background: The Anti-cholinergic drug Biperiden is used to treat Parkinsonism, Parkinsonism as an adverse effect of Psychotropic drugs, Dyskinesia, and Akathisia. In the palliative care field, Biperiden is used to treat Akathisia that has developed as an adverse effect of antipsychotics for managing delirium. There are tablets, granules, and injectable preparations of this drug; thus, it can be used for patients with various conditions.

Discussion: In addition to changing and withdrawing the causative drug, Propranolol, Mirtazapine, and Biperiden, an anticholinergic drug, may be administered to manage drug-induced Akathisia. However, Biperiden used to treat drug-induced Akathisia may exacerbate the Akathisia.

Conclusion: Here, we describe administering intramuscular Biperiden to a patient with gastric cancer at the end of life. When Biperiden is administered to treat drug-induced Akathisia and exacerbation of the Akathisia occurs, it is important to consider whether the deterioration in Akathisia is caused by the Biperiden, rather than simply continuing to administer it.