Biperiden for Excessive Sweating From Methadone

Mr. A was a 30-year-old computer technician who had suffered from excessive sweating since adolescence. He tested different treatments, including Salvia tea, benzodiazepines, carvedilol, and atropine drops, but none of them worked. After entering methadone maintenance treatment (current dose: 50 mg/day), he suffered intolerable sweating, especially at business meetings. After he received biperiden during a psychiatric emergency to antagonize the extrapyramidal side effects of a typical antipsychotic, he noticed a cessation of sweating for several hours. With a dose of 2–4 mg/day of biperiden 3–4 days per week, we could reproduce and maintain this positive effect.

Mr. B was a 43-year-old electrician who had started methadone maintenance treatment 3 years earlier. He had never had a problem with sweating, but from the first day of taking methadone and independently of the dose (20–90 mg/day, currently 40 mg/day), he had to change his wet clothes numerous times a day and suffered from negative reactions at his workplace. Treatment with biperiden resulted in a prompt and stable cessation of the generalized sweating (current dose: 2 mg/day).

Mr. C was a 37-year-old man who had been taking methadone for 6 years (current dose: 18 mg/day). He had had a problem with sweating previously, but with methadone, it became much worse: “In the summer I felt like a hydrant. It was really crazy.” Seeking help, he tried several remedies without any success. Finally, biperiden (a 4-mg controlled-release tablet every morning) resulted in an effective control of the symptom.