Comparison of the efficacy and impact on cognition of glycopyrrolate and biperiden for clozapine-induced sialorrhea in schizophrenic patients: A randomized, double-blind, crossover study

Liang, Chih‐Sung; Ho, Pei‐Shen; Li, Shen; Lee, Wen‐Kuei; Yang, Fei-Wen; Chiang, Kuo-Tung

doi:10.1016/j.schres.2010.02.1060

Cited by 41 publications

(36 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14 A reduction in the frequency and severity of drooling was also observed with glycopyrrolate therapy in a case series and a crossover study comparing oral glycopyrrolate with biperiden capsules in the treatment of clozapine-induced sialorrhea. 15,16 Improvement was observed in both groups compared with baseline, with greater reductions observed with glycopyrrolate. 16 …”

Section: Comparative Efficacymentioning

confidence: 86%

See 1 more Smart Citation

Glycopyrrolate Oral Solution

Cada¹,

Levien

Baker

2010

Hosp Pharm

View full text Add to dashboard Cite

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. Subscribers to The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The December 2010 monograph topics are on fingolimod, ezogabine, telaprevir, clonidine extended release, and risedronate delayed release. The DUE/MUE is on fingolimod.

show abstract

Section: Comparative Efficacymentioning

confidence: 86%

“…15,16 Improvement was observed in both groups compared with baseline, with greater reductions observed with glycopyrrolate. 16 …”

Section: Comparative Efficacymentioning

confidence: 86%

Glycopyrrolate Oral Solution

Cada¹,

Levien

Baker

2010

Hosp Pharm

View full text Add to dashboard Cite

show abstract

“…20 Secondly, it has been used in clozapineinduced sialorrhea. 21,22 Clozapine is an atypical antipsychotic that is prescribed for relieving both the positive and negative symptoms of adolescents with treatment resistant schizophrenia. Sialorrhea is the second most common side effect of clozapine, and glycopyrrolate has been found to be useful in relieving this symptom.…”

Section: Efficacy Studies Including Comparative Studiesmentioning

confidence: 99%

“…There was less impact on cognitive function with glycopyrrolate therapy. 22 This was a small study, there was no control group and there were limitations in using the MMSE to evaluate global cognitive function. Whilst both these studies undertaken in the adult population provide useful information, larger trials are required, involving larger numbers of individuals and more precise monitoring of side effects.…”

mentioning

confidence: 99%

Evaluation of glycopyrrolate in the treatment of chronic drooling

Reddihough¹,

Reid²,

Plover³

2011

DNND

View full text Add to dashboard Cite

Drooling is a major problem for children and adults with cerebral palsy and other neurological conditions. Medication is a major treatment option for these individuals. The focus of this review is to review glycopyrrolate, one of the frequently used medications for poor saliva control. Glycopyrrolate is a quaternary ammonium compound structurally related to atropine. The pharmacology, mode of action and pharmocokinetics are discussed, efficacy studies are reviewed, and safety and tolerability are described. Mention is made of the limited amount of information that is available on patient satisfaction and quality of life. Glycopyrrolate has an important place in the treatment of chronic drooling and possible uses for this medication are described. Further research would be helpful comparing glycopyrrolate with other anticholinergic medication and alternative treatments for drooling including botulinum toxins and surgical procedures. Keywords: dribbling, poor saliva control, cerebral palsy, Parkinson Disease Management issues for chronic severe droolingDrooling, sometimes known as dribbling or poor saliva control, is a distressing problem. Drooling may be odorous; the secretions can cause chronic irritation of the facial skin; dehydration can occur if severe; and excessive drooling may damage clothing, books, and computer equipment. The care required for the individual increases the demands on family members.1 Poor saliva control may result in loss of self esteem. It is a major factor in impeding the successful integration of children and young adults into school, the community, and later the workplace. For adults with neurological conditions such as Parkinson Disease, the impact can be distressing, and individuals that drool have more difficulties with eating, speaking, and with social interactions than individuals with the same condition that do not drool. 2Many factors influence salivary flow including emotional state, environmental temperature, state of hydration, and the presence of food in the mouth. Quantification of salivary flow rate or drooling is challenging. Therefore, few studies documenting prevalence of the condition are available. Drooling has been reported as occurring in between 10% and 78% of children with cerebral palsy, and in 38% of a recent population-based cohort of 385 children from the Victorian Cerebral Palsy Register (manuscript in preparation). It also occurs in many individuals with intellectual disability and in other more unusual neurological and head and neck conditions. 3 For those attending special education settings, the number may be higher and was reported to be present in 58% of children with cerebral palsy. 4 Poor saliva control also occurs in acquired neurological conditions including Parkinson Disease, where it is estimated

show abstract

“…However the aetiology of drooling in children is likely to be different from drug-induced hypersalivation. Oral preparations of glycopyrrolate are not licensed in the UK for the treatment of CIH, but case reports have described the efficacy of glycopyrrolate in the treatment of CIH [16] and a small (n = 13) double-blind, randomised crossover study of glycopyrrolate and biperiden (a centrally acting anticholinergic similar to hyoscine) in CIH reported a significantly greater reduction in hypersalivation scores in patients receiving glycopyrrolate than those receiving biperiden [17]. Furthermore, participants receiving biperiden showed significantly reduced cognitive functioning in comparison to those receiving glycopyrrolate.…”

Section: Introductionmentioning

confidence: 99%

Glycopyrrolate in comparison to hyoscine hydrobromide and placebo in the treatment of hypersalivation induced by clozapine (GOTHIC1): study protocol for a randomised controlled feasibility study

Qurashi

Chu

Husain

et al. 2016

Trials

View full text Add to dashboard Cite

Background: Clozapine is the only medication licensed for the treatment of resistant schizophrenia in the UK. Although efficacious, a common and unpopular side effect of clozapine treatment is clozapine-induced hypersalivation (CIH), which can contribute to non-adherence. The standard treatment for CIH in the UK is hyoscine hydrobromide but this may aggravate cognitive deficits in patients with schizophrenia while glycopyrrolate may be an effective alternative with a more tolerable side effect profile. There is currently no convincing evidence for hyoscine, or any other medication, as an effective treatment for CIH. Methods/design: This is a multicentre randomised, double-blind, placebo-controlled feasibility study of glycopyrronium bromide (glycopyrrolate) and hyoscine hydrobromide (hyoscine) in patients with clozapine-induced hypersalivation. We aim to recruit 42 patients who have been prescribed clozapine and are experiencing hypersalivation, and randomise them to one of three study arms (either hyoscine, glycopyrrolate or placebo). The primary outcome measures will be the participant recruitment and attrition rates, and the secondary outcome will be the metrics of the daytime hypersalivation measure. After a 1-week washout period (discontinuing CIH medication, if any), there will be a 4-week treatment period where participants will be titrated up to the maximum tolerated dose of hyoscine, glycopyrrolate or placebo. Measurements of daytime salivation, nocturnal salivation, cognition and side effects will be taken during home visits in week 2 and week 5. Information on salivation and side effects will also be taken through telephone calls in week 3 and week 4. To gather information on the experience of study participants, exit interviews will also be requested with all participants who drop out of the study and a sample of participants who complete the study. Discussion: There is currently no convincing evidence for hyoscine, or any other medication, as an effective treatment for CIH. There is promising evidence that glycopyrrolate may be more successful in the treatment of CIH causing fewer cognitive side effects. We propose to conduct a randomised placebo-controlled feasibility study of glycopyrrolate and hyoscine in the treatment of clozapine-induced hypersalivation to inform the design of a future efficacy trial. Trial registration: Clinicaltrials.gov NCT02613494, 23 November 2015.

show abstract

Comparison of the efficacy and impact on cognition of glycopyrrolate and biperiden for clozapine-induced sialorrhea in schizophrenic patients: A randomized, double-blind, crossover study

Cited by 41 publications

References 52 publications

Glycopyrrolate Oral Solution

Glycopyrrolate Oral Solution

Evaluation of glycopyrrolate in the treatment of chronic drooling

Glycopyrrolate in comparison to hyoscine hydrobromide and placebo in the treatment of hypersalivation induced by clozapine (GOTHIC1): study protocol for a randomised controlled feasibility study

Contact Info

Product

Resources

About