Evaluation of the anticholinergic actions of glycopyrronium bromide.

Mirakhur, R. K.; Dundee, J. W.; Jones, Christopher J.

doi:10.1111/j.1365-2125.1978.tb01601.x

Cited by 67 publications

(16 citation statements)

References 23 publications

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“…Most importantly, BTX can considerably improve QOL in severely affected patients. [27,32,33,50,127] Currently, Botox Ò is the only BTX-A formulation approved in Canada and the US for the [82,83] Oral glycopyrrolate 1-2 mg one to three times daily Botulinum toxin type A injections Inhibit presynaptic release of acetylcholine and bind to acetylcholine receptors at the postsynaptic membrane, thereby disrupting the sympathetic input to eccrine glands Axillary, palmar, plantar, craniofacial Considerably reduce axillary, [25,[84][85][86] palmoplantar, [86][87][88][89][90][91][92][93][94][95] and craniofacial sweating [96,97] for 4-12 mo treatment of axillary HH. [128] However, data demonstrating the efficacy of both Dysport Ò [125,129] and BTX-B (Myobloc Ò , Elan Pharmaceuticals, South San Francisco, CA, USA) [130][131][132][133][134] suggest that these may also be effective agents for this disorder.…”

Section: Diagnostic Approachmentioning

confidence: 99%

Botulinum Toxin for Hyperhidrosis

Grunfeld

Murray

Solish

2009

American Journal of Clinical Dermatology

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Primary focal hyperhidrosis is a disorder of idiopathic excessive sweating that typically affects the axillae, palms, soles, and face. The disorder, which affects up to 2.8% of the US population, is associated with considerable physical, psychosocial, and occupational impairments. Current therapeutic strategies include topical aluminum salts, tap-water iontophoresis, oral anticholinergic agents, local surgical approaches, and sympathectomies. These treatments, however, have been limited by a relatively high incidence of adverse effects and complications. Non-surgical treatment complications are typically transient, whereas those of surgical therapies may be permanent and significant. Recently, considerable evidence suggests that botulinum toxin type A (BTX-A) injections into hyperhidrotic areas can considerably reduce focal sweating in multiple areas without major adverse effects. BTX-A has therefore shown promise as a potential replacement for more invasive treatments after topical aluminum salts have failed. This article reviews the epidemiology, diagnosis, and management of primary focal hyperhidrosis, with an emphasis on recent research evidence supporting the use of BTX-A injections for this indication.

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Section: Diagnostic Approachmentioning

confidence: 99%

Botulinum Toxin for Hyperhidrosis

Grunfeld

Murray

Solish

2009

American Journal of Clinical Dermatology

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“…[11][12][13] The dose of glycopyrrolate given in phase II of our study (0.2 mg) was therefore not quite equipotent to the hyoscine given in phase I. A review of the literature on the antisialogogue effects of antimuscarinics showed that glycopyrrolate has a slower onset of antisialogogue action than hyoscine HBr in the normal dose ranges.…”

Section: Discussionmentioning

confidence: 63%

A study comparing hyoscine hydrobromide and glycopyrrolate in the treatment of death rattle

Back¹,

Jenkins²,

Blower³

et al. 2001

Palliat Med

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This study looked at the efficacy of drug treatment in managing death rattle in a 30-bedded specialist palliative care unit. The study was conducted in two phases. In the first, patients received hyoscine hydrobromide as the antimuscarinic; glycopyrrolate was used in the second phase. The patients in the two phases were well matched for diagnosis, age, sex and duration of death rattle. A noise score scale of 0-3 was used, which was separately validated using a verbal rating scale and noise-meter readings. Noise scores were taken at the start; 30 min after an antimuscarinic drug was administered; an hour after the initial injection if a repeat dose was given at 30 min; and 4-hourly thereafter. Drug charts of all patients with death rattle were analysed to ascertain the amount of each drug given and the cost. The incidence of death rattle was 44% in phase I, and 36% in phase II. The percentage of patients with reduced noise scores 30 min after one injection of hyoscine was significantly greater than after one dose of glycopyrrolate (56% vs 27%, P = 0.002). The need for a second injection after 30 min was less using hyoscine (33% vs 50%, P = 0.03). There was no statistically significant difference in improvement at 1 h, or at the last recorded score before death. A comparison of the cost of drug treatment using hyoscine or glycopyrrolate was made, and the potential reduction in cost per patient in the glycopyrrolate group was largely offset by increased expenditure on other drugs, especially diamorphine, midazolam and levomepromazine. The results of this study suggest that: (1) glycopyrrolate 0.2 mg is less effective at reducing death rattle than hyoscine hydrobromide 0.4 mg when assessed at 30 min, (2) the use of glycopyrrolate may lead to an increased need for other sedative or anti-emetic medication such as diamorphine, midazolam or levomepromazine, and (3) the cost benefit of using glycopyrrolate over hyoscine hydrobromide is a small part of the total drug budget, and may be less than anticipated due to the increased need of these other drugs.

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“…the blood-brain barrier) is limited, unlike some other antimuscarinic agents (e.g. [7,8] Glycopyrrolate in all three formulations reduced salivation in healthy adult volunteers, [7,8] with oral administration showing a delayed onset and longer duration of reduced salivation compared with the two injected formulations. [4] A study involving patients aged 1 month to 9 years with hydrocephalus found that intravenous atropine 10 mg kg (n = 7) appeared to have greater penetration of the blood-brain barrier than intravenous glycopyrrolate 5 mg kg (n = 9), but that cerebrospinal fluid (CSF) infection may be associated with glycopyrrolate penetration.…”

Section: Pharmacodynamic Profilementioning

confidence: 99%

Glycopyrrolate Oral Solution

Garnock-Jones¹

2012

Pediatric Drugs

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Chronic drooling (sialorrhea) is a common dysfunction in children with neurologic disorders such as cerebral palsy. Glycopyrrolate oral solution, an anticholinergic agent, is the first drug treatment approved in the US for drooling in children with neurologic conditions. This article reviews the clinical efficacy and tolerability of glycopyrrolate oral solution in pediatric patients with neurologic conditions and provides an overview of the pharmacological properties of the drug. In a phase III, randomized, double-blind, multicenter trial, children (aged 3-16 years; n = 36) with problem drooling associated with neurologic conditions and receiving glycopyrrolate oral solution had a significantly (p < 0.01) greater modified Teacher's Drooling Scale (mTDS) response rate at 8 weeks (primary endpoint) than those receiving placebo (73.7% vs 17.6%). At 24 weeks in an additional, noncomparative, phase III study, 52.3% of glycopyrrolate oral solution recipients (aged 3-18 years; n = 137) had an mTDS response (primary endpoint); the response rate was consistently above 50% at all 4-weekly timepoints, aside from the first assessment at week 4 (40.3%). In general, glycopyrrolate oral solution was well tolerated in clinical trials. The majority of adverse events were within expectations as characteristic anticholinergic outcomes.

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Evaluation of the anticholinergic actions of glycopyrronium bromide.

Cited by 67 publications

References 23 publications

Botulinum Toxin for Hyperhidrosis

Botulinum Toxin for Hyperhidrosis

A study comparing hyoscine hydrobromide and glycopyrrolate in the treatment of death rattle

Glycopyrrolate Oral Solution

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