Glycopyrrolate for sialorrhea in Parkinson disease

Arbouw, Maurits E. L.; Movig, Kris L. L.; Koopmann, Matthias; Poels, P.J.E.; Guchelaar, Henk‐Jan; Egberts, Toine C. G.; Neef, Cees; Vugt, Jeroen P. P. van

doi:10.1212/wnl.0b013e3181d8c1b7

Cited by 122 publications

(64 citation statements)

References 13 publications

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“…Treatment Anticholinergics, botulinum toxin, surgical interventions, radiotherapy, speech therapy and trials of devices can improve sialorrhea in PD [124] . Recently, 1 mg of oral glycopyrrolate 3 times daily was shown to be superior to placebo for sialorrhea in PD patients (class I evidence) [120,125] .…”

Section: Diagnosismentioning

confidence: 99%

Nonmotor Disturbances in Parkinson’s Disease

Bassetti

2010

Neurodegener Dis

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Nonmotor disturbances (NMDs) affect most patients with Parkinson’s disease (PD) and often have a profound impact on their quality of life. NMDs such as depression, anxiety, fatigue, REM sleep behavior disorder, constipation, delayed gastric emptying, altered olfaction and pain can precede the onset of motor symptoms. Other NMDs, including hallucinations, dementia, excessive daytime sleepiness, insomnia, orthostatic hypotension and bladder disturbances, typically appear later in the course of PD. For most NMDs of PD, nondopaminergic and non-nigrostriatal mechanisms (e.g. neurodegeneration of other transmitter systems in the cortex and brainstem, side effects of medications, genetic and psychosocial factors) are considered more relevant than the ‘classical’ dopaminergic-nigrostriatal dysfunction. The recognition of NMDs requires a high degree of clinical suspicion, the use of specific questionnaires and ancillary tests. Pharmacological and nonpharmacological approaches can be effective, but for most forms of treatment of NMDs, the scientific evidence is limited.

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Section: Diagnosismentioning

confidence: 99%

Nonmotor Disturbances in Parkinson’s Disease

Bassetti

2010

Neurodegener Dis

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“…Regardless of actual production of saliva in PD, further reduction may be necessary for avoiding sialorrhea. Indeed, subcutaneous injections of botulinum toxin [8,9], or oral therapy with antimuscarinics, such as atropine, scopolamine or glycopyrrolate have been shown to be efficacious for this indication [10][11][12]. Nonetheless, treatment with botulinum toxin is cumbersome and the aforementioned oral antimuscarinics often result in serious central adverse events such as confusion or psychosis, as has been shown with atropine [12].…”

Section: Introductionmentioning

confidence: 99%

A double-blind, placebo-controlled, randomized, crossover pilot study of the safety and efficacy of multiple doses of intra-oral tropicamide films for the short-term relief of sialorrhea symptoms in Parkinson's disease patients

Lloret

Nano

Carrosella

et al. 2011

Journal of the Neurological Sciences

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“…This study provides Class 1 evidence that glycopyrrolate is more effective than placebo in reducing sialorrhea in individuals with Parkinson Disease. 28 2. A randomized, double-blind, cross-over study was conducted to evaluate the efficacy and impact on cognition of glycopyrrolate and biperiden treatments for people with schizophrenia experiencing clozapine-induced sialorrhea.…”

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confidence: 99%

Evaluation of glycopyrrolate in the treatment of chronic drooling

Reddihough¹,

Reid²,

Plover³

2011

DNND

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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

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Glycopyrrolate for sialorrhea in Parkinson disease

Abstract: This study provides Class I evidence that glycopyrrolate 1 mg 3 times daily is more effective than placebo in reducing sialorrhea in patients with Parkinson disease during a 4-week study.

Cited by 122 publications

References 13 publications

Nonmotor Disturbances in Parkinson’s Disease

Nonmotor Disturbances in Parkinson’s Disease

A double-blind, placebo-controlled, randomized, crossover pilot study of the safety and efficacy of multiple doses of intra-oral tropicamide films for the short-term relief of sialorrhea symptoms in Parkinson's disease patients

Evaluation of glycopyrrolate in the treatment of chronic drooling

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