Abstract | BACKGROUND: OBJECTIVE: This article provides an overview of the pharmacology, clinical efficacy, and tolerability of glycopyrrolate when used for sialorrhea in children. METHODS: RESULTS: Oral bioavailability of glycopyrrolate varies widely, with a median of 3.3%. Mean C(max) in children was determined to be 0.37 μg/mL, and mean T(max) was 3.1 hours. The clearance in children ranges from 0.6 to 1.43 L/kg/h. The t(½) ranges from 22 to 130 minutes and 19 to 99 minutes in infants and children, respectively. Six studies describing the use of glycopyrrolate for drooling in children were identified. A double-blind, crossover trial of 27 patients (age range, 4-19 years) demonstrated a reduced mean drooling score (modified Teacher's Drooling Scale [1 = never drools to 9 = clothing, hands, and objects frequently become wet]) for glycopyrrolate (mean highest tolerated dose, 0.11 mg/kg) compared with placebo of 1.85 versus 6.33 (P < 0.001). In a parallel study of 36 patients (age range, 3-16 years), 14 of 20 patients randomized to receive glycopyrrolate solution showed improvement in the mean modified Teacher's Drooling Scale score compared with only 3 patients receiving placebo (-3.5 vs -0.1, respectively). Glycopyrrolate was initiated at 0.02 mg/kg per dose orally TID (Max dose: 3 mg) and titrated over a 4-week period. Adverse effects identified in studies include dry mouth (9%-41%), constipation (9%-39%), and behavioral changes (18%-36%). CONCLUSIONS:
Glycopyrrolate is effective in decreasing sialorrhea in children with cerebral palsy or other neurodevelopmental disabilities. Adverse effects did occur, more frequently at higher doses, and should be monitored.
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Authors | Lea S Eiland |
Journal | Clinical therapeutics
(Clin Ther)
Vol. 34
Issue 4
Pg. 735-42
(Apr 2012)
ISSN: 1879-114X [Electronic] United States |
PMID | 22445330
(Publication Type: Journal Article, Review)
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Copyright | Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved. |
Chemical References |
- Muscarinic Antagonists
- Glycopyrrolate
|
Topics |
- Biological Availability
- Child
- Chronic Disease
(drug therapy)
- Clinical Trials as Topic
- Glycopyrrolate
(pharmacokinetics, therapeutic use)
- Humans
- Muscarinic Antagonists
(pharmacokinetics, therapeutic use)
- Sialorrhea
(drug therapy)
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