Glycopyrrolate for treatment of clozapine-induced sialorrhea in three adolescents
ABSTRACT The aim of this case study was to report preliminary data on the effectiveness and tolerability of glycopyrrolate for the treatment of clozapine-induced sialorrhea, or excessive flow of saliva, in an adolescent population.
Three adolescent females (age 13-16), who developed sialorrhea secondary to clozapine treatment, received an open-label trial of glycopyrrolate (4-8 mg) during inpatient hospitalization for treatment-resistant psychotic illness.
The target symptom of sialorrhea was improved in all three cases, with patient self-reports of decreased production of saliva confirmed by staff observation. Glycopyrrolate was generally well tolerated by the patients. One patient reported constipation, which improved with symptomatic treatment. A second patient reported dry mouth, which improved with a reduction in dose of glycopyrrolate.
These three cases provide support for the potential effectiveness and tolerability of glycopyrrolate for clozapine-induced sialorrhea in adolescents. Further controlled studies are required to determine the safety, efficacy and tolerability of glycopyrrolate in this age group and in adults for clozapine-induced sialorrhea.
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ABSTRACT: The hydroformylation activity of various 5- and 6-membered P-heterocycles was investigated in platinum-catalysed hydroformylation of styrene. All of the tested ligands, such as the phosphole-, oxaphosphorine- and phoshinine-based ligands proved to be catalytically active. Especially good aldehyde selectivities were obtained with the chelating diphenylphosphino-tetrahydrophosphinine and diphenylphosphino-hexahydrophosphinine ligands. While the two aldehyde regioisomers were formed close to equimolar amounts with the monodentate ligands, high branched selectivities were observed with the chelating ones. The effect of the 4-substitution of the parent styrene on chemo- and regioselectivity was investigated.Journal of Organometallic Chemistry 05/2011; 696(10):2234-2237. DOI:10.1016/j.jorganchem.2010.11.045 · 2.30 Impact Factor
Journal of clinical psychopharmacology 04/2014; 34(3). DOI:10.1097/JCP.0000000000000102 · 3.76 Impact Factor
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ABSTRACT: Purpose. Four cases in which glycopyrrolate was used to treat clozapine-induced sialorrhea (CIS) are reported. Summary. Glycopyrrolate is an antimuscarinic agent that can be used preoperatively to inhibit drooling and excessive secretions of the respiratory tract. The outcomes of four patients who received glycopyrrolate for the treatment of CIS are described. The Thomas-Stonell and Greenberg Drooling Severity and Frequency Scale (DSFS) was used retrospectively to rate patients' drooling. Glycopyrrolate was effective in alleviating CIS in cases 1-3. Two patients (cases 1 and 4) exhibited severe drooling, which caused their clothing, hands, and objects to consistently become wet. One patient (case 1) responded well to glycopyrrolate and was restarted on the medication when CIS returned after discontinuation of the drug. While another patient (case 3) displayed a similar response to therapy for CIS as the patient described in case 1, this patient did not experience the psychosocial complications as did the patient in case 1, possibly due to the use of glycopyrrolate as the initial treatment of choice. The patient in case 2 experienced moderate but frequent drooling. Thioridazine's high anticholinergic potential may have contributed to this patient's lower baseline DSFS score compared with the scores of the other three patients, or it could have augmented initial symptom improvement:CIS continued in the patient described in case 4 despite treatment with glycopyrrolate, with only mild improvement in the severity and frequency of drooling. Conclusion. Glycopyrrolate was effective in alleviating symptoms in three of four patients with CIS. In a fourth patient, the degree of improvement was unknown due to documentation discrepancies; however, mild improvement was noted initially.American Journal of Health-System Pharmacy 08/2014; 71(15):1282-7. DOI:10.2146/ajhp130636 · 2.21 Impact Factor