Glycopyrrolate for sialorrhea in Parkinson disease: A randomized, double-blind, crossover trial

Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands.
Neurology (Impact Factor: 8.29). 04/2010; 74(15):1203-7. DOI: 10.1212/WNL.0b013e3181d8c1b7
Source: PubMed


Sialorrhea affects approximately 75% of patients with Parkinson disease (PD). Sialorrhea is often treated with anticholinergics, but central side effects limit their usefulness. Glycopyrrolate (glycopyrronium bromide) is an anticholinergic drug with a quaternary ammonium structure not able to cross the blood-brain barrier in considerable amounts. Therefore, glycopyrrolate exhibits minimal central side effects, which may be an advantage in patients with PD, of whom a significant portion already experience cognitive deficits.
To determine the efficacy and safety of glycopyrrolate in the treatment of sialorrhea in patients with PD.
We conducted a 4-week, randomized, double-blind, placebo-controlled, crossover trial with oral glycopyrrolate 1 mg 3 times daily in 23 patients with PD. The severity of the sialorrhea was scored on a daily basis by the patients or a caregiver with a sialorrhea scoring scale ranging from 1 (no sialorrhea) to 9 (profuse sialorrhea).
The mean (SD) sialorrhea score improved from 4.6 (1.7) with placebo to 3.8 (1.6) with glycopyrrolate (p = 0.011). Nine patients (39.1%) with glycopyrrolate had a clinically relevant improvement of at least 30% vs 1 patient (4.3%) with placebo (p = 0.021). There were no significant differences in adverse events between glycopyrrolate and placebo treatment.
Oral glycopyrrolate 1 mg 3 times daily is an effective and safe therapy for sialorrhea in Parkinson disease. Classification of evidence: 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.

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    • "The traditionally recommended medication for drooling in PD patients has been the administration of oral anticholinergics ; for example, an anticholinergic in frequent use is orally administered glycopyrrolate (Arbouw et al. 2010). These reduce the flow of saliva and are claimed to reduce drooling effectively within a matter of weeks. "

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    • "We investigated the prevalence of diurnal and nocturnal drooling in a large cohort of community-dwelling outpatients with PD. Seventy-one percent of patients confirmed problems with saliva or drooling, which is roughly the prevalence that is usually cited in publications [1, 5, 16, 20]. However, here we demonstrate that actual diurnal drooling, i.e. dribbling of saliva from the mouth while awake, is reported by only 28% of PD patients. "
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