Glycopyrrolate for sialorrhea in Parkinson disease: a randomized, double-blind,
crossover trial.
Author(s): Arbouw ME, Movig KL, Koopmann M, Poels PJ, Guchelaar HJ, Egberts TC, Neef C, van
Vugt JP.
Affiliation(s): Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the
Netherlands.
Publication date & source: 2010, Neurology. , 74(15):1203-7
BACKGROUND: 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.
OBJECTIVE: To determine the efficacy and safety of glycopyrrolate in the
treatment of sialorrhea in patients with PD.
METHODS: 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).
RESULTS: 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.
CONCLUSIONS: 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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