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Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Glycopyrrolate is used for several indications: ulcer disease, functional bowel syndrome, and as a preanesthetic agent. No publications on human or animal exposure to this agent during pregnancy have been published.
Cholinergic Antagonists
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Vishal S. Gulecha, Manoj S. Mahajan, Aman Upaganlawar, Abdulla Sherikar, Chandrashekhar Upasani
Atropine or scopolamine was used as a preanesthetic medication to prevent hazardous effects of ether that significantly increased airway secretions. This may lead to frequent episodes of laryngospasm, (McBrien et al., 2013). The preanaesthetic use of these agents became limited and declined after the availability of nonirritating agents, for example, halothane, enflurane, and so on. As glycopyrrolate has less adverse effects, it is preferred over scopolamine (Sharma and Sharma, 2017).
Positions in neurosurgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Zilvinas Zakarevicius, Mikhail Gelfenbeyn, Irene Rozet
Proper placement requires disconnection of the patient from the ventilator and monitoring devices. Preoxygenation before positioning is recommended, as it may prevent desaturation. Pulse oximetry and/or arterial line should be left in place wherever possible. Limited airway access and copious oral secretions during the long prone procedure may weaken fixation of the endotracheal tube. While securing endotracheal tube, additional adhesives with tape should be considered. Judicious use of the cotton tie for fixation of the ETT in combination with tape, adhesive glue, and adhesive dressing (such as Tegaderm™) covering the tape, may be used. Periodical check that the tie is not interfering with surgical field and not compromising venous outflow is essential; the tie should be cut with any suspicion of increased pressure on the neck. To reduce oral secretions, a small dose of intravenous glycopyrrolate (0.2–0.3 mg) may be considered, particularly in patients with copious oral secretions in the beginning of the case (e.g., in heavy tobacco smokers). Free access to the airway, tubing, and connections is essential.
Care of children with home mechanical ventilation in the healthcare continuum
Published in Hospital Practice, 2021
Benjamin Kalm, Khanh Lai, Natalie Darro
In attempts to mitigate these cyclical issues, we often prescribe medications to decrease saliva production. Glycopyrrolate is commonly used to reduce secretions. Of the systemic agents, glycopyrrolate tends to have the least side effects. However, side effects are still frequent, including constipation, fatigue, poor sleep, and urinary incontinence. In some studies, glycopyrrolate had a cessation rate of over 50% within a year; in many instances related to side effects and lack of significant improvement [28]. In part because of the challenges with glycopyrrolate, buccal/sublingual atropine has become the preferred first line agent to control salivation at our institution. We place ophthalmic atropine 1% on a saline moistened cotton swab (applying more than two drops requires multiple swabs), and then apply it to the oral mucosa up to every six hours. The topical application allows for increased concentrations at the site of salivary production, without causing significant side effects as seen with glycopyrrolate. In our experience, many children have seen significant improvement following this regimen. For those who continue to have increased secretions, we consider salivary gland botulinum toxin injection or salivary duct ligation or gland removal in alignment with national publications [29–31].
State-of-the-art pharmacotherapy for autonomic dysfunction in Parkinson’s disease
Published in Expert Opinion on Pharmacotherapy, 2020
Cecilia Quarracino, Matilde Otero-Losada, Francisco Capani, Santiago Pérez-Lloret
Its efficacy in PD patients was demonstrated in a short-term cross-over, double-blind, placebo-controlled trial [54]. Arbow et al. studied the effect of glycopyrrolate 1 mg three times a day for one week before and after placebo treatment with a 7-day washout period in-between. Sialorrhea symptoms were scored using a 9-level Likert scale. Responders were defined as those patients showing a 30% score improvement. Nine out of 23 patients (39%) responded to glycopyrrolate, largely contrasting with an only 4% positive response found in the placebo group (p = 0.021). The most reported adverse events (by PD and control patients) were xerostomia, uneasiness, worsening of motor symptoms, constipation, and vision disturbances. Nevertheless, to remember, anticholinergics per se can cause dysphagia, altering the esophageal peristalsis and delaying the swallow reflex because of inadequate bolus formation leading to saliva retention [55,56].
Managing autonomic dysfunction in Parkinson’s disease: a review of emerging drugs
Published in Expert Opinion on Emerging Drugs, 2020
Dinkar Kulshreshtha, Jacky Ganguly, Mandar Jog
Anticholinergic medications have been tried to reduce the saliva production. In an open labeled pilot study on 6 PD patients with sialorrhea, sub-lingual atropine drops significantly decreased the saliva production objectively and improved the self-reported drooling severity subjectively [76]. Due to their side effects in the form of urinary retention, constipation, agitation, and hallucinations, they are generally not used. Glycopyrrolate is an exception in this class of medicines and despite having an anticholinergic profile, it does not cross the blood-brain barrier due to its quaternary structure and hence the central side effects are not much. In a randomized controlled trial, it was shown to produce a significant improvement in sialorrhea score in PD patients with comparable side effect profile. Long-term studies of the effectiveness of glycopyrrolate in drooling are lacking [77]. Botulinum toxin blocks the acetylcholine release and hence local injection into the salivary glands inhibits the release of saliva. There have been multiple studies including randomized trials showing the efficacy of onabotulinum toxin A and apobotulinum toxin A injected into the parotid/submandibular salivary gland for patients with sialorrhea [26,78x].