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Introduction to dermatological treatment
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
The hand/foot to be treated is placed in a container with only enough tap water to cover the palmar or plantar surface. A solution of an anti-cholinergic agent (0.05% glycopyrronium bromide in distilled water) works better but is expensive to make up. This is connected to the positive terminal of a DC unit producing up to 50 milliamps. The opposite foot/hand (not being treated) is placed in a deep bath of tap water connected to the –ve terminal (Fig. 2.10). A current of 10 milliamps is given for 10 minutes 3x (1st week), 2x (2nd week) and then weekly until the sweating stops. The current and time can be increased if the treatment is not effective. Pulsed current machines can allow greater currents to be used if required. The sweating will gradually return after weeks – months, when the treatment can be repeated. Treatment response tends to be variable; not all patients respond well.
Drooling and Aspiration
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Glycopyrronium bromide is available as an oral solution and is very effective.37 It has the distinct advantage of not crossing the blood–brain barrier unlike atropine, hyoscine and trihexyphenidyl. This should lead to significantly fewer central side effects although peripheral effects (on bladder, bowel, sweat glands and eyes) will still be seen and 20% of children will have to stop using the drug due to side effects.38
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Excess secretions can become problematic for children as they become less able to cough and swallow. Glycopyrronium bromide or hyoscine hydrobromide are helpful, but intermittent suctioning may also be necessary. In terminally ill children, careful positioning and postural drainage may avoid the need for suction.
Indacaterol/glycopyrronium/mometasone fixed dose combination for uncontrolled asthma
Published in Expert Review of Respiratory Medicine, 2022
Corrado Pelaia, Claudia Crimi, Nunzio Crimi, Luisa Ricciardi, Nicola Scichilone, Giuseppe Valenti, Ornella Bonavita, Stefano Andaloro, Paolo Morini, Andrea Rizzi, Girolamo Pelaia
Among the available anticholinergics, glycopyrronium also known as glycopyrrolate (GLY) is a LAMA with a higher selectivity for M3 receptors, thus promoting long-lasting and selective effects. Glycopyrronium bromide acts by blocking acetylcholine-induced bronchoconstriction on airway smooth muscle cells, thus dilating the airways. Through radioligand binding studies, it was demonstrated a four times greater selectivity of GLY for human M3 receptors compared to human M2 receptors, as well as a rapid onset of action and a longer duration, probably attributable to prolonged concentrations of active substance in the lungs [37]. It has also been shown that differences in the affinity rate M3/M2 are present among different LAMAs [38].
Sofpironium bromide: an investigational agent for the treatment of axillary hyperhidrosis
Published in Expert Opinion on Investigational Drugs, 2022
Stamatios Gregoriou, Aikaterini Tsiogka, George Kontochristopoulos, Annamaria Offidani, Anna Campanati
Topical and systemic anticholinergic agents constitute later-line treatment options, showing benefit in reducing sweat production by inhibiting their neuronal transduction in sweat glands [16–18]. The main limitation of systemic anticholinergics, such as glycopyrrolate and oxybutynin, is the increased likelihood of systemic anticholinergic drug reactions of concern, which may lead to treatment discontinuation. Among topical anticholinergics only glycopyrronium tosylate (GT) has been approved by the US Food and Drug Administration (FDA) for PAH in patients ≥9 years of age (glycopyrronium cloth 2.4%) in 2018 based on phase III results (ATMOS-1, ATMOS-2) [19]. Glycopyrronium bromide (GB) cream formulations in concentrations 0.5%–4% have been also evaluated in PAH, showing significant improvement in sweat production. Further investigational topical anticholinergics that have been proven effective in PAH are topical oxybutynin 3% and 10% as well as umeclidinium in the form of cutaneous solution of 1.85% and sofpironium bromide (SB) [20,21].
Beclomethasone dipropionate, formoterol fumarate and glycopyrronium bromide as a combination therapy for chronic obstructive pulmonary disease
Published in Expert Review of Respiratory Medicine, 2019
The main goal of the TRIDENT [6] trial was to determine the optimal dose of glycopyrronium added to the ICS/LABA combination (BDP/FF) in patients with COPD. The study included 178 patients who used 12.5, 25, 50 μg glycopyrronium twice daily or a placebo with a pMDI inhaler. It was found that the dose of 25 μg glycopyrronium bromide (2 inhalations of 12.5 μg) BID was associated with the best clinical response (as assessed by lung function parameters: FEV1/AUC), and the most optimal safety profile. In details, the mean FEV1 AUC 0–12 h on day 7 increased to 1.500, 1.514 and 1.525 L (for GB doses 12.5, 25 and 50 μg, respectively) as compared to 1.413 for BDP/FF therapy. The addition of GB 12.5, 25 and 50 μg BID doses resulted in increases vs BDP/FF in trough FEV1 at 12 h post-dose of 49, 92 and 106 mL, respectively, on Day 1, and 79, 91 and 105 mL, respectively, on Day 7.