What is the dose of glycopyrrolate (glycopyrrolate) for managing secretions in patients with cerebral palsy?

From the Guidelines

Glycopyrrolate is typically dosed at 0.01-0.02 mg/kg/dose given three to four times daily for managing excessive secretions in patients with cerebral palsy, with a maximum of 0.1 mg/kg/day, as recommended by recent guidelines 1. The dosing of glycopyrrolate for cerebral palsy patients is crucial in managing excessive secretions, and the recommended dose range is based on the patient's weight.

• For children, the dose is 0.01-0.02 mg/kg/dose, given three to four times daily, with a maximum of 0.1 mg/kg/day.
• For adults, the usual dose ranges from 1-2 mg given three to four times daily. The medication works by blocking muscarinic acetylcholine receptors, which reduces secretions from salivary, tracheobronchial, and sweat glands.
• Common side effects include dry mouth, constipation, urinary retention, and flushing.
• The medication should be administered before meals and at bedtime for optimal effect. Regular monitoring for anticholinergic side effects is essential, particularly in children who may be more sensitive to these effects.
• Dosage adjustments may be necessary for patients with renal impairment.
• If excessive dryness occurs, dose reduction should be considered rather than discontinuation, as sudden withdrawal can lead to rebound hypersecretion, as noted in the study 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION NOTE: CONTAINS BENZYL ALCOHOL (See PRECAUTIONS ) Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit Glycopyrrolate injection may be administered intramuscularly, or intravenously, without dilution, in the following indications: Adults Preanesthetic Medication The recommended dose of glycopyrrolate injection is 0. 004 mg/kg by intramuscular injection, given 30 to 60 minutes prior to the anticipated time of induction of anesthesia or at the time the preanesthetic narcotic and/or sedative are administered.

The FDA drug label does not answer the question.

From the Research

Cerebral Palsy Secretions and Glycopyrrolate Dose

• The dosage of glycopyrrolate for cerebral palsy secretions varies widely, with studies indicating a range of 0.01 to 0.82 mg/kg per day 2.
• A study published in 2012 found that oral glycopyrrolate solution 1 mg/5 mL was well tolerated over 24 weeks by pediatric patients aged 3-18 years, with a starting dose of 0.02 mg/kg three times daily and titrated in increments of 0.02 mg/kg every 5-7 days for 4 weeks to an optimal maintenance dose or a maximum dose of 0.1 mg/kg, but not exceeding 3 mg three times daily 3.
• Another study published in 2012 found that glycopyrrolate was effective in decreasing sialorrhea in children with cerebral palsy or other neurodevelopmental disabilities, with a mean highest tolerated dose of 0.11 mg/kg 4.
• The final effective dose of glycopyrrolate can range from 0.01 to 0.82 mg/kg per day, and side effects such as dry mouth, constipation, and behavioral changes can occur, especially at higher doses 2, 4.
• Glycopyrrolate can be given in controlled doses for shorter periods, provided that an adequate medical assessment has been undertaken, and can be effective in reducing drooling in adult patients with cerebral palsy as well 5.

Side Effects and Efficacy

• Common side effects of glycopyrrolate include constipation, vomiting, diarrhea, pyrexia, dry mouth, flushing, and nasal congestion 3.
• The most commonly reported treatment-emergent adverse events in a study of pediatric patients were constipation (20.4%), vomiting (17.5%), diarrhea (17.5%), pyrexia (14.6%), dry mouth (10.9%), flushing (10.9%), and nasal congestion (10.9%) 3.
• Glycopyrrolate has been shown to be effective in reducing drooling in patients with cerebral palsy and other neurodevelopmental disabilities, with response rates ranging from 52.3% to 90% 3, 2.

Treatment Options

• Treatment options for sialorrhea in patients with cerebral palsy and other neurodevelopmental disabilities include conservative measures such as observation, postural changes, and biofeedback, as well as more aggressive measures such as medication, radiation, and surgical therapy 6.
• Anticholinergic medications such as glycopyrrolate and scopolamine are effective in reducing drooling, but their use may be limited by side effects 6.
• The injection of botulinum toxin type A into the parotid and submandibular glands is safe and effective in controlling drooling, but the effects fade in several months, and repeat injections are necessary 6.