Objective: To evaluate the safety, tolerability and effect of glycopyrrolate inhalations in PD patients with sialorrhea.

Background: Sialorrhea is reported in up to 60 percent of patients with Parkinson’s Disease (PD). A frequently prescribed treatment is oral glycopyrrolate (tablets or solution). The absorption of orally administered glycopyrrolate may be influenced by dysfunction in the gastrointestinal tract in patients with PD. Using the respiratory system may improve absorption of glycopyrrolate and therefore reduce drooling and improve the quality of life.

Method: We recruited 10 patients with PD (mean age 67 y, mean H&Y 2,4) and complaints of sialorrhea. Starting with a baseline week, they used a weekly increasing dose of glycopyrrolate during three weeks: once, twice and three times daily 44 mcg. During the fifth week, subjects could use the glycopyrrolate inhalation ‘on demand’ with a maximum of fout inhalatoins per day. During the entire study period, the sialorrhea score was obtained three times per day using a 1-9 point scale.

Results: In 40% of the patients there was a significant reduction of drooling of more than 50%. The mean sialorrhea score of all participants who completed the study decreased from 4.8 (2.4 – 6.9) to 2.2 (1.0 – 4.0). No serious side effects occurred. Tolerability of inhaled glycopyrrolate could be labelled as moderate, because 30% of participants dropped out due to possibly related side effects. Most reported side effect was transitory headache.

Conclusion: 1. Glycopyrrolate inhalations are feasible and safe; 2. When tolerated, inhaled glycopyrrolate seems to be an alternative for oral administration, especially in patients with gastro-intestinal distress; 3. More research is needed to assess effectiveness.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/glycopyrrolate-as-inhalation-for-treating-sialorrhea-in-parkinsons-disease/