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PubMed1983

[Glycopyrrolate (Robinul), a new anticholinergic substance].

Glycopyrrolate is a quaternary ammonium compound with indications for use similar to those for atropine. Because of the quaternary nature, it is poorly absorbed when taken orally and penetrates neither placental nor blood-brain barriers. When given by the parenteral route, the cardio-vagal blocking action of glycopyrrolate is twice that of atropine while inhibition of salivation is 5-6 times greater. The use of glycopyrrolate for premedication provides a therapeutic margin 2-3 times wider than that of atropine. Glycopyrrolate administered with neostigmine to antagonise the residual neuromuscular blockade of non-depolarising relaxants has advantages over atropine because the pharmacodynamic profile is more suited to that of neostigmine. The abrupt changes in cardiac rate, therefore, become minimal. If glycopyrrolate, 5 micrograms/kg-1, is injected intravenously just before the induction of anaesthesia, severe bradycardia is inhibited when repeated doses of succinylcholine are used. Although the alkalinising effect on gastric secretions has not been substantially verified, glycopyrrolate does provide long lasting bronchodilatation from its blocking action on smooth muscle. Only a few studies with glycopyrrolate in children have yet been published. However, it appears that this drug provides no real advantages over atropine when used in paediatric anaesthesia.

Anti-Arrhythmia Agents↗

PubMed1985

The inhibitory effect of glycopyrrolate on human plasma-cholinesterase.

The in vitro inhibitory effect of glycopyrrolate and atropine on the hydrolysis of benzoylcholine at 50.0 microM concentration was determined in the plasma of 6 healthy volunteers at 37 degrees C and at 240 nm by the ultraviolet spectrophotometric method of Kalow. The 50 per cent inhibitory concentration (I50) of glycopyrrolate was found to be 1.0 mM and the I50 of atropine was 0.9 mM. This inhibitory effect of glycopyrrolate and atropine is moderate but its interaction with the in vivo hydrolysis of succinylcholine or that of ester-type of local anaesthetics in patients should be further studied. Although both glycopyrrolate and atropine inhibit PChE to the same extent, glycopyrrolate should be utilized in patients in whom inhibition of brain PChE or central effects ought to be avoided, since glycopyrrolate does not penetrate the blood-brain barrier.

Atropine↗

PubMed1992

Solid-phase extraction techniques for the determination of glycopyrrolate from equine urine by liquid chromatography-tandem mass spectrometry and gas chromatography-mass spectrometry.

Glycopyrrolate (Robinul) is a quaternary ammonium salt which serves as a respiratory enhancing drug. It is reportedly used in horse racing to improve breathing. Extraction of glycopyrrolate from equine urine employing unique solid-phase extraction techniques gave a residue suitable for liquid chromatography-tandem mass spectrometry (LC-MS-MS) and gas chromatography-mass spectrometry (GC-MS). LC-MS-MS analysis employed an extract derived from 5 ml of urine subjected to cation-exchange chromatography. The daughter ion of m/z 318 monitored in the positive-ion mode was m/z 116. Recovery of glycopyrrolate was 99.5% and the within-run coefficient of variation of two quality control samples (1.0 and 10 ng/ml) was less than 5%. The between-run coefficient of variation for the same two quality control samples was less than 6.5%. The minimal detectable concentration for the assay was 250 pg/ml. Due to the extremely low concentration of glycopyrrolate in urine, qualitative detection via full-scan GC-MS required XAD-2 extraction of 50 ml of urine, cation-exchange chromatography clean-up and a tandem hydrolysis-derivatization procedure. The target analyte for GC-MS qualitative analysis was the methyl ester of hydrolyzed glycopyrrolate. Glycopyrrolate could be detected in post-administration (1 mg intravenously) urine samples for up to 9 h by both LC-MS-MS and GC-MS. The success of the method was due to a combination of the extreme sensitivity of the LC-MS-MS method and the very selective extraction process for quaternary ammonium salts.

Animals↗

PubMedDate not supplied

Pharmacokinetics of glycopyrrolate in children.

STUDY OBJECTIVE: To investigate the pharmacokinetics of glycopyrrolate in children. DESIGN: Open study with three parallel groups. SETTING: Pediatric surgery department at a university hospital. PATIENTS: 26 healthy ASA physical status I children undergoing minor surgery. INTERVENTIONS: Patients were assigned to 1 of 3 groups: under 1 year of age (Group 1, n = 8), between 1 and 3 years of age (Group 2, n = 7), and over 3 years of age (Group 3, n = 11). Glycopyrrolate 5 micrograms/kg was given as a single intravenous (i.v.) injection before induction of general anesthesia. Blood samples (for determination of drug concentrations in plasma) were collected via venous cannula inserted into the contralateral antecubital vein. MEASUREMENTS AND MAIN RESULTS: ECG was observed continuously, blood pressure was measured with an automatic noninvasive device, and blood samples were taken just before and at 2, 4, 6, 10, 15, 30, 60, 120, 180, 240, 360, and 480 minutes after injection of glycopyrrolate. Glycopyrrolate concentrations in plasma were determined with a radioreceptor assay. The only significant difference in the pharmacokinetic parameters was the shortened elimination half-life in patients between 1 and 3 years of age. Glycopyrrolate 5 micrograms/kg i.v. did not cause any significant alterations in heart rate. CONCLUSIONS: There were no significant changes in the distribution volume or clearance of glycopyrrolate in children of different ages. The shortened elimination half-life in children between 1 and 3 years of age is of minor clinical importance.

Anesthesia, Intravenous↗

PubMed1996

Preoperative glycopyrrolate: oral, intramuscular, or intravenous administration.

STUDY OBJECTIVE: To evaluate the effects of oral, intramuscular (i.m.) and intravenous (i.v. glycopyrrolate on oral and gastric secretions, and to assess how these routes of administration change intubating conditions. DESIGN: Randomized, double-blinded study. SETTING: University hospital operating room. PATIENTS: 37 ASA status I and II general anesthesia patients. INTERVENTIONS: Patients were randomized to receive glycopyrrolate or placebo just before surgery by three routes: oral, i.m., and i.v.. Glycopyrrolate was received once by one route and placebo by the other two routes. A placebo group received three placebos and no glycopyrrolate. MEASUREMENTS AND MAIN RESULTS: Mouth conditions and intubating conditions were qualitatively assessed by the patient and the intubating anesthesiologist. No difference between groups was noted. Oral and gastric volumes were measured and showed significantly less gastric volume for the i.v. group as compared with the other groups. Oral secretions were reduced in both the i.v. and i.m. groups when compared with placebo or glycopyrrolate administered orally. CONCLUSIONS: Preoperative glycopyrrolate is significantly more effective at reducing oral and gastric secretions if administered intravenously immediately before induction.

Adjuvants, Anesthesia↗

PubMed2005

Glycopyrrolate causes prolonged bronchoprotection and bronchodilatation in patients with asthma.

INTRODUCTION: Inhaled anticholinergic drugs are effective bronchodilators in the treatment of COPD, and tiotropium bromide has recently been introduced as a once-daily bronchodilator for use as a maintenance treatment. Racemic glycopyrrolate is an anticholinergic drug that has been used orally to control gastric acidity, parenterally as an antisialogogue and to reverse neuromuscular blockade, and has been studied by inhalation for asthma and COPD. DESIGN AND OBJECTIVE: We investigated the duration of protection against the constrictor effects of inhaled methacholine of a single dose of inhaled nebulized racemic glycopyrrolate (0.5, 1.0, and 2.0 mg) compared with ipratropium bromide (0.5 mg) and placebo in 10 atopic asthmatic volunteers in a double-blind, five-way, crossover study. RESULTS: Protection against methacholine-induced bronchospasm after administering glycopyrrolate was maintained to 30 h, the last time point measured. Both bronchodilatation and bronchoprotection were significantly longer with glycopyrrolate than after ipratropium bromide, and bronchoprotection was significant at all time points from 2 to 30 h compared to placebo. Dryness of the mouth and nose was described in 18% of patients after the highest dose of glycopyrrolate. CONCLUSIONS: The prolonged bronchodilator response and the protection against methacholine-induced bronchospasm demonstrated in asthma suggests that inhaled racemic glycopyrrolate would be superior to ipratropium bromide for treatment of stable COPD.

Asthma↗

PubMed1990

Comparison of aerosolized glycopyrrolate and metaproterenol in acute asthma.

The efficacy of nebulized glycopyrrolate compared with metaproterenol was evaluated in 46 patients with acute asthma. In a double-blinded, randomized fashion, patients received, as sole therapy, either 2 mg of glycopyrrolate or 15 mg of metaproterenol every 2 h over a 6-h study period. Of the 35 patients completing the study, analysis of variance demonstrated no difference in percentage of change in FEV1 between glycopyrrolate and metaproterenol. Two hours after the initial dose, there was a 30 percent increase in FEV1 for glycopyrrolate compared with a 25 percent increase for metaproterenol (p greater than 0.05, NS). In contrast to the comparable bronchodilator activity, the side effects profile of the two agents were markedly dissimilar. Not only were subjective complaints of tremor, palpitations, and paresthesias increased for metaproterenol, but the heart rate response was significantly elevated (p less than 0.05) compared with glycopyrrolate. Based on these data, administration of the aerosolized anticholinergic agent, glycopyrrolate, is a reasonable therapeutic alternative for acute asthma.

Administration, Inhalation↗

PubMed1984

Effects of pre-anaesthetic glycopyrrolate and cimetidine on gastric fluid acidity and volume in children.

The effects of pre-anaesthetic glycopyrrolate and cimetidine on gastric fluid pH and volume were studied in 96 paediatric patients from ages 6 months to 12 years undergoing elective surgery. They were randomly allocated into six groups with 16 patients in each group. Patients in group I received neither glycopyrrolate nor cimetidine and served as controls. Group II patients received glycopyrrolate, 5 micrograms kg-1 intramuscularly in a.m. Patients in group III received cimetidine 5 mg kg-1 orally in a.m. Group IV patients received cimetidine 5 5 mg kg-1 orally in a.m. and glycopyrrolate 5 micrograms kg-1 in a.m. Patients in group V received cimetidine 5 mg kg-1 orally h.s. and a.m. Group VI patients received cimetidine as in group V and also received glycopyrrolate as in group II. Patients with gastric pH 2.5 or less and volume of gastric contents 0.4 ml kg-1 or greater were defined to be at risk of pulmonary damage if aspiration should occur. The patients in the control group had a mean gastric pH of 1.91 +/- 0.074 and mean gastric volumes of 0.52 +/- 0.06 ml kg-1. Ninety-four per cent of patients in this group had gastric pH less than or equal to 2.5 and 69% of patients had gastric volumes greater than or equal to 0.4 ml kg-1. Glycopyrrolate (group II) reduced patients with pH less than or equal to 2.5 to 50% and volumes greater than or equal to 0.4 ml kg-1 to 44%. Cimetidine markedly reduced both gastric acidity (gastric pH less than or equal to 2.5 in 0-13% of patients in groups III-VI) and gastric volume (greater than or equal to 0.4 ml kg-1 in 19-38% of patients in groups III-VI). Only a maximum of 13% of the patients presented with combination of both risk factors in groups III-VI.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

PubMed1984

Effect of preanesthetic glycopyrrolate and cimetidine on gastric fluid pH and volume in outpatients.

The effects of preanesthetic glycopyrrolate and cimetidine on gastric fluid pH and volume were studied in outpatients. One hundred outpatients scheduled for elective surgery were randomly allocated into four groups with 25 patients in each group. Patients in group I were given neither glycopyrrolate nor cimetidine and served as controls. Group II patients received 4-5 micrograms/kg of glycopyrrolate intramuscularly 45-90 min before induction of anesthesia. Patients in group III received 300 mg of cimetidine orally with a sip of water 1-4 hr before induction of anesthesia. Group IV patients received cimetidine, as in group III, and glycopyrrolate as in group II. Twenty-five inpatients undergoing elective surgery also were studied for comparison. Patients in group I (control) served as the basis for comparison with inpatients. Patients with gastric pH less than or equal to 2.5 or volume of gastric contents greater than or equal to 20 ml were defined to be at risk of pulmonary damage in the event of aspiration. Patients in group I had a mean gastric pH of 2.34 +/- 0.30 with a mean gastric volume of 25.6 +/- 4.1 ml. Seventy-six % of the patients in the control group had gastric contents with a pH less than or equal to 2.5 and 52% had volumes greater than or equal to 20 ml. Glycopyrrolate (group II) failed to increase gastric pH or to reduce gastric volume. In contrast, cimetidine in groups III and IV with or without glycopyrrolate significantly reduced the number of patients at risk of aspiration, by increasing the pH and reducing the volume of gastric contents.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1981

Atropine and glycopyrrolate: hemodynamic effects and placental transfer in the pregnant ewe.

Atropine administration in pregnant women may cause fetal tachycardia and a decrease in beat-to-beat variability of the fetal heart rate. In the present study, placental transfer and maternal and fetal hemodynamic effects of atropine and glycopyrrolate were compared in chronically and in acutely instrumented, unanesthetized pregnant ewes. Administration of either atropine (0.05 mg/kg) or glycopyrrolate (0.025 mg/kg) increased maternal heart rate by 25% without changing maternal arterial pressure, fetal arterial pressure, fetal heart rate, or beat-to-beat variability. Maternal and fetal blood gas tensions also did not change. Placental transfer or atropine was significantly greater than that of glycopyrrolate throughout the entire experimental period. The peak fetal/maternal ratios observed 4 hours after injection were 1.0 for atropine and 0.13 for glycopyrrolate. On the basis of placental transfer data only, it is possible to postulate that the use of glycopyrrolate may be preferable to atropine. However, in view of the absence of circulatory effects in the fetal lamb after either atropine or glycopyrrolate, it was concluded that neither agent is preferable to the other insofar as fetal effects are concerned during ovine pregnancy. Whether these conclusions can be applied to human pregnancy remains to be determined.

Animals↗

PubMed1981

Atropine and glycopyrrolate effects on lung mechanics in normal man.

To assess the comparative bronchomotor effects of large systemic doses of glycopyrrolate and atropine intravenous glycopyrrolate (10 micrograms/kg), atropine (20 micrograms/kg), or a placebo was administered to six healthy male volunteers in double-blind fashion. Both drugs produced bronchodilation reflected by significant decreases in airway resistance and increases in specific airway conductance (sGAW) compared to placebo. Glycopyrrolate increased sGAW to a maximal level of 100% +/- 7% above control; bronchodilation persisted at this level for more than 4 hours after drug administration. Atropine increased sGAW to a maximum of 88% +/- 5% above control 30 minutes after administration, but sGAW returned to control levels between 3 and 4 hours after the drug was given. Both drugs increased maximum expiratory flow rates over the same time course as sGAW, but the percent increases in flow were significantly less than changes in sGAW. Lung elastic recoil was decreased by both drugs over the full range of lung volume. The 32% maximum increase in heart rate after glycopyrrolate was significantly less (p< 0.01) than the 60% increase after atropine. It was concluded that vagal blockade with glycopyrrolate dilates large and small airways to the same extent as atropine, but that the effect is more sustained and associated with less cardiac vagal blockade. Lower doses of glycopyrrolate were also studied and the findings showed that maximal bronchodilation is achieved with lower doses (3.2 micrograms/kg), which are commonly used in routine premedication.

Adult↗

PubMed1994

Effects of glycopyrrolate on capsaicin-induced cough in normal volunteers treated with captopril.

The effects of inhibition of angiotensin converting enzyme (ACE) and glycopyrrolate on cough caused by inhaled capsaicin were investigated in a double-blind, randomised cross-over study in twelve normal volunteers. The capsaicin challenge was performed before and 2 h after dosing with 75 mg captopril or matched placebo given orally, and 20, 40 and 60 min after giving 1 mg glycopyrrolate i.v. to each subject. Captopril and placebo did not alter the cough response when compared to baseline. Glycopyrrolate, however, caused a significant increase in the threshold sensitivity (D2) from baseline, and a significant decrease in the total cough response at 40 and 60 min both after captopril and placebo. The D2-baseline and D2-40 min after glycopyrrolate (mean SD), respectively, were 3.2 (1.0); 17.9 (4.2) after placebo and 2.5 (8.5); 23.6 (6.9) after captopril. Elimination of vagal influences implies attenuation of the effects of tachykinins but not those prostaglandins. We postulate that tachykinins, such as substance P, play a more important role than prostaglandins in capsaicin-induced cough. We conclude that the vagus is important in the capsaicin-induced cough reflex, but, as suppression of this reflex by glycopyrrolate was delayed, the relevant receptors are either poorly accessible peripheral receptors or they are located in the central nervous system.

Administration, Inhalation↗

PubMed1975

Glycopyrrolate methobromide: 2. comparison with atropine sulphate in anaesthesia.

A double blind study of 98 patients was undertaken to compare the clinical usefulness of atropine and glycopyrrolate for pre-anaesthetic medication and their relative effectiveness in antagonizing the muscarinic effects of neostigmine methylsulphate given to reverse neuromuscular blockade. Intramuscular administration of atropine 0.4 mg or of glycopyrrolate 0.2 mg produced the same degree of dryness of the pharynx. However, glycopyrrolate was found to be a more potent antagonizer of the increased salivation induced by neostigmine. By intramuscular administration, both drugs produced the same degree of tachycardia, although atropine tended to cause no change in the pulse rate or even to produce bradycardia in a greater number of patients. Administered intravenously, atropine produced a more significant tachycardia in a large number of patients prior to neostigmine administration, although the protection against a decreased pulse rate from neostigmine is greater in those patients who received glycopyrrolate. It would appear, therefore, that glycopyrrolate is more effective in antagonizing the muscarinic effects of neostigmine methylsulphate.

Adolescent↗

PubMed1983

The heart rate response to succinylcholine in children: a comparison of atropine and glycopyrrolate.

To determine whether intravenous atropine and glycopyrrolate are equally effective in preventing succinylcholine-induced heart rate changes, we studied the heart rate during the first 78 seconds of anaesthesia in 40 children anaesthetized with either thiopentone, atropine (0.02 mg X kg-1) and succinylcholine (2 mg X kg-1), or thiopentone, glycopyrrolate (0.01 mg X kg-1) and succinylcholine (2 mg X kg-1). Each treatment group was divided into four subgroups which differed only in the interval (6, 10, 15, 20 seconds) between injection of atropine or glycopyrrolate and succinylcholine. During the 54 seconds after succinylcholine, the mean heart rate of each subgroup decreased transiently and then returned to the pre-induction heart rate or higher. There was no difference in either the magnitude or the duration of the decrease in heart rate or the subsequent increase in heart rate between respective subgroups. Bradycardia occurred in only two patients, both of whom received glycopyrrolate. We conclude that atropine (0.02 mg X kg-1) and glycopyrrolate (0.01 mg X kg-1) are equally effective in attenuating succinylcholine-induced changes in heart rate in children.

Anesthesia, General↗

PubMed1988

Effects of atropine and glycopyrrolate on neuromuscular transmission in the rat phrenic nerve-diaphragm preparation.

1. The effects of atropine and glycopyrrolate on neuromuscular transmission and on muscle contraction, were studied, in the rat diaphragm preparation, by analyzing their effects on the indirectly (and directly)-elicited twitch (0.2 Hz), tetanic (50 Hz for 20 sec duration), post-tetanic twitch responses (at 5 sec after the tetanus), and on the phenomenon of post-tetanic twitch potentiation (PTP), which is thought to be of a presynaptic origin, i.e. due to increased transmitter release. 2. Atropine (0.001-10 microM) increased the indirectly-elicited twitch tension by 22 +/- 2.1% (control 0.9 +/- 0.1 g, P less than 0.02), the tetanus by 15 +/- 1.1% (control 3.9 +/- 0.7 g, P less than 0.05), the post-tetanic twitch response by 33 +/- 3.1% (control 1.2 +/- 0.1 g, P less than 0.01) and the PTP value by 36 +/- 1.9% (control 33 +/- 2.3%, P less than 0.01, means +/- SEM = 6). 3. Atropine (0.001-10 microM) had little effect on the directly-elicited twitch tension, but in high concentrations (e.g. 20 microM), it blocked the twitch tension. 4. In contrast, glycopyrrolate (0.1-100 microM) had little effect on the twitch tension (direct or indirect), but it significantly reduced the tetanus (by 38 +/- 3.5%, P less than 0.01), the post-tetanic twitch response (by 17 +/- 1.2%, P less than 0.05) and the PTP values (by 24 +/- 3.1% P less than 0.02). 5. In the presence of hemicholinium (1.3 microM) the responses to atropine and glycopyrrolate were altered (decreased), indicating a possible action on presynaptic mechanism of transmission. 6. It is concluded that atropine and glycopyrrolate produce different (opposite) effects at the rat neuromuscular junction, atropine enhances whereas glycopyrrolate depresses neuromuscular transmission. The effects of these two antimuscarinic drugs may be exerted at the presynaptic nerve terminals, i.e. on presynaptic muscarinic receptors, which are involved in the feedback mechanism of transmitter release.

Animals↗

PubMed1994

Effects of combined treatment with glycopyrrolate and albuterol in acute exacerbation of asthma.

STUDY OBJECTIVE: Recent reports suggest that glycopyrrolate is as effective as metaproterenol in the treatment of acute bronchospasm. The purpose of this study was to investigate whether the addition of a single aerosolized dose of glycopyrrolate to an albuterol regimen results in a greater improvement in pulmonary function than treatment with an albuterol regimen alone in patients with acute asthma. DESIGN: Prospective, randomized, double-blinded, controlled study. All patients received a total of three aerosol treatments and 60 mg solumedrol IV push. Patients were randomized to receive 2 mg aerosolized glycopyrrolate (combination therapy) or aerosolized placebo (control) in addition to their first 2.5 mg albuterol aerosol treatment. Both groups received 2.5 mg aerosolized albuterol alone for the next two treatments. SETTING: An urban teaching hospital emergency department. PARTICIPANTS: One hundred twenty-five patients with acute exacerbation of asthma were entered into the study. MAIN RESULTS: There was no difference in pretreatment forced expiratory volume (one second) (FEV1) between the control group and the glycopyrrolate group. Asthmatic patients receiving combination therapy had less of a change in FEV1 (52%) than did control patients (82%, P < .05). CONCLUSION: The combination of glycopyrrolate and albuterol does not appear to be beneficial over albuterol alone in treating patients with acute exacerbation of asthma.

Acute Disease↗

PubMed2000

Glycopyrrolate treatment of drooling in an adult male patient with cerebral palsy.

1. The aim of the study was to assess the effect of glycopyrrolate on drooling in an adult male patient with cerebral palsy. 2. After a thorough medical examination and consent in writing by the responsible guardian, a baseline sum score for frequency and seriousness of drooling was established over a 2 week period in addition to data on shifts of handkerchiefs, urination, defecation and observation of behaviour. Glycopyrrolate (1 mg) tablets were then administered, starting with one tablet daily the third week and increasing the daily dose by one tablet per week until a maximum of four tablets during week six and 4 days of week seven when the daily dose was reduced to two tablets for 3 days. For the four weeks 8-11 three tablets were given daily. In week 12 the dose was reduced to two tablets and for the weeks 13-15 no tablets of glycopyrrolate were given. 3. For as long as the patient received three to four tablets of glycopyrrolate daily, drooling was markedly reduced and handkerchiefs were not necessary on some days. After the tablets were withdrawn drooling increased to approximately the same level as it was before treatment. No adverse medical, psychological, or social effects were observed. 4. For shorter periods, glycopyrrolate can be given in controlled doses provided that an adequate medical assessment has been undertaken.

Cerebral Palsy↗

PubMed1998

Use of glycopyrrolate in the treatment of Meniere's disease.

OBJECTIVES/HYPOTHESIS: The objective of this study was to determine whether glycopyrrolate is useful as a vestibular suppressant in patients with Meniere's disease. The tested hypotheses were that glycopyrrolate would decrease the perception of dizziness measured by the Dizziness Handicap Inventory in patients with Meniere's disease and that placebo would cause no such decrease. STUDY DESIGN: Randomized, prospective. METHODS: Thirty-seven subjects with a diagnosis of Meniere's disease were administered either 2 mg of glycopyrrolate or placebo twice daily as needed for vertigo. All were also administered the regimen of 1500 mg sodium/day diet and diuretic. The following indices were examined: Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Modified Somatic Perception Questionnaire, Beck Depression Inventory, hearing examination, and electronystagmography. After 4 to 6 weeks of the drug regimen, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Modified Somatic Perception Questionnaire, and Beck Depression Scale were reexamined. Paired t tests were performed to verify the significance of improvement before and after treatment. RESULTS: Subjects who received glycopyrrolate had statistically significant reduction in Dizziness Handicap Inventory, Beck Depression Score, and Modified Somatic Perception Score. In the placebo group, no improvement in any index was found. CONCLUSIONS: The hypothesis that glycopyrrolate is a useful vestibular suppressant in patients with Meniere's disease was statistically verified.

Adult↗