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Green HH, Ray L, Buchanan J, Matsler N. Urinary retention and mydriasis secondary to topical glycopyrronium for axillary hyperhidrosis. Am J Health Syst Pharm 2023; 80:1234-1237. [PMID: 37348110 DOI: 10.1093/ajhp/zxad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
PURPOSE Glycopyrronium, also known as glycopyrrolate, is an antimuscarinic competitive inhibitor of acetylcholine widely utilized topically for its anticholinergic properties in dermatology. A single topical glycopyrronium tosylate (GT) formulation is available on the market, and prescription of this medication has become increasingly popular among dermatologists. This medication has a relatively notable adverse effect profile and carries risks that patients need to be counseled on before initiation. SUMMARY A 22-year-old female presented to our emergency department (ED) with a chief complaint of difficulty urinating for 48 hours and blurred vision for 2 weeks. Over the course of a week, she visited the ED once and urgent care multiple times due to complications associated with combination use of GT and cetirizine. Although these clinical effects were reversible, the patient impact in our case was profound given the time, cost, and invasive nature of these visits. CONCLUSION The notable adverse effects of GT should be considered when prescribing this agent.
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Affiliation(s)
- Holly Hoshall Green
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Lance Ray
- Denver Health and Hospital Authority, Denver, CO
- Department of Emergency Medicine, University of Colorado Anschutz, Aurora, CO, USA
| | - Jennie Buchanan
- Denver Health and Hospital Authority, Denver, CO
- Department of Emergency Medicine, Rocky Mountain Poison and Drug Safety, Denver, CO, USA
| | - Nikolaus Matsler
- Denver Health and Hospital Authority, Denver, CO
- Department of Emergency Medicine, Rocky Mountain Poison and Drug Safety, Denver, CO, USA
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Clausen K, Davis S, Pourmand A. Approach to anisocoria in the emergency department; A case report and literature review. Am J Emerg Med 2023:S0735-6757(23)00245-0. [PMID: 37179218 DOI: 10.1016/j.ajem.2023.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
Anisocoria describes asymmetric pupillary diameter, which can result from traumatic, pharmacologic, inflammatory, or ischemic effects on the eye. In many cases, anisocoria represents a normal physiologic variant. Morbidity associated with anisocoria is directly related to the inciting cause and can vary from benign to life-threatening. A thorough understanding by emergency physicians of normal ocular neuroanatomy, and of common causes of pathologic anisocoria, including medication-induced anisocoria, can facilitate appropriate resource utilization and timely subspecialty consultation, and can help prevent irreversible ocular injury and patient morbidity. We describe a patient who presented to the emergency department with acute onset of blurry vision with anisocoria.
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Affiliation(s)
- Kellan Clausen
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Steven Davis
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Ali Pourmand
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
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Mahonski S, Mohan S, Howland MA, Biary R. Antimuscarinic toxicity secondary to moist towelettes containing glycopyrronium tosylate: a case report. TOXICOLOGY COMMUNICATIONS 2022. [DOI: 10.1080/24734306.2022.2077584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Sarah Mahonski
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Sanjay Mohan
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Mary Ann Howland
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
- College of Pharmacy and Health Sciences, St. John’s University, Queens, NY, USA
| | - Rana Biary
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
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Thangaraju P, Velmurugan H, N K. Current Status of Pharmacokinetic Research in Children: A Systematic Review of Clinical Trial Records. Curr Rev Clin Exp Pharmacol 2022; 19:CRCEP-EPUB-128427. [PMID: 36573054 DOI: 10.2174/2772432818666221223155455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/05/2022] [Accepted: 10/18/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Many medications have different pharmacokinetics in children than in adults. Knowledge about the safety and efficacy of medications in children requires research into the pharmacokinetic profiles of children's medicines. By analysing registered clinical trial records, this study determined how frequently pharmacokinetic data is gathered in paediatric drug trials. METHODS We searched for the pharmacokinetic data from clinical trial records for preterm infants and children up to the age of 16 from January 2011 to April 2022. The records of trials involving one or more drugs in preterm infants and children up to the age of 16 were examined for evidence that pharmacokinetic data would be collected. RESULTS In a total of 1483 records of interventional clinical trials, 136 (9.17%) pharmacokinetic data involved adults. Of those 136 records, 60 (44.1%) records were pharmacokinetics trials involving one or more medicines in children up to the age of 16. 20 (33.3 %) in America, followed by 19 (31.6 %) in Europe. Most trials researched medicines in the field of infection or parasitic diseases 20 (33.3%). 27 (48.2%) and 26 (46.4%) trials investigated medicines that were indicated as essential medicine. CONCLUSION The pharmacokinetic characteristics of children's drugs need to be better understood. The current state of pharmacokinetic research appears to address the knowledge gap in this area adequately. Despite slow progress, paediatric clinical trials have experienced a renaissance as the significance of paediatric trials has gained international attention. The outcome of paediatric trials will have an impact on children's health in the future. In recent years, the need for greater availability and access to safe child-size pharmaceuticals has received a lot of attention.
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Affiliation(s)
- Pugazhenthan Thangaraju
- Department of Pharmacology, All India institute of medical sciences, Raipur, Chhattisgarh, India
| | - Hemasri Velmurugan
- Department of Pharmacology, All India institute of medical sciences, Raipur, Chhattisgarh, India
| | - Krishnapriya N
- Department of Pharmacology, All India institute of medical sciences, Raipur, Chhattisgarh, India
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Kaufman AR, Gulati S, Pula JH, Janetos TM, Cherayil NR, Chiu E, Shepherd EA, Golnik KC, Garcia-Valenzuela E, MacIntosh PW, Johnson BT, Curnyn KM. Pharmacologic Mydriasis Secondary to Topical Glycopyrronium Tosylate Cloths: Clinical Characterization From a Multicenter Analysis. J Neuroophthalmol 2022; 42:530-534. [PMID: 35427257 PMCID: PMC9508283 DOI: 10.1097/wno.0000000000001567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Topical glycopyrronium tosylate (GT) is an anticholinergic medication for treatment of axillary hyperhidrosis. Pharmacologic mydriasis and anisocoria from topical GT has been reported and may be underrecognized. This study aims to clinically characterize patients presenting with pharmacologic mydriasis from exposure to this medication. METHODS This study is a retrospective observational case series. A multicenter chart review of 16 patients diagnosed with pharmacologic mydriasis secondary to topical GT was performed. RESULTS Eight patients (50.0%) were age 18 years and younger, and 14 patients (87.5%) were female. Unilateral mydriasis (anisocoria) occurred in 14 patients (87.5%). Fourteen patients (87.5%) did not initially volunteer topical GT as a "medication," and the history of topical GT exposure needed to be elicited with further questioning. Hand hygiene details were known for 12 patients, and all reported that they did not wash their hands after GT application. Six patients (37.5%) were soft contact lens users. One patient had possible exposure through a family member's use of the medication. Ocular symptoms were common (blurry vision [11 patients, 68.8%] and eye dryness [7 patients, 43.8%]), but systemic anticholinergic symptoms were uncommon (such as constipation [1 patient, 6.3%] and urinary symptoms [3 patients, 18.8%]). CONCLUSIONS Mydriasis associated with topical GT seems to be a consequence of local exposure rather than systemic toxicity. Because patients may not volunteer topical GT as a medication, eliciting a history of exposure often requires further specific questioning. Soft contact lens wear and poor postapplication hand hygiene seem to be associated with mydriasis in GT use.
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Affiliation(s)
- Aaron R. Kaufman
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Shawn Gulati
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - John H. Pula
- NorthShore University Health System, Evanston, IL, USA
| | - Timothy M. Janetos
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Neena R. Cherayil
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eric Chiu
- Des Peres Eye Center, Des Peres, MO, USA
| | - E. Annie Shepherd
- Department of Ophthalmology, Rush University Medical Center, Chicago, IL, USA
| | - Karl C. Golnik
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Cincinnati Eye Institute, Cincinnati, OH, USA
| | | | - Peter W. MacIntosh
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Brooke T. Johnson
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Kimberlee M. Curnyn
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
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Wong NS, Adlam TM, Potts GA, Farshchian M. Hyperhidrosis: A Review of Recent Advances in Treatment with Topical Anticholinergics. Dermatol Ther (Heidelb) 2022; 12:2705-2714. [PMID: 36329359 PMCID: PMC9674821 DOI: 10.1007/s13555-022-00838-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background Topical anticholinergics have been reported to be effective in managing hyperhidrosis (HH) given the recent approval of glycopyrronium tosylate. Objective This review aimed to examine the effectiveness of emerging topical anticholinergic treatments for HH and their associated adverse effects in comparison to current treatment options. Methods We conducted a search within the PubMed and Embase databases for current and emerging topical anticholinergic treatments for primary HH. Results The topical anticholinergics that have been recently investigated for use in HH include glycopyrrolate, oxybutynin, sofpironium bromide, and umeclidinium. The only agent currently FDA approved is glycopyrrolate. Conclusion Knowledge of topical anticholinergic treatment options is important for patient care when managing HH. This review shows that while available safety data thus far are limited, emerging topical anticholinergics pose minimal known human risks.
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Affiliation(s)
- Nikita S Wong
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Taylor M Adlam
- Department of Dermatology, Wayne State University, Dearborn, MI, USA
| | - Geoffrey A Potts
- Department of Dermatology, Wayne State University, Dearborn, MI, USA
| | - Mehdi Farshchian
- Department of Medicine, Division of Dermatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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Gregoriou S, Campanati A, Rigopoulos D, Maria Offidani A, Stratigos A, Kontochristoulos G. Investigational topical anticholinergics in clinical development for the treatment of hyperhidrosis. Expert Opin Investig Drugs 2021; 30:479-482. [PMID: 33691553 DOI: 10.1080/13543784.2021.1900114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Stamatios Gregoriou
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Anna Campanati
- Department of Clinical and Molecular Sciences, Polytechnic Marche University, Dermatology Clinic, Ancona, Italy
| | - Dimitrios Rigopoulos
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Anna Maria Offidani
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Alexandros Stratigos
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - George Kontochristoulos
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
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Abels C, Soeberdt M, Kilic A, Reich H, Knie U, Masur C, Szeimies RM. Pharmacokinetic profile data of glycopyrronium bromide 1% cream beyond 2 weeks are important: reply from the authors. Br J Dermatol 2021; 185:468-469. [PMID: 33792915 DOI: 10.1111/bjd.20095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Abels
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - M Soeberdt
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - A Kilic
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - H Reich
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - U Knie
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - C Masur
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
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9
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Gregoriou S, Kontochristopoulos G, Tiligada E. Pharmacokinetic profile data of glycopyrronium bromide 1% cream beyond 2 weeks are important. Br J Dermatol 2021; 185:467-468. [PMID: 33792896 DOI: 10.1111/bjd.20088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/26/2021] [Indexed: 12/21/2022]
Affiliation(s)
- S Gregoriou
- National and Kapodistrian University of Athens, Faculty of Medicine, Department of Dermatology-Venereology, Andreas Syggros Hospital, Athens, Greece
| | | | - E Tiligada
- National and Kapodistrian University of Athens, Faculty of Medicine, Department of Pharmacology, Athens, Greece
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