Dose in adults = 1 patch applied behind the ear every 72 hours, titrated to 1/4 of a patch to 2 patches every 72 hours as appropriate
Refer to SE London hypersalivation guidelines for further information (link above)
Glycopyrronium bromide oral solution (hypersalivation - Sialanar® and Colonis® brands)
Approved for use in severe sialorrhoea in patients with chronic neurological disorders (including off-label use in adults)
The Colonis® and Sialanar® products are both approved for use in this indication
The Colonis® product is 1 mg in 5 mL of glycopyronnium bromide
The Sialanar® product is 400 micrograms in 1 mL glycopyrronium bromide (2 mg in 5 mL)
The packaging of the Sialanar product however states the dosage of glycopyrronium base (320 micrograms glycopyrronium base in 1 mL), therefore patients should ideally not be switched between brands, and the brand should be clearly detailed when prescribing, including the dosage in mg and volume.
Dose of glycopyrronium bromide in adults = 0.5 mg to 1 mg three times a day, titrating to 2 mg three times a day if required
See APC recommendation for further information (link below)
See APC guidance for the management of hypersalivation in adults with neurological conditions (link above)
Propantheline bromide tabs (gastroenterology and neurology use)
Approved for use in:
Symptom control in GI disorders characterised by smooth muscle spasm
Reducing adverse effects pyridostigmine (e.g. abdombinal cramps) in myaesthenia gravis patients: Usual dose = 15 mg to 30 mg three times a day
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Specialist or hospital prescribing only.
The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital.
In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.
Treatment can be initiated in primary care after a recommendation from an appropriate specialist
Specialist initiation followed by maintenance prescribing in primary care
Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation