Sialorrhoea treated with inhaled glycopyrronium

Sialorrhoea or drooling is a distressing and often socially isolating symptom seen in palliative care. Evidence to support efficacy and safety of drug therapy in sialorrhoea is limited. Most drugs, in an adult population, are unlicensed for this indication in the UK including glycopyrronium. A 73-year-old Caucasian man, diagnosed with a right-sided sarcomatoid malignant pleural mesothelioma, presented with difficulty in swallowing and sialorrhoea. A glycopyrronium inhaler (administering 55 μg of glycopyrronium bromide/puff) was initiated in the mornings, increasing up to three times per day as tolerated. He reported a significant decrease in his symptoms 2 days after initiation using a numerical rating scale. A regular dose of one puff two times per day completely resolved the patient's symptoms within 5 days. This case supports the use of inhaled glycopyrronium as a possible therapy for sialorrhoea in palliative care patients. In addition, doses required for resolution of symptoms were significantly lower when compared with systemic dosages.