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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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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: 0] [Impact Index Per Article: 0] [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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