Aims Drooling saliva is a common problem in children with neurodevelopmental disorders. The consequences of drooling include skin breakdown, dehydration, and damage to clothing/equipment. Hyoscine and glycopyrronium are most commonly used to reduce drooling, but there is little evidence about their relative effectiveness, or side effect profiles.
We aimed to investigate in a single blind randomised controlled trial whether hyoscine or glycopyrronium is more effective and acceptable for the treatment of drooling in children with non-progressive neurodisability.
Methods Children age 3–15 years who had never received medication to treat drooling were recruited from 15 UK centres and randomised to hyoscine or glycopyrronium; stratification was by centre and drooling severity. Dose adjustment and side effect monitoring were undertaken weekly by the trial team over 4 weeks to identify the most effective dose for each child in the context of any side effects. Primary outcome data were gathered with the standardised Drooling Impact Scale (DIS) at 4 weeks by a researcher blind to treatment group status. Follow up continued to 12 weeks.
Results 90 children (median age 4.9 years) were randomised (49 hyoscine and 41 glycopyrronium). 48 children started hyoscine treatment, and 38 started glycopyrronium. By 4 weeks, 35/48 children (73%) remained on hyoscine and 33/38 (87%) on glycopyrronium; the remaining children had stopped trial medication due to side effects. By 12 weeks, 26/48 children (54%) remained on hyoscine and 31/38 (82%) on glycopyrronium. At 4 weeks there was no significant difference in DIS scores between the treatment groups suggesting both medications were equally effective at the maximum tolerated dose. However, by 4 and 12 weeks hyoscine was associated with more problematic side effects than glycopyrronium and parents were more likely to stop using hyoscine.
Conclusions Hyoscine and glycopyrronium are equally effective in treating problematic drooling in children with neurodisability. However, hyoscine is associated with more problematic side effects and is less likely to be tolerated.
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