Title:Efficacy and Safety of Glycopyrrolate in the Management of Organophosphate and Carbamate Poisoning: A Systematic Review
Volume: 20
Issue: 1
Author(s): Muhammed Rashid, Pooja Gopal Poojari, Viji Pulikkel Chandran, Rashmi Shetty, Harsimran Kaur, Sreedharan Nair and Girish Thunga*
Affiliation:
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education,
Manipal, 576104 India
- Centre for Toxicovigilance and Drug Safety, Manipal College of Pharmaceutical Sciences,
Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
Keywords:
Antidote, evidence-based medicine, glycopyrrolate, organophosphate, toxicology, treatment.
Abstract:
Objective: There is a lack of evidence on the effectiveness of antidotes in the management
of organophosphate and carbamate (OPC) poisoning. We aimed to review the efficacy and
safety of glycopyrrolate in the management of OPC poisoning.
Methodology: Databases such as PubMed, Scopus, Embase, and Cochrane Library were extensively
searched from inception to November 2022 and updated till October 2023. Interventional, observational,
and descriptive studies assessing the efficacy and safety of glycopyrrolate administered in
any dose, route, and duration for the management of OPC poisoning published in the English language
were considered for this review. The treatment with any other regimen that did not include
glycopyrrolate was regarded as the comparator. The survival, intensive care unit (ICU) and ventilatory
outcomes were considered efficacy outcomes, and adverse effects were considered safety outcomes.
Suitable quality assessment tools were used to assess the risk of bias in the included studies.
Two independent reviewers were involved in the study selection, data extraction, and quality assessment
and any discrepancies were resolved through mutual discussion or consultation with a
third reviewer.
Results: A total of 9 studies (2 RCTs, 4 cohorts, 1 case series, and 2 case reports) out of 591 nonduplicate
records were considered for this review. Overall, the RCTs were observed to have a moderate
quality, and observational studies and descriptive studies were found to have good quality. All
the included studies used atropine administration as a standard treatment option along with glycopyrrolate.
The OPC patients treated with glycopyrrolate had a fewer hospitalization days with comparable
recovery and ventilatory outcomes than those that had not been treated with glycopyrrolate.
The occurrence of adverse events and complications was lower in the glycopyrrolate group than in
the control group.
Conclusion: Currently, there is a lack of comparative studies to recommend the use of glycopyrrolate
in OPC poisoning, and further interventional studies are required to make an evidencebased
recommendation on this topic.
