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Volume 20, Issue 1
  • ISSN: 2772-4328
  • E-ISSN: 2772-4336

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 non-duplicate 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 evidence-based recommendation on this topic.

PROSPERO Registration Number

CRD42022380112

© 2025 Bentham Science Publishers
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2024-05-23
2025-01-08

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References

  1. KoiralaD.P. RaoK.S. MallaK.K. MallaT. A study of clinical features, management and outcome of organophosphate and carbamate poisoning in children.J. Nepal Paediatr. Soc.2013332859010.3126/jnps.v33i2.7799
     [Google Scholar]
  2. BoedekerW. WattsM. ClausingP. MarquezE. The global distribution of acute unintentional pesticide poisoning: Estimations based on a systematic review.BMC Public Health2020201187510.1186/s12889‑020‑09939‑0 33287770
     [Google Scholar]
  3. ReddyB.S. SkariaT.G. PolepalliS. Factors associated with outcomes in organophosphate and carbamate poisoning: A retrospective study.Toxicol. Res.202036325726610.1007/s43188‑019‑00029‑x 32685430
     [Google Scholar]
  4. KhalidA. KaziM.A. BibiI. Effect of atropine and glycopyrrolate in patients with organophosphate poisoning.Indo Am J Pharmaceut Sci201741143704374
     [Google Scholar]
  5. SinghG. SidhuU.P.S. MahajanR. AvasthiG. WhigJ. Phrenic nerve conduction studies in acute organophosphate poisoning.Muscle Nerve200023462763210.1002/(SICI)1097‑4598(200004)23:4<627::AID‑MUS23>3.0.CO;2‑S 10716775
     [Google Scholar]
  6. Balali-MoodM. ShariatM. Treatment of organophosphate poisoning. Experience of nerve agents and acute pesticide poisoning on the effects of oximes.J. Physiol. Paris1998925-637537810.1016/S0928‑4257(99)80008‑4
     [Google Scholar]
  7. LeeP. TaiD.Y.H. Clinical features of patients with acute organophosphate poisoning requiring intensive care.Intensive Care Med.200127469469910.1007/s001340100895 11398695
     [Google Scholar]
  8. SungurM. GüvenM. Intensive care management of organophosphate insecticide poisoning.Crit. Care20015421121510.1186/cc1025 11511334
     [Google Scholar]
  9. GrobD. The manifestations and treatment of poisoning due to nerve gas and other organic phosphate anticholinesterase compounds.Arch. Intern. Med.195698222123910.1001/archinte.1956.00250260095010 13354016
     [Google Scholar]
  10. BeardsS.C. KrausP. LipmanJ. Paralytic ileus as a complication of atropine therapy following severe organophosphate poisoning.Anaesthesia199449979179310.1111/j.1365‑2044.1994.tb04454.x 7978137
     [Google Scholar]
  11. TuA. The first mass chemical terrorism using sarin in Matsumoto, Japan. Archives of toxicology.Kinetics and Xenobiotic Metabolism2001936593
     [Google Scholar]
  12. BardinP.G. Van EedenS.F. Organophosphate poisoning.Crit. Care Med.199018995696010.1097/00003246‑199009000‑00010 2394119
     [Google Scholar]
  13. KhalafM.A.M. HashemM.A. Abd-ElAziz Abd-El ZaherM. TaghianA.S. TaghianA.S. A comparative study between the use of atropine alone and in combination with glycopyrrolate in acute organophosphorus poisoning in minia poison control center.Indian J. Public Health Res. Dev.2020112135910.37506/v11/i2/2020/ijphrd/195011
     [Google Scholar]
  14. EddlestonM. ChowdhuryF.R. Pharmacological treatment of organophosphorus insecticide poisoning: The old and the (possible) new.Br. J. Clin. Pharmacol.201681346247010.1111/bcp.12784 26366467
     [Google Scholar]
  15. MoherD. LiberatiA. TetzlaffJ. AltmanD.G. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.PLoS Med.200967e100009710.1371/journal.pmed.1000097 19621072
     [Google Scholar]
  16. RashidM. ThungaG. PoojariP.G. ChandranV.P. ShettyR. ChhabraM. Efficacy and safety of glycopyrrolate in the management of organophosphate and carbamate poisoning.Prospero202202280112
     [Google Scholar]
  17. HigginsJ.P.T. AltmanD.G. GøtzscheP.C. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.BMJ20113432d592810.1136/bmj.d5928 22008217
     [Google Scholar]
  18. PetersonJ. WelchV. LososM. TugwellP. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa.Ottawa Hos Res Ins201121112
     [Google Scholar]
  19. MuradM.H. SultanS. HaffarS. BazerbachiF. Methodological quality and synthesis of case series and case reports.BMJ Evid. Based Med.2018232606310.1136/bmjebm‑2017‑110853 29420178
     [Google Scholar]
  20. ThungaG. RashidM. ChandranV.P. N-acetyl cysteine in rodenticide poisoning: A systematic review and meta-analysis.Curr Rev Clin Exp Pharmacol202217319220410.2174/2772432816666210825102726 34455951
     [Google Scholar]
  21. ChoiP.T.L. QuinonezL.G. CookD.J. BaxterF. WhiteheadL. The use of glycopyrrolate in a case of intermediate syndrome following acute organophosphate poisoning.Can. J. Anaesth.199845433734010.1007/BF03012025 9597208
     [Google Scholar]
  22. TraceyJ.A. GallagherH. Use of glycopyrrolate and atropine in acute organophosphorus poisoning.Hum. Exp. Toxicol.1990929910010.1177/096032719000900207 2340198
     [Google Scholar]
  23. ArendseR. IrusenE. An atropine and glycopyrrolate combination reduces mortality in organophosphate poisoning.Hum. Exp. Toxicol.2009281171572010.1177/0960327109350666 19850654
     [Google Scholar]
  24. KrishnaP.G. GirishT. ManasaC. Demographics, clinical characteristics, treatment and outcomes of acute organo-phosphorous pesticide poisoning from South India.Res. J. Pharm. Biol. Chem. Sci.201566826834
     [Google Scholar]
  25. ChilkotiG.T. MohtaM. SddiquiS. BanerjeeA. Glycopyrrolate for organophosphosphate poisoning: What is its stand? – A case study and literature review.Indian J. Anaesth.202367766266310.4103/ija.ija_67_22 37601940
     [Google Scholar]
  26. BlainP.G. Organophosphorus poisoning (acute).Clin. Evid.201120112102 21575287
     [Google Scholar]
  27. HerbertJ. ThiermannH. WorekF. WilleT. COPD and asthma therapeutics for supportive treatment in organophosphate poisoning.Clin. Toxicol. (Phila.)201957764465110.1080/15563650.2018.1540785 30696282
     [Google Scholar]
  28. PeterJ.V. MoranJ.L. PichamuthuK. ChackoB. Adjuncts and alternatives to oxime therapy in organophosphate poisoning--is there evidence of benefit in human poisoning? A review.Anaesth. Intensive Care200836333935010.1177/0310057X0803600305 18564794
     [Google Scholar]
  29. DavisW.M. HatoumN.S. Synergism of the toxicity of physostigmine and neostigmine by lithium or by a reserpine-like agent (Ro4-1284).Toxicology19801711710.1016/0300‑483X(80)90021‑9 6904065
     [Google Scholar]
  30. DicksonE.W. BirdS.B. GaspariR.J. BoyerE.W. FerrisC.F. Diazepam inhibits organophosphate-induced central respiratory depression.Acad. Emerg. Med.200310121303130610.1111/j.1553‑2712.2003.tb00001.x 14644779
     [Google Scholar]
  31. GeaneyD.P. SoperN. ShepstoneB.J. CowenP.J. Effect of central cholinergic stimulation on regional cerebral blood flow in Alzheimer disease.Lancet199033587041484148710.1016/0140‑6736(90)93028‑N 1972432
     [Google Scholar]
  32. CohenS. HunterC.W. YanniB. StrikerP. HijaziR.H. Central anticholinergic syndrome strikes again.J. Clin. Anesth.200618539940010.1016/j.jclinane.2005.11.007 16905092
     [Google Scholar]
  33. UnnikrishnanR. ShenoyA. Clinical outcomes of patients admitted with organophosphorus poisoning in a tertiary hospital in Udupi district.Indian J Respiratory Care2012115965
     [Google Scholar]
  34. BhandarkarA.A. Efficacy of atropine alone and with glycopyrrolate combination in organophosphate poisoning.Value Health2014177A750A75110.1016/j.jval.2014.08.197 27202722
     [Google Scholar]
  35. GautamV.K. KamathS.D. Study of organophosphorus compound poisoning in a tertiary care hospital and the role of peradeniya organophosphorus poisoning scale as a prognostic marker of the outcome.J. Assoc. Physicians India20227041112 35443548
     [Google Scholar]
  36. FinkelsteinY. KushnirA. Raikhlin-EisenkraftB. TaitelmanU. Antidotal therapy of severe acute organophosphate poisoning: A multihospital study.Neurotoxicol. Teratol.198911659359610.1016/0892‑0362(89)90044‑5 2696878
     [Google Scholar]
/content/journals/crcep/10.2174/0127724328290595240509051331
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Efficacy and Safety of Glycopyrrolate in the Management of Organophosphate and Carbamate Poisoning: A Systematic Review
Curr Rev Clin Exper Pharm 20, 38 (2025); https://doi.org/10.2174/0127724328290595240509051331
/content/journals/crcep/10.2174/0127724328290595240509051331
/content/journals/crcep/10.2174/0127724328290595240509051331
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Supplements

PRISMA checklist is available as supplementary material on the publisher’s website along with the published article. The supplementary material is available on the publisher’s website along with the published article.

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  • Article Type:     Review Article
Keyword(s): Antidote; evidence-based medicine; glycopyrrolate; organophosphate; toxicology; treatment

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