piperidines and Sialorrhea

Capromorelin is a ghrelin receptor agonist that is FDA approved for appetite stimulation in dogs. The objective of this study was to evaluate the safety of daily oral administration of capromorelin to cats over a range of doses and for an extended period. Two randomized, controlled studies were conducted: in Study 1, cats (n = 6 per group) received placebo or capromorelin at a dose of 9, 15, 30 or 60 mg/kg once daily for 14 days; and in Study 2, cats received capromorelin at 6 mg/kg (n = 8) or placebo (n = 4) once daily for 91 days. Cats were evaluated using clinical observations and clinical pathology test results for both studies, with the addition of postmortem examination in Study 1 and measurements of growth hormone and insulin-like growth factor 1 in Study 2. Abnormal clinical observations were limited to emesis, hypersalivation, lethargy/depression, head shaking and lip smacking, which occurred more frequently in the capromorelin-treated groups than in the placebo group. There were no clinically relevant differences in clinical pathology test results between the capromorelin and placebo groups in either study.

Topics: Administration, Oral; Animals; Cat Diseases; Cats; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Growth Hormone; Insulin-Like Growth Factor I; Lethargy; Male; Piperidines; Pyrazoles; Sialorrhea; Vomiting

Schizophrenia is a disorder with cognitive deficits that could stem from cholinergic dysfunction.. Our aim was to examine if donepezil administered to stable, medicated outpatients with schizophrenia improves cognition and psychopathology.. We conducted a double-blind placebo-controlled trial of donepezil up to 10 mg/day added for 8 weeks to ongoing antipsychotic treatment in 36 typical community-treated schizophrenia patients not selected for cognitive impairment.. Donepezil did not improve measures of cognition or psychopathology. It was well tolerated.. Consistent with other studies, addition of donepezil to stable patients with schizophrenia did not improve cognition or measures of psychopathology. This result does not support the hypothesis that residual symptoms and cognitive problems result from a cholinergic deficit that can be remedied by an acetylcholinesterase inhibitor. A donepezil add-on strategy might make sense in selected schizophrenia cases where a pathological process is known to affect cholinergic neurons (e.g., history of head injury or comorbid dementia).

Topics: Capsules; Cholinesterase Inhibitors; Cognition Disorders; Donepezil; Dose-Response Relationship, Drug; Double-Blind Method; Dyskinesias; Female; Humans; Indans; Male; Middle Aged; Piperidines; Placebos; Schizophrenia; Sialorrhea; Time Factors; Treatment Outcome

Salivary drooling is a common and debilitating problem in cerebral palsy (CP). We hypothesised that gastro-oesophageal reflux (GOR) may exacerbate drooling by stimulation of the oesophago-salivary reflex. The aim of our study was to assess the role of GOR in children with CP and severe drooling. Twenty-four children with CP and severe drooling underwent oesophageal pH monitoring (N = 23) or oesophagoscopy (N = 1). Nine had pathological GOR and were enrolled in a double blinded, placebo controlled cross-over trial of medical antireflux therapy (ranitidine plus cisapride) versus placebo. Drooling was measured by semi-quantitative observation (drooling quotient) and a questionnaire-based scoring system (rated by the child's caregivers). Mean drooling quotients and scores for drooling severity and frequency were not significantly different between active medication and placebo. In our study, treatment of pathological GOR did not improve salivary drooling in children with CP.

Topics: Adolescent; Cerebral Palsy; Child; Child, Preschool; Cisapride; Esophagus; Female; Gastroesophageal Reflux; Histamine H2 Antagonists; Humans; Hydrogen-Ion Concentration; Male; Parasympathomimetics; Piperidines; Ranitidine; Salivation; Severity of Illness Index; Sialorrhea

(1) Sialorrhoea is the production of saliva that patients perceive as excessive; (2) Saliva accumulation is either due to a reduction in swallowing frequency or to an increase in saliva production; (3) Patients who drool may be ostracized, and there is also an increased risk of aspiration pneumonia; (4) Sialorrhoea can be caused by buccal, gastrointestinal or neurological disorders, or by drugs; (5) Sedatives such as benzodiazepines, neuroleptics, cholinesterase inhibitors and pilocarpine carry a dose-dependent risk of sialorrhoea; (6) In practice, the role of a drug should be borne in mind when a patient presents with sialorrhoea or excessive saliva accumulation. The parents of children treated with sedative drugs should be informed of this risk.

Topics: Antipsychotic Agents; Benzodiazepines; Cholinesterase Inhibitors; Clozapine; Deglutition Disorders; Donepezil; Galantamine; Humans; Hypnotics and Sedatives; Indans; Phenylcarbamates; Pilocarpine; Piperidines; Quality of Life; Risperidone; Rivastigmine; Sialorrhea