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POLLY E. KINTZEL, PHARM.D., is Clinical Pharmacy Specialist, Adult Oncology; SANDRA L. CHASE, PHARM.D., is Clinical Pharmacy Specialist, Cardiology; WENDY THOMAS, PHARM.D., is Clinical Pharmacy Specialist, Adult Intensive Care; DIANE M. VANCAMP, PHARM.D., is Staff Pharmacist; and ELIZABETH A. CLEMENTS, PHARM.D., is Pharmacy Clinical Manager, Spectrum Health Hospitals, Grand Rapids, MI.

Address correspondence to Dr. Kintzel at Spectrum Health Hospitals, Pharmacy MC001, 100 Michigan Street, Northeast, Grand Rapids, MI 49503 (polly.kintzel{at}spectrum-health.org).

Purpose. Anticholinergic medications for reducing noisy respirations in adult hospice patients are evaluated. Summary. Anticholinergic medications used to reduce noisy respirations from retained secretions in terminal patients include atropine, glycopyrrolate, scopolamine, and scopolamine derivatives. Pharmaceutical anticholinergic treatment of retained secretions in hospice patients was evaluated in six studies, three of which compared the efficacy of glycopyrrolate to scopolamine in actively dying patients. Subcutaneous glycopyrrolate, scopolamine hydrobromide, and scopolamine butylbromide were similar in their ability to reduce noisy respirations overall and lower and the level of distress exhibited by family members and visitors. Two of the six studies compared the efficacy of medication therapy after institutional formulary changes from scopolamine to glycopyrrolate. The same dosages of subcutaneous glycopyrrolate and scopolamine, which delivered an initial bolus followed by continuous infusion, were reported in each study. Both studies concluded that there was equivalent efficacy between the two products. One study reported a more rapid response in patients treated with glycopyrrolate. In comparison, the last study reported more rapid responses in patients who received scopolamine compared with patients who received glycopyrrolate. Retrospective reports described symptom improvement with parenteral scopolamine in most patients. Conclusion. Parenteral and transdermal anticholinergic medications are useful for the reduction of noisy respirations in hospitalized hospice patients. Difficult administration makes oral and sublingual products less desirable for use in this population. Index terms: Atropine; Dosage; Glycopyrrolate; Hospices; Parasympatholytic agents; Respiration disorders; Scopolamine butylbromide; Scopolamine hydrobromide