Intramuscular neostigmine and glycopyrrolate safely accelerated bowel evacuation in patients with spinal cord injury and defecatory disorders.
Difficulty with evacuation after spinal cord injury (SCI) may be due to a lack of parasympathetic stimulation of the colon. Prior studies in persons with spinal cord injury have suggested that intravenous administration of neostigmine stimulates colonic motility while glycopyrrolate attenuates some of the cholinergic side effects of neostigmine. We thus performed a double-blind, cross-over study to evaluate the effect of neostigmine/glycopyrrolate injections in patients with SCI and defecatory difficulties. Seven subjects received active treatment (neostigmine 2 mg and glycopyrrolate 0.4 mg intramuscularly) during three consecutive bowel evacuation sessions and were crossed-over to placebo injections for three consecutive sessions. Compared with placebo, neostigmine/glycopyrrolate reduced the total bowel evacuation time from 98.1 +/- 7.2 to 74.8 min +/- 5.8 (p < 0.05). The lowest heart rate or blood pressure was not significantly different between the treatment and placebo groups. In conclusion, neostigmine/glycopyrrolate may improve bowel evacuation in patients with SCI-related defecatory disorders.
Rosman
Alan S
AS
Gastroenterology Practice and the Spinal Cord Center of Excellence, James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA.
Chaparala
Geeta
G
Monga
Amit
A
Spungen
Ann M
AM
Bauman
William A
WA
Korsten
Mark A
MA
D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D003248:Constipation / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D018592:Cross-Over Studies; D003672:Defecation / Q000187:drug effects* / Q000502:physiology*; D004311:Double-Blind Method; D006024:Glycopyrrolate / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007273:Injections, Intramuscular; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D009388:Neostigmine / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D010277:Parasympathomimetics / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology*
D018727:Muscarinic Antagonists; D010277:Parasympathomimetics; D009388:Neostigmine; D006024:Glycopyrrolate