Dose Table
See Sialanar’s® dosing table in full.
Sialanar® is licensed for the symptomatic treatment of severe sialorrhoea in children and adolescents aged 3 years and older with chronic neurological disorders.1
Patients should start titration from dose level 1, increasing every 7 days until efficacy is balanced with undesirable effects1
- The dosing schedule is based upon the weight of the child, starting with dose level 1 at 16mcg/kg per dose glycopyrronium bromide three times per day, then increasing the dose as per doses shown every 7 days
- Dose titration should be continued until efficacy is balanced with undesirable effects and amended up or down, as appropriate, to a maximum individual dose of 80mcg/kg glycopyrronium bromide or 6mL (2.4mg glycopyrronium bromide) whichever is less, three times per day
- Doses should be reduced by 30% in patients with mild to moderate renal impairment (eGFR <90 - ≥30 ml/min/1.73m2) as per doses shown here
- Undesirable effects may be minimised by using the lowest effective dose necessary to control symptoms
Titration schedule based on a 30kg child
Dose titrations should be conducted in discussion with the carer to assess both efficacy and undesirable effects until an acceptable maintenance dose is achieved.
Dose level should be titrated up until drooling is appropriately managed but reduced in the event of a known anticholinergic reaction.
BNFC Guidance on glycopyrronium bromide2
- Oral preparations are not interchangeable on a microgram-for-microgram basis due to differences in bioavailability.
- Sialanar® oral solution has approximately 25% higher bioavailability and therefore equivalent doses will be lower than for tablets and generic oral solutions.
- The prescriber should state the specific branded or generic oral preparation to be used.
To ensure your patients receive a product designed for children, prescribe as Sialanar®
Dose Timing
Sialanar® should be administered three times per day:
- 1 hour before mealtime OR 2 hours after OR at consistent times with respect to food intake.
How to Administer Sialanar® Orally
- Remove the child-resistant closure from the bottle.
- Insert the syringe adaptor with the hole into the neck of the bottle (this may have been done already by the pharmacist).
- Insert the end of the oral syringe into the syringe adaptor and ensure it is secure.
- Hold the oral syringe in place and turn the bottle upside down. Gently pull down the plunger to the correct level (see the tables for the correct dose). Check you have the correct level. The maximum volume of the highest dose is 6 ml.
- Turn the bottle upright.
- Remove the oral syringe by holding the bottle and twisting the oral syringe gently.
- Place the oral syringe inside the child’s mouth and press the plunger slowly to gently release the medicine.
- After use, leave the syringe adaptor in the neck of the bottle. Replace the closure.
The oral syringe should be gently washed with warm water and allowed to dry after each use (i.e. three times per day). Do not use a dishwasher 4
How to Administer Sialanar® via Feeding Tubes Guide
If your child is given the medicine through a feeding tube, flush the tube with 10 ml of water after you have given the medicine. 4
Switching Patients to Sialanar®
Guidance on switching patients from hyoscine or 1mg/5ml glycopyrronium bromide oral solutions to Sialanar®.
Safety
Head to this section for guidance on side effects and titration. Safety