Behavioral Side Effects of Glycopyrrolate: A Novel Case in a Pediatric Patient

Case Diagnosis: 5 year-old female with Cerebral Palsy develops behavioral side effects of glycopyrrolate.

Case Description or Program Description: A 5-year-old female, born prematurely at 24 weeks gestation, with a history of cerebral palsy, global developmental delay, feeding difficulties with failure to thrive requiring g-tube placement, bronchopulmonary dysplasia requiring surfactant therapy, laryngomalacia, metabolic bone disease, hearing impairment with hearing aids, patent ductus arteriosus, and neonatal seizures follows in the pediatric rehabilitation clinic.

She presented for follow-up with concerns of excessive drooling and was started on a trial of glycopyrrolate. At the next visit, her mother reported new behavioral concerns, including tantrums and agitation occurring around the time glycopyrrolate was administered. While undergoing other causes for the sudden altered behavior, glycopyrrolate was also weaned as this was the only medication change appreciated during that time frame.

Setting: Outpatient Pediatric Rehabilitation Clinic

Assessment/Results: Following this adjustment, the patient’s tantrums resolved and she returned to her baseline behavior. Although ABA therapy was initially prescribed, she was unable to begin it before discontinuing glycopyrrolate. At her two-month follow-up, she continued to demonstrate such significant behavioral improvement that the family decided to forgo ABA therapy altogether.

Discussion (relevance): Glycopyrrolate is widely used for sialorrhea in pediatric patients, with known side effects such as dry mouth and constipation. However, behavioral disturbances have not been well-documented. To our knowledge, this is the first reported case linking glycopyrrolate to significant behavioral changes. The temporal association between glycopyrrolate initiation, symptom onset, and resolution after discontinuation suggests a causal relationship. This case highlights the need for clinicians to monitor for neurobehavioral side effects in children receiving glycopyrrolate, particularly those with developmental disabilities.

Conclusions: This case underscores the importance of considering medication side effects when evaluating new-onset behavioral concerns in pediatric patients. Further research is needed to better understand glycopyrrolate’s potential impact on behavior.