Delivery of neostigmine and glycopyrrolate by iontophoresis: A nonrandomized study in individuals with spinal cord injury

Mark A. Korsten, Brian L. Lyons, Miroslav Radulovic, Tradd M. Cummings, Gautam Sikka, Kamaldeep Singh, Joshua Hobson, Anton Sabiev, Ann M. Spungen, William A. Bauman

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Study design: Phase I Clinical Trial. Objectives: In this proof-of-principle study, the effectiveness and safety of transdermal administration of neostigmine/glycopyrrolate to elicit a bowel movement was compared to intravenous administration in patients with spinal cord injury. Setting: James J. Peters Veterans Affairs Medical Center (Bronx, NY). Methods: Individuals were screened for responsiveness (Physical Response) to intravenous neostigmine (0.03 mg/kg)/glycopyrrolate (0.006 mg/kg). Intravenous neostigmine/glycopyrrolate responders (Therapeutic Response) were administered low-dose transdermal neostigmine/glycopyrrolate [(0.05 mg/kg)/(0.01 mg/kg)] by iontophoresis. Non-responders to low-dose transdermal neostigmine/glycopyrrolate were administered high-dose transdermal neostigmine/glycopyrrolate [(0.07 mg/kg)/(0.014 mg/kg)] by iontophoresis. Bowel movement, bowel evacuation time, and cholinergic side effects were recorded. Visits were separated by 2 to 14 days. Results: Eighteen of 25 individuals (72.0%) had a bowel movement (20 ± 22 min) after intravenous neostigmine/glycopyrrolate. Of these 18 individuals, 5 individuals experienced a bowel movement with low-dose transdermal neostigmine/glycopyrrolate. Another five individuals had a bowel movement after high-dose transdermal neostigmine/glycopyrrolate administration. Fewer side effects were observed in individuals who received neostigmine/glycopyrrolate transdermally compared to those who were administered intravenous neostigmine/glycopyrrolate. Conclusions: Transdermal administration of neostigmine/glycopyrrolate by iontophoresis appears to be a practical, safe, and effective approach to induce bowel evacuation in individuals with spinal cord injury.

Original languageEnglish
Pages (from-to)212-217
Number of pages6
JournalSpinal Cord
Issue number3
StatePublished - 1 Mar 2018


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