Glycopyrrolate

Indications
 Oral
Peptic ulcer
Adult: 1-2 mg bid-tid.
Parenteral
Reduction of secretions
Adult: Preoperative: 4 mcg/kg via IM admin 30-60 minutes before procedure. Intraoperative: 0.1 mg via IV admin, repeat at 2-3 minute intervals when needed.
Child: Preoperative: IM admin: <2 yr: 4-9 mcg/kg; >2 yr: 4 mcg/kg, dose to be given 30-60 minutes before procedure. Intraoperative: IV admin: 4 mcg/kg (Max: 0.1 mg); repeat at 2-3-minute intervals as needed.
Max Dosage: Adult: 400 mcg/dose. Child >1 mth: 200 mcg/dose.
Intravenous
Reversal of neuromuscular blockade
Adult: 200 mcg for each 1 mg of neostigmine or 5 mg of pyridostigmine. Alternatively, 5-15 mcg/kg with 50 mcg/kg neostigmine with 25-70 mcg/kg of neostigmine or 0.1-0.3 mg/kg of pyridostigmine.
Child: 10 mcg/kg with 50 mcg/kg neostigmine.
Parenteral
Peptic ulcer
Adult: 0.1-0.2 mg 3-4 times daily via IM/IV admin.
Contraindications
 Hypersensitivity. Glaucoma; obstructive uropathy; obstructive GI diseases; intestinal atony; paralytic ileus; pyloric stenosis; myasthenia gravis. Unstable CV status in acute haemorrhage. Injectable not recommended in new borns ≤1 mth if benzyl alcohol is present in the preparation.
Warnings / Precautions
 Pregnancy, lactation. CV disease, hyperthyroidism, hepatic or renal impairment. Enlarged prostate, diarrhoea, fever. May cause ileus or megacolon in patients with ulcerative colitis. Children and elderly.
Adverse Reactions
 Xerostomia; loss of taste, nausea, vomiting, constipation, reduced sweating; urinary hesitancy and retention; blurred vision; cycloplegia; increased ocular tension; tachycardia; palpitation; headache, anxiety, bloated feeling, impotence, skin reactions.
Potentially Fatal: Severe anaphylaxis.
Drug Interactions
 Decreases levodopa effects. Effects may be enhanced by using drugs with antimuscarinic properties or MAOIs concurrently. May antagonise the GI effects of cisapride, metoclopramide and dompeidone.
Potentially Fatal: IV admin in the presence of cyclopropane anesth can result in ventricular arrhythmias.
See Below for More glycopyrronium bromide Drug Interactions
Mechanism of Actions
 Glycopyrronium bromide is a quarternary ammonium antimuscarinic. It blocks acetylcholine at parasympathomimetic sites and induces smooth muscle relaxation. It also reduces gastric acid secretions and controls pharyngeal, tracheal and bronchial secretions. It antagonises muscarinic symptoms such as bronchorrhoea, bronchospasm, bradycardia and intestinal hypermotility induced by anticholinesterases.
Onset: 15-30 minutes (IM), 1 minutes (IV).
Duration: 2-3 hr (vagal blocking effect), 7 hr (sialogogue effects).
Absorption: Poorly absorbed from the GI tract (oral); about 10-25% is absorbed after an oral dose.
Distribution: Blood-brain barrier (poor penetration).
Excretion: Via bile and urine.
Storage Conditions
 Intravenous: Store at 20-25°C. Oral: Store at 20-25°C. Parenteral: Store at 20-25°C.
Storage
 Intravenous: Store at 20-25°C. Oral: Store at 20-25°C. Parenteral: Store at 20-25°C.
Available As
  • Glycopyrrolate 0.2 mg
  • Glycopyrrolate 0.5 mg
  • Glycopyrrolate 1 mg

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