glycopyrrolate (glycopyrronium (UK))
Robinul, Robinul Forte
Pharmacologic class: Anticholinergic
Therapeutic class: Antispasmodic, antimuscarinic, parasympatholytic
Pregnancy risk category B
Inhibits action of acetylcholine on muscarinic receptors that mediate effects of parasympathetic postganglionic impulses. This inhibition relaxes cardiac smooth muscle, inhibits vagal reflexes, and decreases tracheal and bronchial secretions.
Injection: 0.2 mg/ml
Tablets: 1 mg, 2 mg
⊘Indications and dosages
➣ Adjunct in peptic ulcer disorders
Adults: 1 mg P.O. t.i.d. or 2 mg (Forte) two to three times daily, to a maximum of 8 mg/day; or 0.1 to 0.2 mg I.M. or I.V. three or four times daily
➣ To diminish secretions and block cardiac vagal reflexes before surgery
Adults and children ages 2 and older: 0.0044 mg/kg I.M. 30 to 60 minutes before anesthesia
Children ages 1 month to 2 years: 0.0088 mg/kg I.M. 30 to 60 minutes before anesthesia
➣ To diminish secretions and block cardiac vagal reflexes during surgery
Adults: 0.1 mg I.V. May repeat as needed at 2- to 3-minute intervals.
Children: 0.004 mg/kg I.V., not to exceed 0.1 mg as a single dose. May repeat at 2- to 3-minute intervals.
➣ To diminish or block cholinergic effects caused by anticholinesterase
Adults and children: 0.2 mg I.V. for each 1 mg neostigmine or 5 mg pyridostigmine. May give I.V. undiluted or with dextrose injection by infusion.
• Hypersensitivity to drug
• Chronic obstructive pulmonary disease
• GI disease, infection, atony or ileus
• Myasthenia gravis
• Obstructive uropathy
• Severe prostatic hypertrophy
Use cautiously in:
• cardiovascular disease, heart failure, hypertension, renal or hepatic disease, Down syndrome, hyperthyroidism, hiatal hernia, ulcerative colitis, mild to moderate prostatic hypertrophy, autonomic neuropathy, spasticity, suspected brain damage
• pregnant or breastfeeding patients.
• Give oral dose 30 to 60 minutes before meals.
• For I.V. injection, give either undiluted or diluted with dextrose 5% or 10% in water or saline solution. Give each 0.2 mg over 1 to 2 minutes.
☞ Keep resuscitation equipment on hand to treat curare-like effects of overdose.
CNS: weakness, nervousness, insomnia, drowsiness, dizziness, headache, confusion, excitement
CV: palpitations, tachycardia
EENT: blurred vision, photophobia, mydriasis, increased intraocular pressure, cycloplegia
GI: nausea, vomiting, constipation, abdominal distention, epigastric distress, heartburn, gastroesophageal reflux, dry mouth, paralytic ileus
GU: urinary hesitancy or retention, lactation suppression, erectile dysfunction
Skin: urticaria, decreased sweating or anhidrosis
Other: loss of taste, fever, allergic reaction, irritation at I.M. injection site, anaphylaxis, malignant hyperthermia
Drug-drug.Amantadine, antihistamines, antiparkinsonian drugs, disopyramide, glutethimide, meperidine, phenothiazines, procainamide, quinidine, tricyclic antidepressants: additive anticholinergic effects
☞ Check for signs and symptoms of anaphylaxis and malignant hyperthermia.
• Monitor neurologic and cardiovascular status.
☞ Assess for curare-like effects (neuromuscular blockade leading to muscle weakness and possible paralysis), which indicate overdose.
• Assess fluid intake and output. Have patient void before each dose to avoid urinary retention.
• Advise patient to take oral dose 30 to 60 minutes before meals.
☞ Tell patient to immediately report signs and symptoms of serious adverse effects, especially anaphylaxis.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, vision, and alertness.
• Tell patient to minimize GI upset by eating frequent, small servings of food and drinking adequate fluids.
• Advise patient to report urinary hesitancy or retention.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.
Pregnancy Category: C (oral solution)
Time/action profile (anticholinergic effects)
|PO||1 hr||unknown||8–12 hr|
|IM||15–30 min||30–45 min||2–7 hr*|
|IV||1–10 min||unknown||2–7 hr*|
Adverse Reactions/Side Effects
Central nervous system
- headache (most frequent)
Ear, Eye, Nose, Throat
- nasal congestion (most frequent)
- blurred vision
- dry eyes
- tachycardia (most frequent)
- orthostatic hypotension
- dry mouth (most frequent)
- vomiting (most frequent)
- urinary hesitancy (most frequent)
- urinary retention
- flushing (most frequent)
Drug-Drug interactionMay ↑ GI mucosal lesions in patients taking oral potassium chloride tablets; concurrent use with oral glycopyrrolate solution contraindicated.Additive anticholinergic effects with other anticholinergics, including antihistamines, phenothiazines, meperidine, amantadine, tricyclic antidepressants, quinidine, and disopyramide.May alter the absorption of other orally administered drugs by slowing motility of the GI tract.May ↑ GI transit time of oral digoxin and ↑ digoxin levels.Antacids or adsorbentantidiarrheal agents ↓ absorption of anticholinergics.May ↑ GI mucosal lesions in patients taking oral potassium chloride tablets.May ↑ atenolol and metformin levels.May ↓ levels of haloperidol and levodopa.Concurrent use may ↓ absorption of ketoconazole (administer 2 hr after ketoconazole).
Route/DosageControl of Secretions during Surgery
Availability (generic available)
- Assess heart rate, BP, and respiratory rate before and periodically during parenteral therapy.
- Monitor intake and output ratios in geriatric or surgical patients; glycopyrrolate may cause urinary retention. Instruct patient to void before parenteral administration.
- Assess patient routinely for abdominal distention and auscultate for bowel sounds. If constipation becomes a problem, increasing fluids and adding bulk to the diet may help alleviate the constipating effects of the drug.
- Periodic intraocular pressure determinations should be made for patients receiving long-term therapy.
- Pediatric: Monitor amount and frequency of drooling periodically during therapy.
- Assess for hyperexcitability, a paradoxical response that may occur in children.
- Lab Test Considerations: Antagonizes effects of pentagastrin and histamine during the gastric acid secretion test. Avoid administration for 24 hr preceding the test.
If overdose occurs, neostigmine is the antidote.
- May cause ↓ uric acid levels in patients with gout or hyperuricemia.
Potential Nursing DiagnosesImpairedoral mucous membrane (Side Effects)
Constipation (Side Effects)
- Do not administer cloudy or discolored solution.
- Oral: Administer 30–60 min before meals to maximize absorption.
- For drooling: Administer at least 1 hr before or 2 hr after meals.
- Do not administer within 1 hr of antacids or antidiarrheal medications.
- Oral dose is 10 times the parenteral dose.
- Intramuscular: May be administered undiluted (200 mcg/mL).
- pH: 2.0–3.0.
- Diluent: May be given undiluted through Y-site.Concentration: 200 mcg/mL.
- Rate: Administer at a maximum rate of 20 mcg over 1 min.
- Y-Site Compatibility: acyclovir, alfentanil, amikacin, aminophylline, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, azithromycin, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carmustine, caspofungin, cefazolin, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, cisplatin, clindamycin, cyanocobalamin, cyclosporine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxycycline, enalaprilat, ephedrine, epinephrine, epoetin alfa, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, folic acid, ganciclovir, gemcitabine, gentamicin, granisetron, heparin, hydrocortisone, hydromorphone, idarubicin, imipenem/cilastatin, isoproterenol, ketorolac, labetalol, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methoxamine, methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, mitoxantrone, morphine, multivitamins, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, papaverine, pemetrexed, penicillin G, pentamidine, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, phytonadione, potassium acetate, potassium chloride, procainamide, promethazine, propofol, propranolol, protamine, pyridoxime, ranitidine, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, vancomycin, vasopressin, vecruonium, verapamil, vinorelbine, voriconazole, zoledronic acid
- Y-Site Incompatibility: amphotericin B colloidal, amphotericin B lipid complex, dantrolene, diazepam, diazoxide, indomethacin, irinotecan, pantoprazole, phenytoin, piperacillin/tazobactam, trimethoprim/sulfamethoxazole
- Solution Compatibility: D5/0.45% NaCl, D5W, 0.9% NaCl, Ringer’s solution. Administer immediately after admixing
- Additive Incompatibility: methylprednisolone sodium succinate
- Instruct patient to take glycopyrrolate as directed and not to take more than the prescribed amount. Take missed doses as soon as remembered if not just before next dose.
- Medication may cause drowsiness and blurred vision. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.
- Inform patient that frequent oral rinses, sugarless gum or candy, and good oral hygiene may help relieve dry mouth. Consult health care professional regarding use of saliva substitute if dry mouth persists for more than 2 wk.
- Advise patient to change positions slowly to minimize the effects of drug-induced orthostatic hypotension.
- Caution patient to avoid extremes of temperature. This medication decreases the ability to sweat and may increase the risk of heat stroke.
- Advise patient to notify health care professional immediately if eye pain or increased sensitivity to light occurs. Emphasize the importance of routine eye exams throughout therapy.
- Advise patient to consult health care professional before taking any OTC medications concurrently with this therapy.
- Geriatric: Advise geriatric patients about increased susceptibility to side effects and to call health care professional immediately if they occur.
- Pediatric: Instruct parents to use a calibrated measuring device with solution for accurate dosing.
- Advise parents to stop glycopyrrolate and notify health care professional if constipation; signs of urinary retention (inability to urinate, dry diapers or undergarments, irritability or crying); or rash, hives, or an allergic reaction occurs.
- Glycopyrrolate reduces sweating. Advise parents to avoid exposure of the patient to hot or very warm environmental temperatures to avoid overheating and heat exhaustion or heat stroke.
- Mouth dryness preoperatively.
- Reversal of cholinergic medications.
- Decrease in GI motility and pain in patients with peptic ulcer disease.
- Reduce chronic severe drooling in children with neurologic conditions associated with drooling.