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glycopyrrolate (glycopyrronium (UK))
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.