GLYCOPYRROLATE

Indications & Dose:

Premedication at induction

•   BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INJECTION

Adult: 200–400 micrograms, alternatively

4–5 micrograms/kg (max. per dose 400 micrograms)

Intra-operative bradycardia

•  BY INTRAVENOUS INJECTION

Adult: 200–400 micrograms, alternatively 4–5 micrograms/kg (max. per dose 400 micrograms), repeated if necessary

Control of muscarinic side-effects of neostigmine in reversal of non-depolarising neuromuscular block

•  BY INTRAVENOUS INJECTION

Adult: 10–15 micrograms/kg, alternatively, 200 micrograms per 1mg of neostigmine to be administered

Bowel colic in palliative care | Excessive respiratory secretions in palliative care

•  BY SUBCUTANEOUS INJECTION

Adult: 200 micrograms every 4 hours and when required, hourly use is occasionally necessary, particularly in excessive respiratory secretions

•   BY SUBCUTANEOUS INFUSION

Adult: 0.6–1.2 mg/24 hours 

Contraindications:

Narrowangle glaucoma, obstructive uropathy, GI tract obstruction, paralytic ileus, intestinal atony, acute hemorrhage, severe ulcerative colitis, .toxic megacolon, myasthenia gravis. 

Side Effects:

Cautions:

Precautions:

Glaucoma, asthma, elderly, prostatic hypertrophy, renal disease, CHF, pulmonary disease, hyperthyroidism, CAD, hypertension 

Interaction:

DRUGS  

anticholinergics, antiparkinsonian drugs, phenothiazines, tricyclic antidepressants: Possibly increased anticholinergic effects antidiarrheals

(adsorbent): Decreased glyco-pyrrolate absorption, leading to decreased therapeutic effectiveness antimyasthenics: Possibly reduced intestinal motility

atenolol: Possibly potentiated atenolol effects calcium- or magnesium-containing antacids, carbonic anhydrase inhibitors, citrates,

sodi-um bicarbonate: Possibly reduced excretion of glycopyrrolate and increased therapeutic and adverse effects

cyclopropane: Possibly ventricular arrhythmias

digoxin: Possibly potentiated digoxin effects haloperidol, levodopa,

phenothiazines: Possibly decreased effectiveness of these drugs

ketoconazole: Possibly decreased ketocon-azole absorption

metformin: Possibly potentiated metformin effects

metoclopramide: Possibly antagonized effects of metoclopramide

opioids: Possibly severe constipation and urine retention, risk of ileus

potassium chloride: Possibly increased severity of potassium chloride-induced gastric lesions

Warnings:

Adverse Effects:

Lactations:

Pregnancy ; has been used prior to cesarean section to decrease gastric secretions; quaternary structure results in limited placental transfer; excretion into breast milk is unknown, but should be minimal due to quaternary structure 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Anxiety, confusion, delusions, depression, dizziness, flushing, hallucinations, headache, incoherence, irritability, lethargy, restlessness, sedation, weakness

CV: Palpitations, paradoxical bradycardia, postural hypotension, tachycardia

EENT: Blurred vision, cycloplegia, difficulty swallowing, dilated pupils, increased intraocular pressure, mydriasis, nasal congestion, photophobia

GI: Abdominal distress, altered taste perception, constipation, dry mouth, nausea, paralytic ileus, vomiting

GU: Hesitancy, impotence, retention

SKIN: Allergic reactions, decreased sweating, urticaria 

Adverse Reactions 

CNS: Confusion, dizziness, drowsiness, headache, insomnia, nervousness, weakness

CV: Bradycardia (low doses), heart block, palpitations, prolonged QT interval, tachy-cardia (high doses)

EENT: Blurred vision, cycloplegia, dilated pupils, dry mouth, increased intraocular pressure, loss of taste, mydriasis, nasal congestion, photophobia, taste perversion

GI: Abdominal distention, constipation, dysphagia, nausea, vomiting

GU: Impotence, urinary hesitancy, urine retention

RESP: Dyspnea

SKIN: Decreased sweating (heat exhaustion), dry skin, flushing, pruritus, urticaria

Other: Anaphylaxis 

Patient And Carer Advice: