Glycopyrrolate

Name: Glycopyrrolate

Overdose

To combat peripheral anticholinergic effects, a quaternary ammonium anticholinesterase such as neostigmine methylsulfate (which does not cross the blood-brain barrier) may be given intravenously in increments of 0.25 mg in adults. This dosage may be repeated every five to ten minutes until anticholinergic overactivity is reversed or up to a maximum of 2.5 mg. Proportionately smaller doses should be used in pediatric patients. Indication for repetitive doses of neostigmine should be based on close monitoring of the decrease in heart rate and the return of bowel sounds.

If CNS symptoms (e.g., excitement, restlessness, convulsions, psychotic behavior) occur, physostigmine (which does cross the blood-brain barrier) may be used. Physostigmine 0.5 to 2 mg should be slowly administered intravenously and repeated as necessary up to a total of 5 mg in adults.  Proportionately smaller doses should be used in pediatric patients.

To combat hypotension, administer IV fluids and/or pressor agents along with supportive care.

Fever should be treated symptomatically.

Following overdosage, a curare-like action may occur, i.e., neuromuscular blockade leading to muscular weakness and possible paralysis. In the event of a curare-like effect on respiratory muscles, artificial respiration should be instituted and maintained until effective respiratory action returns.

Glycopyrrolate and Lactation

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if glycopyrrolate crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using glycopyrrolate.

Other Requirements

Glycopyrrolate to be used with Neohaler

  • Store glycopyrrolate (inhaler and blister-packaged capsules) at room temperature between 68°F to 77°F (20°C to 25°C).
  • Do not remove glycopyrrolate capsules from the blister card it comes in until you are ready to use a dose of Seebri Neohaler.
  • Do not store glycopyrrolate capsules in the Neohaler inhaler.
  • Keep Neohaler in a dry place away from moisture.

Glycopyrrolate tablets:

  • Store glycopyrrolate tablets at 20° to 25°C (68° to 77°F) 

Keep glycopyrrolate and all medicines out of the reach of children.

What is glycopyrrolate (cuvposa, robinul, robinul forte)?

Glycopyrrolate reduces the secretions of certain organs in the body.

Glycopyrrolate helps to control conditions such as peptic ulcers that involve excessive stomach acid production.

Glycopyrrolate is also used to reduce drooling in children ages 3 to 16 who have certain medical conditions, such as cerebral palsy.

Glycopyrrolate may also be used for purposes not listed in this medication guide.

Side effects

Anticholinergics, including ROBINUL Injection, can produce certain effects, most of which are extensions of their pharmacologic actions. Adverse reactions may include xerostomia (dry mouth); urinary hesitancy and retention; blurred vision and photophobia due to mydriasis (dilation of the pupil); cycloplegia; increased ocular tension; tachycardia; palpitation; decreased sweating; loss of taste; headache; nervousness; drowsiness; weakness; dizziness; insomnia; nausea; vomiting; impotence; suppression of lactation; constipation; bloated feeling; severe allergic reactions including anaphylactic/anaphylactoid reactions; hypersensitivity; urticaria, pruritus, dry skin, and other dermal manifestations; some degree of mental confusion and/or excitement, especially in elderly persons.

In addition, the following adverse events have been reported from post-marketing experience with ROBINUL: malignant hyperthermia; cardiac arrhythmias (including bradycardia, ventricular tachycardia, ventricular fibrillation); cardiac arrest; hypertension; hypotension; seizures; and respiratory arrest. Postmarketing reports have included cases of heart block and QTc interval prolongation associated with the combined use of glycopyrrolate and an anticholinesterase. Injection site reactions including pruritus, edema, erythema, and pain have also been reported.

ROBINUL is chemically a quaternary ammonium compound; hence, its passage across lipid membranes, such as the blood-brain barrier is limited in contrast to atropine sulfate and scopolamine hydrobromide. For this reason the occurrence of CNS-related side effects is lower, in comparison to their incidence following administration of anticholinergics which are chemically tertiary amines that can cross this barrier readily.

Read the entire FDA prescribing information for Robinul (Glycopyrrolate)

Read More »

How should I take glycopyrrolate?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results.

Take glycopyrrolate on an empty stomach, at least 1 hour before or 2 hours after a meal.

Measure liquid medicine with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Store at room temperature away from moisture and heat.

What other drugs will affect glycopyrrolate?

Many drugs can interact with glycopyrrolate. Below is just a partial list. Tell your doctor if you are using:

  • amantadine (Symmetrel);

  • atenolol (Tenormin, Tenoretic);

  • digoxin (Lanoxin, Lanoxicaps);

  • haloperidol (Haldol);

  • levodopa (Larodopa); or

  • metformin (Glucophage, Actoplus Met, Avandamet, Janumet, Kombiglyze, PrandiMet).

This list is not complete and other drugs may interact with glycopyrrolate. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Uses for Glycopyrrolate

Peptic Ulcer Disease

Has been used as an adjunct in the treatment of peptic ulcer disease;a b however, no conclusive data that it aids in the healing, decreases the rate of recurrence, or prevents complications of peptic ulcers.c d

With the advent of more effective therapies for the treatment of peptic ulcer disease, antimuscarinics have only limited usefulness in this condition.c d

Surgery

To inhibit salivation and excessive secretions of the respiratory tract (antisialogue).b c d However, current surgical practice (e.g., using general anesthetics that do not stimulate salivary and tracheobronchial secretions) has reduced the need to control excessive respiratory secretions during surgery.c d

To prevent other cholinergic effects during surgery (e.g., cardiac arrhythmias, hypotension, bradycardia) secondary to visceral traction (resultant vagal stimulation), carotid sinus stimulation, or concomitant drugs (e.g., succinylcholine).b c d

To block adverse muscarinic effects of anticholinesterase agents that are used after surgery to terminate curarization.b c d

Ineffective for preventing acid-aspiration pneumonitis† during surgery.c d

Uses For glycopyrrolate

Glycopyrrolate is used to treat peptic ulcers in adults. It is also used to treat chronic, severe drooling caused by certain neurologic disorders (e.g., cerebral palsy) in children 3 to 16 years of age. glycopyrrolate is an anticholinergic.

Glycopyrrolate may also be used for other conditions as determined by your doctor.

glycopyrrolate is available only with your doctor's prescription.

Before Using glycopyrrolate

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For glycopyrrolate, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to glycopyrrolate or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of glycopyrrolate in children 3 to 16 years of age. However, safety and efficacy have not been established in children younger than 3 years of age.

Geriatric

No information is available on whether the risk of glycopyrrolate-induced adverse effects are increased in the elderly; however, it should be used with caution because elderly patients are more likely to have age related liver disease, kidney disease, heart disease, or prostate problems. This may require a dosage adjustment or careful monitoring in elderly patients receiving glycopyrrolate.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking glycopyrrolate, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using glycopyrrolate with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Potassium

Using glycopyrrolate with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Bupropion
  • Donepezil
  • Tiotropium

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of glycopyrrolate. Make sure you tell your doctor if you have any other medical problems, especially:

  • Colostomy (bowel surgical procedure) or
  • Congestive heart failure or
  • Heart disease or
  • Heart rhythm problems or
  • Hiatal hernia with gastroesophageal reflux disease (GERD) or
  • Hypertension (high blood pressure) or
  • Hyperthyroidism (overactive thyroid) or
  • Ileostomy (bowel surgical procedure) or
  • Liver disease or
  • Nerve problems (e.g., neuropathy) or
  • Prostatic hypertrophy (enlarged prostate) or
  • Ulcerative colitis—Use with caution. May make these conditions worse.
  • Glaucoma or
  • Myasthenia gravis (severe muscle weakness) or
  • Obstructive uropathy (urinary blockage due to enlarged prostate or other condition) or
  • Paralytic ileus (bowel blockage) or
  • Stomach or intestinal problems (e.g., ulcerative colitis, toxic megacolon, bowel obstruction), severe or
  • Trouble urinating—Should not be used in patients with these conditions.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
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