Glycopyrrolate

Glycopyrrolate Brand Names

Cuvposa | Glycate | GLYRX-PF | Lonhala Magnair | Robinul | Robinul Forte | Seebri Neohaler

What is Glycopyrrolate

Glycopyrrolate is an antimuscarinic anticholinergic agent.

Parenterally, glycopyrrolate is used as a preanesthetic and intraoperative antimuscarinic agent, where it helps block cardiac vagal inhibitory reflexes and helps reduce excessive salivary, tracheobronchial, and pharyngeal secretions.

Since glycopyrrolate is a quaternary (i.e., charged) compound, it is less likely to penetrate the CNS and cause CNS side effects when compared to atropine or scopolamine.

Historically, oral and parenteral glycopyrrolate are indicated to treat and prevent peptic ulcers; however, due to the availability of more effective alternatives for treatment, antimuscarinics have limited utility for this purpose.

Oral products are commonly used to reduce severe chronic drooling (sialorrhea) in patients 3 years and older with certain neurologic conditions.

Glycopyrrolate inhalation powder and nebulizer solution are beneficial for the long-term maintenance treatment of airflow obstruction in adults with chronic obstructive pulmonary disease (COPD).

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, glycopyrrolate, like other long-acting muscarinic antagonists (LAMAs), may be used as initial monotherapy in all groups of COPD patients.

However, combination therapy with a long-acting beta-agonist (LABA) or inhaled corticosteroid (ICS) may be needed in patients in Group D or those patients still experiencing dyspnea or exacerbations upon follow-up.

Glycopyrrolate first received FDA approval in 1961.

Indications

1. aspiration prophylaxis
2. bradycardia
3. cholinesterase inhibitor-induced muscarinic effects prophylaxis
4. chronic bronchitis
5. chronic obstructive pulmonary disease (COPD)
6. diarrhea
7. duodenal ulcer
8. emphysema
9. irritable bowel syndrome
10. sialorrhea

For use as a preoperative antimuscarinic to reduce salivary, tracheobronchial, and pharyngeal secretions; reduce gastric acid production and acidity (aspiration prophylaxis); and to block vagal inhibitory reflexes during intubation and induction of anesthesia

Side Effects

1. abdominal pain
2. agitation
3. anaphylactoid reactions
4. angioedema
5. anhidrosis
6. arrhythmia exacerbation
7. atrial fibrillation
8. back pain
9. blurred vision
10. bradycardia
11. bronchospasm
12. cardiac arrest
13. confusion
14. constipation
15. cough
16. cycloplegia
17. diarrhea
18. dizziness
19. drowsiness
20. dysgeusia
21. dyspnea
22. dysuria
23. edema
24. emotional lability
25. fatigue
26. flatulence
27. flushing
28. GI obstruction
29. headache
30. hyperglycemia
31. hypertension
32. hypotension
33. impotence (erectile dysfunction)
34. infection
35. injection site reaction
36. insomnia
37. lactation suppression
38. mydriasis
39. nasal congestion
40. nasal dryness
41. nausea
42. nystagmus
43. ocular hypertension
44. pallor
45. palpitations
46. peripheral edema
47. pharyngitis
48. pruritus
49. QT prolongation
50. rash
51. restlessness
52. seizures
53. sinus tachycardia
54. sinusitis
55. urinary retention
56. urticaria
57. ventricular tachycardia
58. vomiting
59. weakness
60. wheezing
61. xerosis
62. xerostomia

Monitoring Parameters

• laboratory monitoring not necessary
• pulmonary function tests (PFTs)

Contraindications

• achalasia
• acute bronchospasm
• ambient temperature increase
• anticholinergic medications
• autonomic neuropathy
• benzyl alcohol hypersensitivity
• biliary-GI fistula
• breast-feeding
• cardiac arrhythmias
• children
• closed-angle glaucoma
• constipation
• coronary artery disease
• dementia
• diarrhea
• Down’s syndrome
• driving or operating machinery
• esophagitis
• gastroesophageal reflux disease (GERD)
• geriatric
• GI bleeding
• GI obstruction
• heart failure
• hemorrhagic shock
• hepatic disease
• hiatal hernia
• hypertension
• hyperthyroidism
• ileus
• infants
• infertility
• latex hypersensitivity
• milk protein hypersensitivity
• myasthenia gravis
• neonates
• ocular exposure
• paradoxical bronchospasm
• pregnancy
• prostatic hypertrophy
• pyloric stenosis
• renal failure
• renal impairment
• tachycardia
• toxic megacolon
• ulcerative colitis
• urinary retention
• urinary tract obstruction
• ventricular tachycardia

Interactions

• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Diphenhydramine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Tramadol
• Aclidinium
• Aclidinium; Formoterol
• Acrivastine; Pseudoephedrine
• Albuterol; Ipratropium
• Alfentanil
• Alogliptin; Metformin
• Alosetron
• Aluminum Hydroxide
• Aluminum Hydroxide; Magnesium Carbonate
• Aluminum Hydroxide; Magnesium Hydroxide
• Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
• Aluminum Hydroxide; Magnesium Trisilicate
• Amantadine
• Ambenonium Chloride
• Amoxapine
• Antacids
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
• Aspirin, ASA; Oxycodone
• Atenolol
• Atenolol; Chlorthalidone
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Edrophonium
• Belladonna; Opium
• Benzhydrocodone; Acetaminophen
• Botulinum Toxins
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion
• Bupropion; Naltrexone
• Butorphanol
• Calcium Carbonate
• Calcium Carbonate; Magnesium Hydroxide
• Calcium Carbonate; Risedronate
• Calcium Carbonate; Simethicone
• Canagliflozin; Metformin
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbetapentane; Pyrilamine
• Carbidopa; Levodopa
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Cetirizine
• Cetirizine; Pseudoephedrine
• Chlophedianol; Dexbrompheniramine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chlorcyclizine
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Cholinergic agonists
• Cisapride
• Clemastine
• Clozapine
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Crofelemer
• Cyclizine
• Cyclobenzaprine
• Cyproheptadine
• Dapagliflozin; Metformin
• Dexchlorpheniramine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Digoxin
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Dimenhydrinate
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Disopyramide
• Donepezil
• Donepezil; Memantine
• Doxylamine
• Doxylamine; Pyridoxine
• Dronabinol
• Edrophonium
• Eluxadoline
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Ertugliflozin; Metformin
• Erythromycin
• Erythromycin; Sulfisoxazole
• Ezogabine
• Fentanyl
• Fluoxetine; Olanzapine
• Fluphenazine
• Fluticasone; Umeclidinium; Vilanterol
• Galantamine
• Glipizide; Metformin
• Glucagon
• Glyburide; Metformin
• Glycopyrronium
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Haloperidol
• Homatropine; Hydrocodone
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hydroxyzine
• Ibuprofen; Oxycodone
• Ipratropium
• Itraconazole
• Levocetirizine
• Levodopa
• Levorphanol
• Linaclotide
• Linagliptin; Metformin
• Loperamide
• Loperamide; Simethicone
• Loxapine
• Lubiprostone
• Lurasidone
• Macimorelin
• Magnesium Hydroxide
• Maprotiline
• Meclizine
• Memantine
• Meperidine
• Meperidine; Promethazine
• Metformin
• Metformin; Pioglitazone
• Metformin; Repaglinide
• Metformin; Rosiglitazone
• Metformin; Saxagliptin
• Metformin; Sitagliptin
• Methacholine
• Methadone
• Metoclopramide
• Mirtazapine
• Molindone
• Morphine
• Morphine; Naltrexone
• Nabilone
• Nalbuphine
• Neostigmine
• Nitrofurantoin
• Olanzapine
• Omeprazole; Sodium Bicarbonate
• Orphenadrine
• Oxycodone
• Oxymorphone
• Paroxetine
• Pentazocine
• Pentazocine; Naloxone
• Perphenazine
• Perphenazine; Amitriptyline
• Phentermine; Topiramate
• Phenylephrine; Promethazine
• Physostigmine
• Potassium
• Pramlintide
• Procainamide
• Prochlorperazine
• Promethazine
• Proton pump inhibitors
• Pyridostigmine
• Quetiapine
• Quinidine
• Rasagiline
• Remifentanil
• Revefenacin
• Rivastigmine
• Secretin
• Sedating H1-blockers
• Sincalide
• Sodium Bicarbonate
• Solifenacin
• Sufentanil
• Tacrine
• Tapentadol
• Tegaserod
• Thiazide diuretics
• Thioridazine
• Thiothixene
• Tiotropium
• Tiotropium; Olodaterol
• Tolterodine
• Topiramate
• Tramadol
• Tricyclic antidepressants
• Trifluoperazine
• Trimethobenzamide
• Triprolidine
• Trospium
• Umeclidinium
• Umeclidinium; Vilanterol
• Zonisamide