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
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