Glycopyrrolate

Administration

• Type: Anticholinergics
• Dosage Forms: Oral tab 1mg; INJ
• Routes of Administration: Oral, IM, IV
• Common Trade Names: Robinul

Adult Dosing

• PUD, adjunct tx
  • PO Dose: 1-2 mg PO bid-tid;
    • Start: 1 mg PO tid
    • Max: 8 mg/day
  • IM/IV Dose: 0.1-0.2 mg IM/IV tid-qid
    • Max: 0.8 mg/day
    • Space dose 4h apart
• Antisialagogue
  • PO Dose: 1-2 mg PO bid-tid;
    • Max: 8 mg/day
  • Parenteral Dose: 0.1-0.2 mg SC/IM/IV q4-8h prn
    • Max: 0.8 mg/day

Pediatric Dosing

• Antisialagogue
  • PO Dose, 2+ yo: 0.04-0.1 mg/kg PO q4-8h prn
    • Max: 1-2 mg/dose, 8mg/day
  • Parenteral Dose, 2+ yo: 0.0004-0.01 mg/kg SC/IM/IV q4-8h prn
    • Max: 0.1-0.2 mg/dose, 0.8 mg/day

Special Populations

• Pregnancy Rating: B; No known risk of teratogenicity w/ INJ form at 5x MRHD and w/ PO form at 320x MRHD
• Lactation risk: L3; Safety unknown

Renal Dosing

• Adult: Not defined; consider decreased dose.
• Pediatric: No defined; consider decreased dose.

Hepatic Dosing

• Adult: Not defined.
• Pediatric: Not defined.

Contraindications

• Allergy to class/drug
• Neonates (benzyl alcohol-containing INJ forms)
• Glaucoma, angle-closure
• Obstructive uropathy
• GI Obstruction
• Paralytic ileus
• Toxic megacolon
• Ulcerative colitis, severe
• Intestinal atony in elderly, debilitated pts
• Myasthenia gravis
• Acute hemorrhage w/ unstable cardiovascular status
• Caution if CAD
• Caution if HTN
• Caution if CHF
• Caution if arrhythmia
• Caution in elderly/debilitated pts
• Caution if renal impairment
• Caution if pulmonary disease
• Caution if hyperthyroidism
• Caution if autonomic neuropathy
• Caution if BPH
• Caution if high environmental temperature
• Caution if febrile
• Caution if ulcerative colitis
• Caution if hiatal hernia w/ reflux esophagitis

Adverse Reactions

Serious

• Hypersensitivity reaction
• Anaphylaxis
• Intestinal obstruction
• Heat stroke
• Seizure
• Arrhythmia
• Cardiac arrest
• Respiratory arrest

Common

• Xerostomia
• Vomiting
• Constipation
• Flushing
• Headache
• Urinary retention
• Urinary hesitancy
• Blurred vision
• Palpation
• Tachycardia
• Anhidrosis
• Dysgeusia
• Lactation suppression

Pharmacology

• Half-life: 0.83h
• Metabolism: Unknown
• Excretion: Urine 85%, bile

Mechanism of Action

• Antagonizes acetylcholine receptors.

References

Authors

Jonathan Warren, Claire