• Inhibits salivation and excessive respiratory secretions when given preoperatively.
• Reverses some of the secretory and vagal actions of cholinesterase inhibitors used to treat nondepolarizing neuromuscular blockade (cholinergic adjunct).
• Adjunctive management of peptic ulcer disease.

Oral solution:

• Reduce chronic severe drooling in children with neurologic conditions associated with drooling.

Contraindicated in:

• Hypersensitivity
• Angle-closure glaucoma
• Acute hemorrhage
• Tachycardia secondary to cardiac insufficiency or thyrotoxicosis
• Severe ulcerative colitis
• Toxic megacolon
• Myasthenia gravis
• Obstructive uropathy
• Paralytic ileus
• Concurrent use of oral potassium chloride dose forms (oral solution only).

Use Cautiously in:

• Patients who may have intra-abdominal infections
• Prostatic hyperplasia
• Chronic renal, hepatic, pulmonary, or cardiac disease
• Hyperthyroidism
• Down syndrome and children with spastic paralysis or brain damage (may be hypersensitive to antimuscarinic effects)
• OB: Safety not established in pregnancy
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
• Pedi: ↑sensitivity to anticholinergic effects and adverse reactions
• Geri: ↑sensitivity to anticholinergic effects and adverse reactions in children.

CV: tachycardia, orthostatic hypotension, palpitations.

Derm: flushing.

EENT: nasal congestion, blurred vision, cycloplegia, dry eyes, mydriasis.

GI: dry mouth, vomiting, constipation.

GU: urinary hesitancy, urinary retention.

Neuro: headache, confusion, drowsiness.

Drug-Drug:

• May ↑ GI mucosal lesions in patients taking oral potassium chloride tablets; concurrent use with oral glycopyrrolate solution contraindicated.
• Additive anticholinergic effects with other anticholinergics, including antihistamines, phenothiazines, meperidine, amantadine, tricyclic antidepressants, quinidine, and disopyramide.
• May alter the absorption of other orally administered drugs by slowing motility of the GI tract.
• May ↑ GI transit time of oral digoxin and ↑ digoxin levels.
• Antacids or adsorbent antidiarrheal agents↓ absorption of anticholinergics.
• May ↑ GI mucosal lesions in patients taking oral potassium chloride tablets.
• May ↑ atenolol and metformin levels.
• May ↓ levels of haloperidol and levodopa.
• Concurrent use may ↓ absorption of ketoconazole (administer 2 hr after ketoconazole).

(Generic available)

• Tablets: 1 mg; 1.5 mg; 2 mg;
• Oral solution (cherry-flavor): 1 mg/5 mL;
• Solution for injection: 200 mcg (0.2 mg)/mL;
• In combination with: neostigmine (Prevduo). See Appendix [not included in this PDA edition].

Control of Secretions during Surgery

• IM (Adults): 4.4 mcg/kg 30–60 min before surgery (not to exceed 0.1 mg).
• IM (Children >2 yr): 4.4 mcg/kg 30–60 min before surgery.
• IM (Children <2 yr): 4.4–8.8 mcg/kg 30–60 min before surgery.

Control of Secretions (chronic)

• IM, IV (Children): 4–10 mcg/kg/dose every 3–4 hr.
• PO (Children): 40–100 mcg/kg/dose 3–4 times/day.

Cholinergic Adjunct

• IV (Adults and Children): 200 mcg for each 1 mg of neostigmine or 5 mg of pyridostigmine given at the same time.

Peptic Ulcer

• PO (Adults): 1–2 mg 2–3 times daily. An additional 2 mg may be given at bedtime; may be ↓ to 1 mg twice daily (not to exceed 8 mg/day).
• IM, IV (Adults): 100–200 mcg every 4 hr up to 4 times daily.

Chronic Severe Drooling

• PO (Children 3–16 yr): Oral solution: 0.02 mg/kg 3 times daily; may ↑ by 0.02 mg/kg 3 times daily every 5–7 days (not to exceed 0.1 mg/kg 3 times daily or 1.5–3 mg/dose).

Cuvposa, Glycate, Glyrx-PF, Robinul, Robinul Forte

• Inhibits the action of acetylcholine at postganglionic sites located in smooth muscle, secretory glands, and the CNS (antimuscarinic activity).
• Low doses decrease sweating, salivation, and respiratory secretions.
• Larger doses decrease GI and GU tract motility.

• Decreased GI and respiratory secretions.

Therapeutic Classification: antispasmodics

Pharmacologic Classification: anticholinergics

Absorption: Incompletely absorbed (<10%) after oral administration. Well absorbed after IM administration. IV administration results in complete bioavailability.

Distribution: Distribution not fully known. Does not significantly cross the blood-brain barrier or eye.

Metabolism/Excretion: Eliminated primarily unchanged in the urine and bile.

Half-life: 1.7 hr (0.6–4.6 hr).

(anticholinergic effects)

*Antisecretory effect lasts up to 7 hr; vagal blockade lasts 2–3 hr.

• Instruct patient to take glycopyrrolate as directed and not to take more than the prescribed amount. Take missed doses as soon as remembered if not just before next dose.
• Medication may cause drowsiness and blurred vision. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.
• Inform patient that frequent oral rinses, sugarless gum or candy, and good oral hygiene may help relieve dry mouth. Consult health care professional regarding use of saliva substitute if dry mouth persists for more than 2 wk.
• Advise patient to change positions slowly to minimize the effects of drug-induced orthostatic hypotension.
• Caution patient to avoid extremes of temperature. This medication decreases the ability to sweat and may increase the risk of heat stroke.
• Advise patient to notify health care professional immediately if eye pain or increased sensitivity to light occurs. Emphasize the importance of routine eye exams throughout therapy.
• Advise patient to consult health care professional before taking any OTC medications concurrently with this therapy.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.
• Geri: Advise geriatric patients about increased susceptibility to side effects and to call health care professional immediately if they occur.
• Pedi: Instruct parents to use a calibrated measuring device with solution for accurate dosing.
  • Advise parents to stop glycopyrrolate and notify health care professional if constipation; signs of urinary retention (inability to urinate, dry diapers or undergarments, irritability, or crying); or rash, hives, or an allergic reaction occurs.
  • Glycopyrrolate reduces sweating. Advise parents to avoid exposure of the patient to hot or very warm environmental temperatures to avoid overheating and heat exhaustion or heat stroke.

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