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ALIMENTARY TRACT AND METABOLISM › DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS › DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS › Synthetic anticholinergics, quaternary ammonium compounds
glycopyrronium bromide
A03AB02
Forms & Strengths
- Oral tablet: 1 mg, 2 mg
- Oral liquid: 1 mg/5 mL
- Solution for injection: 0.2 mg/mL
- Inhalation powder (Cuvposa/Seebri): capsule with device 15.6 mcg
Adult Dosing
- Preoperative antiaialogogue (IV/IM): 0.1 mg to 0.2 mg single dose
- Reversal of neuromuscular blockade (IV): 0.2 mg per 1.0 mg neostigmine
- Peptic ulcer disease (Oral): 1 mg to 2 mg 2 to 3 times daily
- COPD maintenance (Inhalation): 15.6 mcg once daily
Pediatric Dosing
- Chronic severe drooling (Oral liquid, ages 3-16 years): Initial 0.02 mg/kg up to 3 times daily, titrated by 0.02 mg/kg every 5-7 days up to max 0.1 mg/kg or 1.5-3 mg/dose
- Preoperative (IV/IM, ages 1 month-12 years): 0.004 mg/kg up to 0.1 mg max single dose
Indications
- Reduction of salivary secretions in chronic neurologic conditions associated with problem drooling (pediatric population)
- Preanesthetic medication to reduce salivary and tracheobronchial secretions
- Reversal of acute neuromuscular blockade
- Maintenance treatment of chronic obstructive pulmonary disease (COPD)
Mechanism of Action
- Competitive antagonist at muscarinic acetylcholine receptors
- Inhibits parasympathetic stimulation of salivary glands, bronchial smooth muscle, and GI tract
- Quaternary ammonium structure limits penetration across the blood-brain barrier, reducing central nervous system side effects
Contraindications
- Glaucoma (narrow-angle)
- Myasthenia gravis
- Paralytic ileus or GI obstruction
- Severe ulcerative colitis or toxic megacolon
- Urinary retention or severe obstructive uropathy
- Hypersensitivity to glycopyrrolate
Adverse Reactions
- Dry mouth
- Constipation
- Urinary retention
- Blurred vision and mydriasis
- Tachycardia
- Flushing
- Drowsiness and paradoxical CNS excitation
- Decreased sweating and hyperthermia
Drug Interactions
- Anticholinergic agents (additive anticholinergic toxicity)
- Potassium chloride oral supplements (increased risk of GI mucosal ulceration)
- Gastrointestinal prokinetics like metoclopramide (antagonism of GI motility effects)
- Symptomatic interactions with drugs sensitive to reduced GI motility or transit time
Curated Content: Needs Vetting Before Put to Clinical Use