Glycopyrronium bromide (Glycopyrrolate) Inj

Introduction: Glycopyrronium bromide Injection is a quaternary ammonium antimuscarinic agent used to reduce salivary, tracheobronchial and pharyngeal secretions and to prevent bradycardia during anesthesia.

How it works: Glycopyrronium bromide blocks acetylcholine at parasympathomimetic sites and induces smooth muscle relaxation. It also reduces gastric acid secretions and controls pharyngeal, tracheal and bronchial secretions.

Important Information: It is given as IM or IV injection under medical supervision. It may also be used as adjunctive therapy for peptic ulcer.

• Pre-operative antimuscarinic agent: to reduce salivary, tracheobronchial and pharyngeal secretions and to reduce gastric acidity
• Intra-operative antimuscarinic: to attenuate or prevent bradycardia due to suxamethonium or cardiac vagal reflexes
• Reversal of neuromuscular blockade: to protect against peripheral muscarinic actions of neostigmine and pyridostigmine
• Peptic Ulcer: adjunctive therapy in adults

Anticholinergics (antimuscarinics)/ Anti-spasmodics

Quaternary Ammonium Antimuscarinic

Glycopyrronium bromide is a quaternary ammonium antimuscarinic with peripheral effects. It is used in anesthetic practice. Given as a premedication before general anesthesia, it diminishes the risk of vagal inhibition of the heart and reduces salivary and bronchial secretions. Intra-operatively, it may be given to reduce bradycardia and hypotension induced by drugs such as suxamethonium, halothane or propofol. Antimuscarinic drugs are competitive inhibitors of the actions of acetylcholine at the muscarinic receptors of autonomic effector sites innervated by parasympathetic nerves.

Glycopyrronium bromide blocks acetylcholine receptors to reduce salivary and bronchial secretions and prevent bradycardia.

Pre-anesthetic (Adults):

• 0.2-0.4 mg IV or IM before induction of anesthesia
• or 0.004-0.005 mg/kg (max 0.4 mg)

Pre-anesthetic (Children 1 month-12 years):

• 0.004-0.008 mg/kg (max 0.2 mg) IV or IM

Intraoperative (Adults):

• 0.2-0.4 mg (or 0.004-0.005 mg/kg, max 0.4 mg) IV

Reversal of Neuromuscular Blockade:

• Adults: 0.2 mg IV per 1 mg neostigmine
• Children: 0.01 mg/kg IV with 0.05 mg/kg neostigmine

* Use as directed by the registered physician

Intravenous (IV) or intramuscular (IM) injection. Your doctor or nurse will give you this medicine. Do not self-administer.

If you miss a dose, consult your doctor.

Common Side Effects:

• Dry mouth
• Constipation
• Tachycardia
• Palpitations
• Urinary retention
• Blurred vision
• Photophobia
• Flushing
• Nausea
• Dizziness

Precautions:

• Use with caution in Down's syndrome, children and elderly
• Caution in gastro-esophageal reflux disease, diarrhea, ulcerative colitis
• Caution in acute myocardial infarction, hypertension, hyperthyroidism
• Avoid repeated or large doses in uremia patients
• Caution in myasthenia gravis

Contraindications:

• Angle-closure glaucoma
• Myasthenia gravis (large doses)
• Paralytic ileus
• Pyloric stenosis
• Prostatic enlargement
• Prolonged QT interval (with neostigmine+glycopyrronium combination)

Drug Interactions:

• Decreases levodopa effects
• Effects may be enhanced with antimuscarinic drugs or MAOIs
• May antagonize GI effects of cisapride, metoclopramide, domperidone
• IV administration with cyclopropane anesthesia may cause ventricular arrhythmias

Food Interactions:

• It is not known whether it is safe to consume alcohol. Please consult your doctor.

Use in Pregnancy: Generally considered safe during pregnancy. Animal studies have shown low or no adverse effects.

Use in Lactation: Probably safe during breastfeeding. Long-term use may reduce milk production.

Pediatric Use: Pediatric patients have higher risk of arrhythmias. Children are more susceptible to toxic effects of anticholinergics. Long-term IV use safety not established.

Geriatric Use: Limited number of subjects aged 65 and over. Start at low end of dosing range.

Renal Impairment: Avoid repeated or large doses in uremia patients due to prolonged renal elimination.

Hepatic Impairment: No specific restrictions.

Overdose: Glycopyrronium bromide is a quaternary ammonium agent - symptoms are peripheral. Neostigmine methylsulphate IV (0.25 mg increments in adults, repeated every 5-10 minutes, max 2.5 mg) may be given.

Storage: Keep below 25°C, away from light and moisture. Keep out of reach of children.

Glycopyrronium bromide (Glycopyrrolate) Injection