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Glycopyrrolate

Classification

Anticholinergic agent

Indications

ACP: Management of excessive respiratory secretions in palliative care

Contraindications

Known hypersensitivity to glycopyrrolate
Glaucoma
Obstructive uropathy
Obstructive diseases of the gastrointestinal tract
Paralytic ileus
Intestinal atony
Chronic lung diseases in elderly or debilitated patients
Unstable cardiovascular status in acute hemorrhage
Severe ulcerative colitis
Toxic megacolon (as a complication of ulcerative colitis)
Myasthenia gravis

Adult dosages

ACP: Management of excessive respiratory secretions in palliative care

Requires specific training and license endorsement
CliniCall (and patient's care team) consultation required prior to administration to select a dosing strategy.
Initial dose: 0.4 mg SC, then 0.2-0.4 mg SC every 1-4 hours as required

Pediatric Considerations And Dosing

CliniCall consultation required prior to administration to pediatrics.

Mechanism Of Action

Blocks the action of acetylcholine at parasympathetic sites in secretory glands, smooth muscle, and the central nervous system, reducing the rate of salivation indirectly by preventing simulation of acetylcholine receptors.

Pharmacokinetics

Subcutaneous:

Onset: 15-30 minutes
Peak: 30-45 minutes
Duration: 7 hours

Adverse Effects

Dry mouth
Urinary retention
Visual disturbances
Confusion
Tachycardia

Warning And Precautions

Use half the dose in end-stage renal failure.
Elderly patients may be particularly susceptible to glycopyrrolate’s anticholinergic action. Start with low doses.
Glycopyrrolate may decrease sweat production, which can exacerbate fever or provoke heat exhaustion in warm environments.
Investigate any tachycardia before administering glycopyrrolate, as it may independently raise the heart rate. Caution is advised in patients with a history of coronary artery disease, heart failure, cardiac arrhythmias, or hypertension.

Drug Interactions

Glycopyrrolate may decrease serum concentrations of haloperidol; concurrent use should be avoided if possible.