Glycopyrrolate

Glycopyrrolate

ADMINISTRATION ROUTES:

  • IV

ALTERNATIVE NAMES:

  • Robinul

ICU INDICATIONS:

  1. protection against the peripheral muscarinic effects of cholinergics given to reverse neuromuscular blockade
  2. to reduce secretions

PRESENTATION AND ADMINISTRATION:

  • IV:
    Robinul contains 0.2mg of glycopyrrolate in a 1ml vial.
    In order to minimize the appearance of cardiac side effects, glycopyrrolate and neostigmine may be administered simultaneously by IV injection and may be mixed in the same syringe when given for reversal of neuromuscular paralysis.
    Compatible in the following IV fluids:
    Dextrose 5% and 10% in water, or saline, dextrose 5% in sodium chloride 0.45%, and sodium chloride 0.9%
    Store at room temperature

DOSAGE:

  • IV:
    To prevent bradycardia during reversal of neuromuscular blockade

    The recommended dose of glycopyrrolate injection is 0.2 mg for each 1.0 mg of neostigmine.
    To Reduce Secretions & Treating Bradycardia

    0.2mg 6-8 hourly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Glycopyrrolate is renally excreted and its effect is significantly prolonged by renal impairment. However, dosage adjustment is generally not required.

DOSAGE IN PAEDIATRICS:

  • Reversal of Neuromuscular Blockade:
    10mcg/kg of glycopyrrolate with 0.05mg/kg neostigmine
  • To Reduce Secretions or Treat Bradycardia:
    5-10mcg/kg 6-8 hourly IV

CLINICAL PHARMACOLOGY:

  • Glycopyrrolate is a synthetic anticholinergic agent. Glycopyrrolate, like other anticholinergic (antimuscarinic) agents, inhibits the action of acetylcholine on structures innervated by postganglionic cholinergic nerves and on smooth muscles that respond to acetylcholine but lack cholinergic innervation.

CONTRAINDICATIONS:

  1. hypersensitivity to glycopyrrolate

WARNINGS

  • This drug should be used with great caution, if at all, in patients with glaucoma. Exposure to excessive amounts of benzyl alcohol has been associated with toxicity (hypotension, metabolic acidosis), particularly in neonates.

PRECAUTIONS

  • General:
    Investigate any tachycardia before giving glycopyrrolate injection since an increase in the heart rate may occur. Use with caution in patients with: coronary artery disease; congestive heart failure; cardiac arrhythmias; hypertension; hyperthyroidism.
    Infants, patients with Down’s syndrome, and paediatric patients with spastic paralysis or brain damage may experience an increased response to anticholinergics, thus increasing the potential for side effects.
  • Laboratory Tests:
    No tests in addition to routine ICU tests are required
  • Drug/Laboratory Test Interactions:
    None noted

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • The concurrent use of glycopyrrolate injection with other anticholinergics or medications with anticholinergic activity, such as phenothiazines, antiparkinson drugs, or tricyclic antidepressants, may intensify the antimuscarinic effects and may result in an increase in anticholinergic side effects.

ADVERSE REACTIONS

  • Body as a Whole:
    Anaphylactic/anaphylactoid reactions, malignant hyperthermia
  • Cardiovascular System:
    Tachycardia, cardiac arrhythmias (including bradycardia, ventricular tachycardia, ventricular fibrillation)
  • Gastrointestinal System:
    Nausea, vomiting, dry mouth, constipation
  • Renal System:
    Urinary hesitancy and retention

Critical Care Drug Manual

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