glycopyrrolate (Robinul, Robinul Forte, Cuvposa, Glycate)

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GENERIC NAME: glycopyrrolate

BRAND NAME: Robinul, Robinul Forte, Cuvposa, Glycate

DRUG CLASS AND MECHANISM: Glycopyrrolate is a synthetic anti-cholinergic medication. Glycopyrrolate works by blocking acetylcholine activity on smooth muscles and other tissues. Acetylcholine is neurotransmitter, a chemical that nerves use for communicating. Blocking of acetylcholine leads to decrease in volume and acidity of stomach secretions and decrease in pharyngeal, tracheal, and bronchial secretions. It also reverses symptoms of excessive bronchial secretions, bronchospasm, low heart rate, and intestinal hypermotility caused by medications that increase the action of acetylcholine. The FDA approved glycopyrrolate in August 1961.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Glycopyrrolate injection is available in 0.2 mg/ml strength in 1 ml and 2 ml single-use vials. It is also available in 5 ml and 20 ml multi-use vials. All vials contain benzyl alcohol 0.9% as preservative.

STORAGE: Store Glycopyrrolate injection at room temperature between 20 C and 25 C (68 F and 77 F).

PRESCRIBED FOR: Glycopyrrolate injection is used as preoperative medication to prevent secretions during surgery, to reverse irregular heart rate, and to reverse neuromuscular (neurons and muscles) blockade. It is also used as adjunct therapy in peptic ulcer disease to produce rapid anti-cholinergic effects when oral therapy is not tolerated.

DOSING:

Adults

  • Preanesthetic medication: Inject 0.004 mg/kg intramuscularly or intravenously 30 to 60 minutes prior to surgery.
  • Intraoperative medication: Inject 0.1 mg as a single dose intravenously every 2 to 3 minutes as needed.
  • Reversal of neuromuscular blockade: Inject 0.2 mg for each 1 mg of neostigmine or 5 mg of pyridostigmine given.
  • Peptic ulcer: Inject 0.1 mg intramuscularly or intravenously at 4-hour intervals, up to 3 to 4 times daily. May increase to 0.2 mg if needed.

Children

  • Preanesthetic medication (children over 2 years of age): Inject 0.004 mg/kg intramuscularly, given 30 to 60 minutes prior to anesthesia, narcotic, or sedative.
  • Preanesthetic medication (Infants of 1 month to 2 years of age): Inject up to 0.009 mg/kg.
  • Intraoperative medication: Inject 0.004 mg/kg as single dose intravenously every 2 to 3 minutes as needed. Do not exceed 0.1 mg in a single dose.
  • Reversal of neuromuscular blockade: Inject 0.2 mg for each 1 mg of neostigmine or 5 mg of pyridostigmine given.

Glycopyrrolate Injection is not recommended for the treatment of peptic ulcer in pediatric patients.

DRUG INTERACTIONS: Glycopyrrolate should not be used with anti-cholinergic drugs such as phenothiazines, Parkinson's drugs, or tricyclic antidepressants because it can significantly increase anticholinergic side effects like mydriasis (pupil dilation), high blood pressure (hypertension), flushing, fever, and increased heart rate.

Glycopyrrolate should be used with caution with potassium chloride because concomitant use can decrease bowel movement and can cause irritation or lesions in the stomach and intestine.

PREGNANCY: There are no adequate studies done on glycopyrrolate to determine safe and effective use in pregnant women. It has been shown that small amounts of glycopyrrolate will pass the placental barrier.

NURSING MOTHERS: It is not known whether glycopyrrolate enters breast milk; therefore, it is best to be cautious before using it in nursing mothers. Anticholinergics may cause suppression of lactation.

SIDE EFFECTS: Side effects of glycopyrrolate are dry mouth, urinary retention, blurred vision, dilated pupils, increased heart rate, sweating, weakness, dizziness, dry skin, constipation, urinary retention and mental confusion. This drug should not be used in patients with glaucoma.

REFERENCE: FDA Prescribing Information.


Medically Reviewed by a Doctor on 6/27/2014



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