Inhibits salivation and excessive respiratory secretions when given preoperatively.
Reverses some of the secretory and vagal actions of cholinesterase inhibitors used to treat nondepolarizing neuromuscular blockade (cholinergic adjunct).
Adjunctive management of peptic ulcer disease.
Oral solution: Reduce chronic severe drooling in children with neurologic conditions associated with drooling.
Absorption: Incompletely absorbed (<10%) after oral administration. Well absorbed after IM administration. IV administration results in complete bioavailability.
Distribution: Distribution not fully known. Does not significantly cross the blood-brain barrier or eye.
Metabolism and Excretion: Eliminated primarily unchanged in the urine and bile.
Half-life: 1.7 hr (0.6–4.6 hr).
TIME/ACTION PROFILE (anticholinergic effects)
ROUTE
ONSET
PEAK
DURATION
PO
1 hr
unknown
8–12 hr
IM
15–30 min
30–45 min
2–7 hr*
IV
1–10 min
unknown
2–7 hr*
*Antisecretory effect lasts up to 7 hr; vagal blockade lasts 2–3 hr.
IM (Adults): 4.4 mcg/kg 30–60 min before surgery (not to exceed 0.1 mg).
IM (Children >2 yr): 4.4 mcg/kg 30–60 min before surgery.
IM (Children <2 yr): 4.4–8.8 mcg/kg 30–60 min before surgery.
Control of Secretions (chronic)
IM IV (Children): 4–10 mcg/kg/dose every 3–4 hr.
PO (Children): 40–100 mcg/kg/dose 3–4 times/day.
Cholinergic Adjunct
IV (Adults and Children): 200 mcg for each 1 mg of neostigmine or 5 mg of pyridostigmine given at the same time.
Peptic Ulcer
PO (Adults): 1–2 mg 2–3 times daily. An additional 2 mg may be given at bedtime; may be ↓ to 1 mg twice daily (not to exceed 8 mg/day).
IM IV (Adults): 100–200 mcg every 4 hr up to 4 times daily.
Chronic Severe Drooling
PO (Children 3–16 yr): Oral solution: 0.02 mg/kg 3 times daily; may ↑ by 0.02 mg/kg 3 times daily every 5–7 days (not to exceed 0.1 mg/kg 3 times daily or 1.5–3 mg/dose).
Assess HR, BP, and respiratory rate before and periodically during parenteral therapy.
Monitor intake and output in older adults or surgical patients; glycopyrrolate may cause urinary retention. Instruct patient to void before parenteral administration.
Assess routinely for abdominal distention and auscultate for bowel sounds. If constipation occurs, ↑ fluids and add high-fiber foods into diet to help alleviate it.
Periodic intraocular pressure determinations should be made for patients receiving long-term therapy.
Pedi: Monitor amount and frequency of drooling periodically during therapy.
Assess for hyperexcitability, a paradoxical response that may occur in children.
Lab Test Considerations:
Antagonizes effects of pentagastrin and histamine during the gastric acid secretion test. Avoid administration for 24 hr preceding the test.
May ↓ uric acid levels in patients with gout or hyperuricemia.
Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Instruct patient to take as directed and not to take more than the prescribed amount. Take missed doses as soon as remembered if not just before next dose.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
Medication may cause drowsiness and blurred vision. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.
Inform patient that frequent oral rinses, sugarless gum or candy, and good oral hygiene may help relieve dry mouth. Consult health care provider regarding use of saliva substitute if dry mouth persists for >2 wk.
Advise patient to change positions slowly to minimize the effects of drug-induced orthostatic hypotension.
Caution caregivers and patient to avoid extremes of temperature. This medication ↓ the ability to sweat and may ↑ the risk of heat stroke.
Advise patient to notify health care provider immediately if eye pain or ↑ sensitivity to light occurs. Emphasize the importance of routine eye exams throughout therapy.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.
Geri: Advise older adults about ↑ susceptibility to side effects and to call health care provider immediately if they occur.
Pedi: Instruct caregivers to use a calibrated measuring device with solution for accurate dosing.
Advise caregivers to stop glycopyrrolate and notify health care provider if constipation, signs of urinary retention (inability to urinate, dry diapers or undergarments, irritability, crying), rash, hives, or an allergic reaction occurs.