glycopyrrolate, oral inhalation

General

Pronunciation:
glye-koe-pye-roe-late

Trade Name(s)

  • Lonhala Magnair
  • Seebri Neohaler

Ther. Class.
bronchodilators

Pharm. Class.
anticholinergics

Indications

Maintenance treatment of COPD.

Action

Inhibits the action of acetylcholine at the muscarinic receptor, M3, in the bronchial smooth muscle, leading to bronchodilation.

Therapeutic Effect(s):

Bronchodilation with decreased airflow obstruction.

Pharmacokinetics

Absorption: 40% systemically absorbed from lungs and GI tract following inhalation.

Distribution: Unknown.

Metabolism and Excretion: Undergoes hydroxylation to inactive metabolites. Eliminated primarily unchanged in the urine and bile.

Half-life: 33–53 hr.

TIME/ACTION PROFILE (blood levels)

ROUTEONSETPEAKDURATION
Inhalnunknown5 minunknown

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity to any components or severe hypersensitivity to milk proteins;
  • Acute attack of COPD (onset of action is delayed).

Use Cautiously in:

  • Narrow-angle glaucoma;
  • Urinary retention, prostatic hyperplasia, bladder-neck obstruction;
  • OB: Lactation: Safety not established;
  • Pedi: Safety and effectiveness not established.

Adverse Reactions/Side Effects

CNS: fatigue

EENT: nasopharyngitis, rhinitis, sinusitis

GI: diarrhea, nausea

MS: arthralgia

Resp: dyspnea, paradoxical bronchospasm, upper respiratory tract infection

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANGIOEDEMA, URTICARIA, OR RASH)

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

↑ risk of adverse anticholinergic adverse reactions when used concurrently with other anticholinergics; avoid concurrent use.

Route/Dosage

Inhaln (Adults) Lonhala Magnair–1 vial (25 mcg) twice daily; Seebri Neohaler–1 capsule (15.6 mcg) twice daily.

Availability

Solution for oral inhalation (Lonhala Magnair): 25 mcg/vial

Dry powder capsules for oral inhalation (Seebri Neohaler): 15.6 mcg

Assessment

  • Assess lung sounds, pulse, and BP before administration and during peak of medication. Note amount, color, and character of sputum produced. Closely monitor patients on higher dose for adverse effects.
  • Monitor pulmonary function tests before initiating and periodically during therapy to determine effectiveness.
  • Observe for paradoxical bronchospasm (wheezing, dyspnea, tightness in chest) and hypersensitivity reaction (rash; urticaria; swelling of the face, lips, or eyelids). If condition occurs, withhold medication and notify health care professional immediately.
  • Monitor ECG periodically during therapy. May cause prolonged QTc interval.
  • Monitor patient for signs of hypersensitivity reactions (difficulties in breathing or swallowing, swelling of tongue, lips and face), urticaria, or skin rash) throughout therapy. Discontinue therapy and consider alternative if reaction occurs.

Lab Test Considerations:

May cause ↑ serum glucose and decreased serum potassium.

Potential Diagnoses

Implementation

  • Inhaln Administer as 2 inhalations twice daily, morning and evening.
    • For Longhala: Only administer with Magnair nebulizer; do not swallow or inject solution. Remove vial from foil pouch immediately before use. Discard unopened vials after 7 days. Throw away plastic dispensing vials immediately after use; may risk choking in young children due to small size. Discard Magnair Handset parts after use with 60 vials; use replacement parts with next 60 vials.
    • For Seebri: Remove capsule from blister pack immediately before use. Use only with Neohaler. Always use new Neohaler provided with each Rx. Powder is only for oral inhalation and capsules must not be swallowed. To make sure full dose is taken, open inhaler to check that no powder left in capsule. If capsule is empty, full dose was delivered.

Patient/Family Teaching

  • Instruct patient to use medication as directed. Do not discontinue therapy without discussing with health care professional, even if feeling better. If a dose is missed skip dose and take next dose at regularly scheduled time. Do not double doses. Use a rapid-acting bronchodilator if symptoms occur before next dose is due. Caution patient not to use more than 2 times a day; may cause adverse effects, paradoxical bronchospasm, or loss of effectiveness of medication. Instruct patient to review Medication Guide before starting therapy and with each Rx refill in case of changes.
  • Caution patient not to use medication to treat acute symptoms. A rapid-acting inhaled beta-adrenergic bronchodilator should be used for relief of acute asthma attacks. Notify health care professional immediately if symptoms get worse or more inhalations than usual are needed from rescue inhaler.
  • Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or nausea, vomiting, shakiness, headache, fast or irregular heartbeat, sleeplessness, or signs and symptoms of narrow angle glaucoma (eye pain or discomfort, blurred vision, visual halos or colored images, red eyes) or urinary retention (difficulty passing urine, painful urination) occur.
  • Advise patient to consult health care professional before taking any Rx, OTC, or herbal products or alcohol concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants.
  • Advise patient to notify health care professional if pregnancy is planned or suspected, or if breast feeding.
  • Make sure piercing buttons are to left and right of inhaler (not up and down). Exhale completely, and then close lips firmly around mouthpiece. Breathe in rapidly but steadily, as deeply as possible. As you breathe in through inhaler, capsule spins around in chamber and you should hear a whirring noise. If you do not hear whirring noise, capsule may be stuck in capsule chamber. Open inhaler and carefully loosen capsule by tapping base of inhaler. You may experience a sweet flavor as you inhale the medicine. Hold breath for 5–10 seconds to ensure deep instillation of medication. Remove inhaler from mouth and breathe out gently. Open inhaler to see if powder is left in capsule. If powder left in capsule, close inhaler and repeat inhalation. Capsule is usually emptied with 1 or 2 inhalations. Allow 1–2 min between inhalations. Remove empty capsule by tipping it out of capsule chamber, and throwing it away; do not leave empty capsule in chamber. (See medication administration techniques).
  • See manufacturer's instructions for set up and use of Magnair nebulizer. Once Magnair nebulizer handset is set up, insert 1 vial into bottom of medication cap until it clicks. Make sure aerosol head is installed before attaching medication cap; medicine could leak and not deliver full treatment. Place medication cap with vial on the top of the handset body. To attach medication cap to handset body, turn medication cap in a clockwise direction until click is heard. Notch in medication cap (at the base of opening) should line up with blue line on handset body. Insert mouthpiece into mouth. Do not tilt handset, loosen or remove medication cap, or unclasp handset body until treatment is complete or full treatment will not be delivered. Press on button and breath normally. Magnair will beep at end of treatment and controller will automatically shut off. Treatment usually takes 2 to 3 minutes.

Evaluation/Desired Outcomes

Bronchodilation with decreased airflow obstruction.

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