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. These peripheral cholinergic receptors are present in the autonomic effector cells of smooth muscle, cardiac muscle, the sinoatrial node, the atrioventricular node, exocrine glands and, to a limited degree, in the autonomic ganglia. Thus, it diminishes the volume and free acidity of gastric secretions and controls excessive pharyngeal, tracheal, and bronchial secretions.

Anesthesia adjunct:

• Reduces salivary, tracheobronchial, and pharyngeal secretions

• Minimizes vagal reflexes during induction and intubation

• Used intraoperatively for vagal-induced arrhythmias

• Counters muscarinic effects of cholinergic agents like neostigmine/pyridostigmine

Peptic ulcer (adults only): adjunct therapy when oral medications aren’t tolerated

The recommended dose of glycopyrrolate injection is 0.004 mg/kg by intramuscular injection, given 30 to 60 minutes prior to the anticipated time of induction of anesthesia or at the time the preanesthetic narcotic and/or sedative are administered.

Common: dry mouth, urinary retention, blurred vision, tachycardia, constipation

Serious: seizures, cardiac arrest, respiratory arrest, QT prolongation (esp. with anticholinesterases)

Injection site reactions: pain, redness, swelling

Known hypersensitivity to glycopyrrolate injection or any of its inactive ingredients.

Benzyl alcohol warning: associated with fatal “gasping syndrome” in neonates

Contraindications:

• Glaucoma, obstructive uropathy/GI tract diseases, unstable CV status, myasthenia gravis, etc.

Use caution in:

• Elderly, renal impairment, hepatic disease, Down syndrome, autonomic neuropathy