Product Details

Glycopyrrolate

A to Z Drug Facts

Glycopyrrolate

Action
Indications
Contraindications
Route/Dosage
Interactions
Lab Test Interferences
Adverse Reactions
PrecautionsPatient Care Considerations
Administration/Storage
Assessment/Interventions
Patient/Family Education

(glie-koe-PIE-row-late)Robinul, Robinul ForteClass: Anticholinergic; Antispasmodic

 Action Exerts anticholinergic effects, resulting in GI smooth muscle relaxation, diminished volume and acidity of GI secretions and reduced pharyngeal, tracheal, and bronchial secretions.

 Indications

Oral: Adjunctive treatment of peptic ulcer. Parenteral: Preoperative administration for reduction of salivary, tracheobronchial and pharyngeal secretions, reduction of volume and acidity of gastric secretions, and blockade of cardiac vagal inhibitory reflexes before and during induction of anesthesia and intubation; intraoperatively for counteraction of drug-induced or vagal traction reflexes with associated arrhythmias.

 Contraindications Narrow angle glaucoma; adhesions between iris and lens; obstructive uropathy; obstructive disease of GI tract; paralytic ileus; intestinal atony of elderly or debilitated patient; severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; hepatic or renal disease; tachycardia; myocardial ischemia; unstable cardiovascular status in acute hemorrhage; myasthenia gravis.

 Route/Dosage

Peptic Ulcer

ADULTS & CHILDREN > 12 yr: PO 1 to 2 mg bid or tid. IM/IV 0.1 to 0.2 mg tid or qid.

Preanesthetic Medication

ADULTS: IM 0.004 mg/kg 20 min to 1 hr prior to anesthesia. CHILDREN < 12 yr: IM 0.0044 to 0.0088 mg/kg. CHILDREN < 2 yr: IM up to 0.0088 mg/kg.

Intraoperative Medication

ADULTS: IV 0.1 mg. May repeat at 2 to 3 min intervals. CHILDREN: IV 0.004 mg/kg (maximum 0.1 mg in single dose); may repeat at 2 to 3 min intervals.

Reversal of Neuromuscular Blockade

ADULTS & CHILDREN: IV 0.2 mg for each 1 mg neostigmine or 5 mg pyridostigmine. Administer simultaneously.

 Interactions

Haloperidol: May cause decreased serum haloperidol levels, worsened schizophrenic symptoms and tardive dyskinesia. INCOMPATIBILITIES: Because stability of glycopyrrolate is questionable above pH of 6, do not combine in same syringe with methohexital sodium, chloramphenicol sodium succinate, dimenhydrinate, pentobarbital sodium, thiopental sodium, secobarbital sodium, sodium bicarbonate, diazepam, dexamethasone sodium phosphate, or buffered solution of Lactated Ringer's solution.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Palpitations; tachycardia; orthostatic hypotension. CNS: Headache; flushing; nervousness; drowsiness; weakness; dizziness; confusion; insomnia; fever (especially in children); mental confusion or excitement (especially in elderly, even with small doses); CNS stimulation (restlessness, tremor, hallucinations). DERM: Severe allergic reactions including anaphylaxis, urticaria and dermal manifestations. EENT: Blurred vision; mydriasis; photophobia; cycloplegia; increased intraocular pressure; dilated pupils; nasal congestion. GI: Dry mouth; altered taste perception; nausea; vomiting; dysphagia; heartburn; constipation; bloated feeling; paralytic ileus. GU: Urinary hesitancy and retention; impotence. OTHER: Suppression of lactation; decreased sweating.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Not recommended for treatment of peptic ulcer in children < 12 yr. Elderly and debilitated patients: May react with excitement, agitation, drowsiness, and other untoward manifestations even with small doses. Special risk patients: Use with caution in patients with autonomic neuropathy, hepatic or renal disease, ulcerative colitis, hyperthyroidism, coronary heart disease, CHF, cardiac tachyarrhythmias, hypertension, prostatic hypertrophy, hiatal hernia associated with reflux esophagitis. Anticholinergic psychosis: Reported in sensitive individuals; may include confusion, disorientation, short-term memory loss, hallucinations, dysarthria, ataxia, coma, euphoria, anxiety, fatigue, insomnia, agitation, and inappropriate affect. Diarrhea: May be symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. Treatment of diarrhea with drug is inappropriate and possibly harmful. Gastric ulcer: May delay gastric emptying rate and complicate therapy. Heat prostration: Can occur in presence of high environmental temperature.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

• For IM administration give drug undiluted or mixed with D5W, D10W or 0.9% Sodium Chloride.
• May administer undiluted drug IV.
• Do not administer parenteral solution if cloudy.
• Store parenteral and oral formulations at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess bowel sounds and frequency of bowel movements.
• Monitor I & O.
• Monitor vital signs closely, particularly heart rate and BP, during parenteral administration.
• Assess for side effects: Palpitations, neurologic alterations, GI alterations.
• Assess urinary output and signs and symptoms of urinary retention.
• Assess for presence of abdominal pain.

OVERDOSAGE: SIGNS & SYMPTOMS Dry mouth, thirst, vomiting, nausea, abdominal distention, difficulty swallowing, muscular weakness, paralysis, fever, coma, circulatory failure, rapid pulse and respiration, vasodilation, tachycardia with weak pulse, hypertension, hypotension, respiratory depression, palpitations

 Patient/Family Education

• Instruct patient that constipation can occur and to institute preventive measures (increase fluids, bulk in diet, and activity).
• Advise patient that urinary hesitancy or retention may be experienced. Instruct patient to assess urination patterns and to notify health care provider if urinary retention is experienced.
• Inform male patient that impotence is potential side effect and to report this symptom to health care provider.
• Because drug interferes with body's thermoregulation, instruct patient to avoid exposure to high environmental temperature to prevent heat prostration.
• Instruct patient to notify health care provider immediately if eye pain or increased sensitivity to light occurs. Emphasize importance of routine eye examinations throughout therapy.
• Inform patient that dry mouth is a normal side effect. Instruct patient to take sips of water frequently, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs.
• Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
• Advise patient that drug may cause drowsiness and blurred vision and to use caution while driving or performing other tasks requiring mental alertness.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts