In Anesthesia: ItInjection is indicated for use as a preoperative antimuscarinic to reduce salivary,tracheobronchial,and pharyngeal secretions; to reduce the volume and free acidity of gastric secretions; and to block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation. When indicated,ItInjection may be used intraoperatively to counteract surgically or druginduced or vagal reflexes associated arrhythmias. Glycopyrrolate protects against the peripheral muscarinic effects (e.g.,bradycardia and excessive secretions) of cholinergic agents such as neostigmine and pyridostigmine given to reverse the neuromuscular blockade due to non-depolarizing muscle relaxants. In Peptic Ulcer: For use in adults as adjunctive therapy for the treatment of peptic ulcer when rapid anticholinergic effect is desired or when oral medication is not tolerated.
Anticholinergics (antimuscarinics)/ Anti-spasmodics
Adults Preanesthetic Medication. The recommended dose of ItInjection 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. Intraoperative Medication. ItInjection may be used during surgery to counteract drug-induced or vagal reflexes and their associated arrhythmias (e.g.,bradycardia). It should be administered intravenously as single doses of 0.1 mg and repeated,as needed,at intervals of 2 to 3 minutes. The usual attempts should be made to determine the etiology of the arrhythmia,and the surgical or anesthetic manipulations necessary to correct parasympathetic imbalance should be performed. Reversal of Neuromuscular Blockade. The recommended dose of ItInjection is 0.2 mg for each 1.0 mg of neostigmine or 5.0 mg of pyridostigmine. In order to minimize the appearance of cardiac side effects,the drugs may be administered simultaneously by intravenous injection and may be mixed in the same syringe. Peptic Ulcer. The usual recommended dose of ItInjection is 0.1 mg administered at 4-hour intervals,3 or 4 times daily intravenously or intramuscularly. Where more profound effect is required,0.2 mg may be given. Some patients may need only a single dose,and frequency of administration should be dictated by patient response up to a maximum of four times daily. ItInjection is not recommended for the treatment of peptic ulcer in pediatric patients
Known hypersensitivity to glycopyrrolate or any of its inactive ingredients. In addition,in the management of peptic ulcer patients,because of the longer duration of therapy, ItInjection may be contraindicated in patients with the following concurrent conditions: glaucoma; obstructive uropathy (for example,bladder neck obstruction due to prostatic hypertrophy); obstructive disease of the gastrointestinal tract (as in achalasia,pyloroduodenal stenosis,etc.); paralytic ileus,intestinal atony of the elderly or debilitated patient; unstable cardiovascular status in acute hemorrhage; severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; myasthenia gravis.
Anticholinergics,including ItInjection,can produce certain effects,most of which are extensions of their pharmacologic actions. Adverse reactions may include xerostomia (dry mouth); urinary hesitancy and retention; blurred vision and photophobia due to mydriasis (dilation of the pupil); cycloplegia; increased ocular tension; tachycardia; palpitation; decreased sweating; loss of taste; headache; nervousness; drowsiness; weakness; dizziness; insomnia; nausea; vomiting; impotence; suppression of lactation; constipation; bloated feeling; severe allergic reactions including anaphylactic/anaphylactoid reactions; hypersensitivity; urticaria,pruritus,dry skin,and other dermal manifestations; some degree of mental confusion and/or excitement,especially in elderly persons.
Pregnancy Category B. Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect.Nursing Mothers It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk,caution should be exercised when ItInjection is administered to a nursing woman. As with other anticholinergics,glycopyrrolate may cause suppression of lactation
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