Glycopyrrolate

Glycopyrrolate is an anticholinergic medicine that reduces body secretions. It is used during anesthesia, as an add-on for peptic ulcer symptoms, and in inhaled form for COPD. This guide covers glycopyrrolate uses, how it works, dosage, side effects, precautions, drug interactions, use in pregnancy and breastfeeding, brand names and its approximate price in India.

At a Glance

What is Glycopyrrolate?

Glycopyrrolate is an anticholinergic medicine. It blocks a body chemical called acetylcholine. This lowers secretions, such as saliva, airway mucus and stomach acid, and relaxes smooth muscle in places like the gut and airways. It is made in different forms, and each form is approved for different conditions. The injection is used in anesthesia, in adults and children. The tablet is used in adults for peptic ulcer symptoms. The inhaled form is used for COPD. A form made for one use should not be used for another.

How Glycopyrrolate Works

Acetylcholine tells glands to make secretions and tells muscles to contract. Glycopyrrolate blocks acetylcholine at its receptors, so fewer secretions are made and some muscles relax. In the stomach, it lowers the amount and acidity of gastric juice. During anesthesia, it reduces saliva and airway secretions. It also blocks certain cardiac inhibitory (vagal) reflexes that can slow the heart during induction of anesthesia and intubation. In the airways, the inhaled form relaxes the muscles around the airways, which widens them. Glycopyrrolate does not easily cross from the blood into the brain. Because of this, it causes fewer brain-related side effects than some older anticholinergics, such as atropine.

When Glycopyrrolate Is Used

Anesthesia (injection): To reduce saliva, airway and stomach secretions before and during surgery. It is also used to block cardiac inhibitory reflexes during induction of anesthesia and intubation, and to counter slow heartbeat or rhythm changes caused by vagal reflexes or drugs during surgery. It is also given with neostigmine or pyridostigmine, when these are used to reverse muscle relaxants after surgery, to block their unwanted effects.

Peptic ulcer (tablet or injection): As an add-on in adults to reduce symptoms. The injection is used when a fast effect is wanted or tablets cannot be taken. It is not used alone, because it has not been shown to heal ulcers by itself.

COPD (inhaled form only): For long-term maintenance treatment of airflow blockage, including chronic bronchitis and emphysema. It does not give quick relief during a sudden attack. Tablets and injections are not used for COPD.

Glycopyrrolate Dosage

The dosage details below are based on U.S. prescribing information. Approved products and instructions can differ by country, so always follow the leaflet and advice for the product your doctor prescribes. Do not mix doses between forms.

• Injection, adults: It is given into a muscle or a vein by a trained healthcare professional, and the dose depends on the reason for use. Before anesthesia, the label dose is 4 mcg per kg into a muscle, given 30 to 60 minutes before. It takes time to work after a muscle injection, which is why it is given early. During surgery, the label dose is 0.1 mg into a vein, repeated if needed at 2 to 3 minute intervals. To counter the effects of neostigmine or pyridostigmine, the dose is matched to the amount of that medicine used. For a peptic ulcer, the label dose is 0.1 mg every 4 hours, up to four times a day, adjusted to the response.
• Injection, children: The injection is used in anesthesia in children, with a dose based on body weight that the anesthesia team decides. It is not approved for peptic ulcer in children.
• Tablet (peptic ulcer add-on, adults only): The label starting dose for the 1 mg tablet is 1 mg three times a day, in the morning, early afternoon and at bedtime. A dose of 1 mg twice a day is often enough later. The highest daily dose is 8 mg, and doctors aim for the lowest dose that works. The 2 mg tablet is not meant for starting treatment. Safety and effectiveness of the tablet in children have not been established.
• Inhaled form (COPD, adults): The dose and how often it is used depend on the specific inhaled product, its strength and its device. Follow the prescribing information and instructions for your product, and do not use more than prescribed. Inhaled glycopyrrolate for COPD is not recommended in children.

Take it only as advised by your doctor or healthcare professional. Do not start, stop, or change the dose on your own.

Side Effects of Glycopyrrolate

Side effects can differ by form, and the frequencies seen in studies are not directly comparable between products.

Injection and tablet: The usual side effects come from blocking acetylcholine. They can include dry mouth, blurred vision, sensitivity to light, constipation, trouble passing urine, less sweating, fast heartbeat, drowsiness, dizziness, headache, nausea and vomiting. Flushing is also listed for the tablets. It can reduce breast milk production.

Inhaled form: In trials of one inhaled product, the most commonly reported side effects were shortness of breath and urinary tract infections. Eye and urinary problems linked to anticholinergics can also occur, as described below.

Serious side effects need medical care:

• Eye pressure: Glycopyrrolate can trigger acute angle-closure glaucoma in people at risk. Eye pain and redness, blurred vision or halos around lights need urgent medical care.
• Trouble passing urine: It can cause or worsen urinary retention, especially with an enlarged prostate or bladder blockage. Difficulty or pain passing urine needs medical advice.
• Gut blockage and slow gut movement (injection and tablet): Diarrhea can be an early sign of a partial blockage, especially in people with an ileostomy or colostomy. Vomiting, bloating, early fullness or growing belly pain should be reported.
• Overheating: Less sweating can lead to fever, heat exhaustion or heat stroke, especially in older adults and children, in hot weather or with exercise.
• Heart rate and rhythm: It can speed up the heart. Rhythm problems have also been reported with the injection, which is why it is given only by trained professionals.
• Confusion: Mental confusion or delirium can occur, especially in older adults.
• Sudden breathlessness after inhaling: Inhaled medicines can cause paradoxical bronchospasm, a sudden tightening of the airways right after use. Stop the inhaled medicine and get urgent medical care.
• Allergy: Serious allergic reactions, including anaphylaxis, have been reported.

Who Should Not Use Glycopyrrolate, and Precautions

Do not use glycopyrrolate if you are allergic to it or any ingredient.

• Tablets: Do not use the tablets if you have glaucoma, difficulty passing urine from a blockage (such as an enlarged prostate), a blockage or severe slow movement of the gut, a bleeding ulcer in the stomach or gut, active colitis that can lead to toxic megacolon, past toxic megacolon, or myasthenia gravis. Your doctor will check for these first. The injection also should not be used for ulcer treatment in people with these conditions.
• Inhaled form: Use with caution if you have narrow-angle glaucoma, an enlarged prostate or bladder blockage. Do not use it for a sudden breathing attack or when COPD is getting worse quickly.
• Take extra care with heart disease, fast heartbeat, high blood pressure, an overactive thyroid, nerve damage that affects the body’s automatic functions, liver disease, ulcerative colitis, or hiatal hernia. These conditions can get worse with anticholinergics.
• Older adults: Older adults may be more sensitive to anticholinergic side effects, such as urinary retention, bowel blockage, overheating, rhythm problems, confusion, falls and fractures. For the injection, clinicians choose the dose carefully according to the person’s overall health, kidney, liver and heart function, other conditions and other medicines. This does not mean every older adult gets a lower dose. The tablets are not recommended for adults aged 65 and over. For one inhaled product, no age-based dose change was needed, but greater sensitivity in some older people could not be ruled out.
• Kidney problems: Glycopyrrolate leaves the body mainly through the kidneys. In kidney failure it can stay longer, so doctors may adjust the dose or watch more closely. For one inhaled product, no change was needed in mild to moderate kidney impairment, and use in severe kidney impairment is considered only if the benefit outweighs the risk.
• Liver problems: Use the injection with caution in liver disease. Your doctor will decide what is right for you.
• Driving: It can cause drowsiness or blurred vision. Do not drive or use machines until you are sure you are not affected.
• Heat: Avoid very hot weather and heavy exercise.
• Monitoring: Doctors watch for slow gut movement, fast heartbeat, eye pain and other anticholinergic side effects, and look at kidney function when needed.

Glycopyrrolate in Pregnancy and Breastfeeding

1. Pregnancy: Data are limited. For the injection, studies of its use during Cesarean delivery have not shown harm to mothers or newborns. There is not enough information on use in early pregnancy to be sure of the risk. For inhaled products, there are no adequate studies in pregnant women, and use should be considered only if the expected benefit outweighs the risk. Tell your doctor if you are pregnant or planning a pregnancy. Your doctor will weigh the benefits and risks.
2. Breastfeeding: It is not known whether glycopyrrolate passes into breast milk. Anticholinergics can reduce milk supply. Your doctor will weigh the benefits of breastfeeding against your need for the medicine.

Glycopyrrolate Interactions and Other Medicines

• Other anticholinergic medicines: Examples are some antidepressants (tricyclics), phenothiazines, antiparkinson medicines, antispasmodics, amantadine, some antiepileptics and some heart rhythm medicines. Together they can add up to stronger side effects. The tablet label does not recommend combining them, and the inhaled label advises avoiding other anticholinergic-containing medicines.
• Antipsychotics: The tablet prescribing information notes that using them with glycopyrrolate may worsen tardive dyskinesia (unwanted body movements).
• Potassium chloride (solid tablets): Glycopyrrolate slows the gut, so these tablets stay longer and can damage the gut lining.
• Medicines that depend on gut movement for absorption: Slowed gut movement can change how much of them is absorbed.
• Neostigmine or pyridostigmine: They are given with the injection on purpose after surgery. Heart block and heart rhythm changes have been reported with the combined use of glycopyrrolate and anticholinesterases, so this is done by trained professionals.

This list is not complete. Tell your doctor and pharmacist about all prescription medicines, over-the-counter medicines, vitamins and herbal products you use.

Glycopyrrolate Brands in India

Examples of brands available in India include Glycolate (Intas), which comes as tablets and injections, Pyrolate (Neon), which is an injection, and Glycohale (Cipla), which is made for inhalation and used for COPD. Glycohale FB is a different product, a combination inhaler that also has other medicines. Each brand is made for a specific form, so please do not swap one for another. This list is not complete. Brand availability, strength, formulation and pack size can vary, so please verify the current product information with a licensed pharmacy or healthcare professional.

Glycopyrrolate Price in India

The prices below are approximate maximum retail prices (MRP) seen on online pharmacy listings. They may have changed and may not be current. The actual price varies by brand, strength, formulation, pack size, pharmacy and location. Please check the current price with a licensed pharmacy.

Glycolate 1 mg tablet (Intas), strip of 10 tablets: roughly Rs 100 to Rs 120 per strip. Online selling prices are sometimes lower.

Pyrolate injection (Neon), glycopyrrolate 0.2 mg per mL: roughly Rs 15 to Rs 16 for a 1 mL pack, and roughly Rs 120 to Rs 130 for a 10 mL vial.

Glycohale FB inhaler (glycopyrrolate 12.5 mcg, formoterol 6 mcg and budesonide 200 mcg, 120 doses): roughly Rs 970. This is a combination product and is not the same as glycopyrrolate alone.

For other products, such as Glycohale respules, please check the current price with a licensed pharmacy.

How HealthPil Can Help

Medicines should be started, adjusted, or stopped only under the guidance of a qualified healthcare professional. If you have questions about glycopyrrolate, its side effects, or your treatment plan, you can consult a doctor, such as a respiratory specialist or surgeon, through HealthPil.