PYROLATE
GLYCOPYRROLATE · by BROOKES
Composition
Inj: Per 1 ml amp: Glycopyrrolate 0.2 mg. Tab: Glycopyrrolate 1 mg.
Indications & Dosage
Control of upper airway secretions; Intra-operative: BY IV INJ: Adult: 0.1 mg repeated as needed at 2-3 mins intervals. Children: Neonate: 10 mcg/kg, repeated if necessary; 1 month-18 yr: 4-8 mcg/kg, max 200 mcg, repeated if necessary. Excessive secretions of the respiratory tract preoperative: BY IM OR IV INJ: Adult: 4.4 mcg/kg 30-60 min before procedure. Children: Neonate: 5 mcg/kg; 1 month-12 yr: 4-8 mcg/kg, max 200 mcg; 12-18 yr: 200-400 mcg or 4-5 mcg/kg, max 400 mcg. Reverse neuromuscular blockade: BY IV INJ: Adult: 0.2 mg for each 1 mg of neostigmine or 5 mg of pyridostigmine administered or 5-15 mcg/kg glycopyrrolate with 25-70 mcg/kg of neostigmine or 0.1-0.3 mg/kg of pyridostigmine (agents usually administered simultaneously, but glycopyrrolate may be administered first if bradycardia is present). Children: Neonate, 10 mcg/kg; 1 month-12 yr: 10 mcg/kg, max 500 mcg; 12-18 yr: 200 mcg per 1 mg of neostigmine, or 10-15 mcg/kg. Adjunct in treatment of peptic ulcer: BY IM OR IV INJ: Adult: 0.1-0.2 mg 3-4 times a day. ORAL: Adult: 1-2 mg 2-3 times daily.
Administration
Administer IV at a rate of 0.2 mg over 1-2 min. May be administered IV or IM without dilution and via tubing of a running IV infusion of a compatible solution. May be administered IV in the same syringe with neostigmine or pyridostigmine.
Compatibility
Do not mix glycopyrrolate with alkaline drugs or solutions that have a pH over 6.0 because drug stability may be affected. A pH over 6.0 may occur if glycopyrrolate is mixed with dexamethasone sodium phosphate or LR solution. Gas or precipitate may form if glycopyrrolate is mixed in same syringe as chloramphenicol, diazepam, dimenhydrinate, methohexital sodium, pentobarbital sodium, seco-barbital sodium, sodium bicarbonate,-or thiopental sodium.
Stability
Store at 20C-25C.
Contraindications
Acute haemorrhage, ulcerative colitis, narrow-angle glaucoma, tachycardia, obstructive uropathy, paralytic ileus, obstructive disease of GI tract, myasthenia gravis, hypersensitivity to glycopyrrolate or any component of the formulation. Not recommended in children <12 years of age for the management of peptic ulcer; infants, patients with Down syndrome, and children with spastic paralysis or brain damage may be hypersensitive to antimuscarinic effects.
Precautions
Use caution in elderly, patients with autonomic neuropathy, hepatic or renal disease, ulcerative colitis may predispose megacolon, hyperthyroidism, CAD, CHF, arrhythmias, tachycardia, BPH, hiatus hernia with reflux.
Interactions
Amantadine, cyclopropane, anticholinergic agents, levodopa.
Pregnancy
Caution advised
Lactation
: Caution advised
Side Effects
Nausea, vomiting, dry skin, constipation, dry throat, dry mouth, irritation at injection site, dry nose, diaphoresis