GLYCOPYRROLATE

GLYCOPYRROLATE (glye-koe-pye'roe-late) Robinul, Robinul Forte Classifications: anticholinergic; antimuscarinic; antispasmodic; Therapeutic: gi antispasmodic Prototype: Atropine Pregnancy Category: B

Availability

1 mg, 2 mg tablets; 0.2 mg/mL injection

Action

Synthetic anticholinergic (antimuscarinic) compound with pharmacologic effects similar to those of atropine. Inhibits muscarinic action of acetylcholine on autonomic neuroeffector sites innervated by postganglionic cholinergic nerves.

Therapeutic Effect

Inhibits motility of GI tract and genitourinary tract and decreases volume of gastric and pancreatic secretions, saliva, and perspiration.

Uses

Adjunctive management of peptic ulcer and other GI disorders associated with hyperacidity, hypermotility, and spasm. Also used parenterally as preanesthetic and intraoperative medication and to reverse neuromuscular blockade.

Contraindications

Glaucoma; asthma; prostatic hypertrophy, obstructive uropathy; obstructive lesions or atony of GI tract; achalasia; severe ulcerative colitis; myasthenia gravis; BPH; urinary tract obstruction; during cyclopropane anesthesia; neonates <1 mo.

Cautious Use

Autonomic neuropathy, hepatic or renal disease; cardiac arrhythmias; pregnancy (category B), lactation.

Route & Dosage

Peptic Ulcer Adult: PO 1 mg t.i.d or 2 mg b.i.d. or t.i.d. in equally divided intervals (max: 8 mg/d), then decrease to 1 mg b.i.d. IM/IV 0.1–0.2 mg 3–4 times/day Reversal of Neuromuscular Blockade Adult/Child: IV 0.2 mg administered with 1 mg of neostigmine or 5 mg pyridostigmine Preanesthetic Child: PO 40–100 mcg/kg t.i.d.–q.i.d. IM 4–10 mcg/kg q3–4h Adult: IM 4 mcg/kg 30–60 min before procedure

Administration

Oral

• Give without regard to meals.

Intramuscular

• Give undiluted, deep into a large muscle.

Intravenous PREPARE: Direct: Give undiluted. • Inspect for cloudiness and discoloration. Discard if present.  ADMINISTER: Direct: Give 0.2 mg or fraction thereof over 1–2 min.   INCOMPATIBILITIES Solution/additive: Chloramphenicol, dexamethasone, diazepam, dimenhydrinate, methohexital, methylprednisolone, pentazocine, phenobarbital, secobarbital, sodium bicarbonate, thiopental. Y-site: Propofol.

• Store at 20°–25° C (68°–77° F).

Adverse Effects (≥1%)

Body as a Whole: Decreased sweating, weakness. CNS: Dizziness, drowsiness, overdosage (neuromuscular blockade with curare-like action leading to muscle weakness and paralysis is possible). CV: Palpitation, tachycardia. GI: Xerostomia, constipation. GU: Urinary hesitancy or retention. Special Senses: Blurred vision, mydriasis.

Interactions

Drug: Amantadine, antihistamines, tricyclic antidepressants, quinidine, disopyramide, procainamide compound anticholinergic effects; decreases levodopa effects; methotrimeprazine may precipitate extrapyramidal effects; decreases antipsychotic effects (decreased absorption) of phenothiazines.

Pharmacokinetics

Absorption: Poorly and incompletely absorbed from GI tract. Onset: 1 min IV; 15–30 min IM/SC; 1 h PO. Peak: 30–45 min IM/SC; 1 h PO. Duration: 2–7 h IM/SC; 8–12 h PO. Distribution: Crosses placenta. Metabolism: Minimally in liver. Elimination: 85% in urine. Half-Life: 30–70 min (adult), 20–99 min (child), 20–120 min (infant).

Nursing Implications

Assessment & Drug Effects

• Incidence and severity of adverse effects are generally dose related.
• Monitor I&O ratio and pattern particularly in older adults. Watch for urinary hesitancy and retention.
• Monitor vital signs, especially when drug is given parenterally. Report any changes in heart rate or rhythm.

Patient & Family Education

• Avoid high environmental temperatures (heat prostration can occur because of decreased sweating).
• Do not drive or engage in other potentially hazardous activities requiring mental alertness until response to drug is known.
• Use good oral hygiene, rinse mouth with water frequently and use a saliva substitute to lessen effects of dry mouth.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug