Version July 2025
Endotracheal intubation, nonemergent: Limited data available: Neonates: IV: 4 to 10 mcg/kg as a single dose (acceptable, but not preferred vagolytic) (Ref).
Dosage guidance:
Safety: Dosing may be presented as mcg/kg or mg/dose; use extra caution.
Dosage form information: Dartisla ODT has been discontinued in the United States for >1 year.
Chronic drooling: Children ≥3 years and Adolescents ≤16 years: Oral solution (Cuvposa): Initial: 20 mcg/kg/dose 3 times daily; titrate in increments of 20 mcg/kg/dose every 5 to 7 days as tolerated to response up to a maximum dose of 100 mcg/kg/dose 3 times daily, not to exceed 1,500 to 3,000 mcg/dose.
Hyperhidrosis, primary focal: Limited data available; optimal dose not established:
Children ≥8 years and Adolescents: Oral: Usual dose: 1 to 2 mg once or twice daily; titrate per response and tolerability; reported range: 0.5 to 6 mg per day in divided doses one to three times daily (Ref).
Reduction of respiratory secretions, palliative care: Limited data available: Children: Oral: 40 to 100 mcg/kg/dose every 4 to 8 hours (Ref).
Reduction of secretions, preoperative:
Infants and Children ≤2 years: IM: 4 to 9 mcg/kg as a single dose 30 to 60 minutes before procedure.
Children >2 years and Adolescents: IM: 4 mcg/kg as a single dose 30 to 60 minutes before procedure.
Reversal of bradycardia, vagal reflexes (intraoperative): Infants, Children, and Adolescents: IV: 4 mcg/kg/dose (maximum dose: 100 mcg/dose) at 2- to 3-minute intervals.
Reversal of muscarinic effects of cholinergic agents: Infants, Children, and Adolescents: IV: 0.2 mg for each 1 mg of neostigmine or 5 mg of pyridostigmine administered.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no specific dosage adjustments provided in the manufacturer's labeling; elimination is severely impaired in renal failure; use with caution; dosage adjustment may be necessary.
There are no specific dosage adjustments provided in the manufacturer's labeling (has not been studied); use with caution.
(For additional information see "Glycopyrrolate (glycopyrronium) (systemic): Drug information")
Note: Orally disintegrating tablet 1.7 mg = Regular tablet 2 mg. Dartisla ODT has been discontinued in the United States for >1 year.
Reduction of secretions (preoperative): IM: 4 mcg/kg 30 to 60 minutes before anesthesia or when the preanesthetic opioid and/or sedative are administered
Reversal of bradycardia, vagal reflexes (intraoperative): IV: 0.1 mg as a single dose; repeat as needed at 2- to 3-minute intervals
Reversal of muscarinic effects of cholinergic agents: IV: 0.2 mg for each 1 mg of neostigmine or 5 mg of pyridostigmine administered
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no specific dosage adjustments provided in the manufacturer's labeling; elimination is severely impaired in renal failure; use with caution; dosage adjustment may be necessary.
There are no specific dosage adjustments provided in the manufacturer's labeling; use with caution; consider dose reduction.
Anticholinergic agents, including systemic glycopyrrolate, may cause reversible, dose-dependent anticholinergic effects, including, but not limited to, CNS effects (eg, behavioral changes [eg, irritability, agitation, dizziness, headache]); genitourinary effects (eg, urinary retention); GI effects (eg, xerostomia, constipation, gastrointestinal pseudo-obstruction); ophthalmic effects (eg, blurred vision, mydriasis); cardiovascular effects (eg, palpitations); and dermatologic effects (eg, hypohidrosis) in adult and pediatric patients (Ref). Xerostomia is the most frequent adverse reaction resulting in discontinuation (Ref).
Mechanism: Dose-related; an extension of antimuscarinic pharmacological properties (Ref).
Risk factors:
• Higher doses (Ref)
• Concurrent use of other anticholinergic medications
• Older age
Various GI effects may occur with systemic glycopyrrolate, including xerostomia, constipation, and gastrointestinal pseudo-obstruction in adult and pediatric patients (Ref). Diarrhea may be an early sign of incomplete intestinal obstruction, especially in patients with an ileostomy or colostomy.
Mechanism: Dose-related; an extension of antimuscarinic pharmacological properties (Ref).
Risk factors:
• Mechanical GI obstructive diseases (contraindicated)
• GI motility disorders (contraindicated)
• Concurrent use of medications that affect GI peristalsis
Anticholinergic agents, including systemic glycopyrrolate, may cause hypohidrosis, which may result in life-threatening hyperthermia or heatstroke (Ref).
Mechanism: Dose-related; related to the pharmacologic action. Antagonism of central and peripheral muscarinic receptors results in increased heat production due to increased muscle activity and impaired sweat gland function (Ref).
Risk factors:
• Physical exertion in high ambient temperature and humidity (Ref)
• Concurrent use of other anticholinergic medications (Ref)
• Children and older adults
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Incidences reported with oral use of glycopyrrolate in children and adolescents.
>10%:
Cardiovascular: Flushing (30%)
Gastrointestinal: Constipation (35%) (table 1), vomiting (40%), xerostomia (40%) (table 2)
|
Drug (Glycopyrrolate) |
Placebo |
Population |
Dose |
Dosage Form |
Indication |
Number of Patients (Glycopyrrolate) |
Number of Patients (Placebo) |
|---|---|---|---|---|---|---|---|
|
35% |
22% |
Pediatric patients 3 to 16 years |
20 mcg/kg/dose 3 times daily, titrate in increments of 20 mcg/kg/dose every 5 to 7 days up to a maximum dose of 100 mcg/kg/dose 3 times daily |
Oral solution |
Chronic drooling |
20 |
18 |
|
Drug (Glycopyrrolate) |
Placebo |
Population |
Dose |
Dosage Form |
Indication |
Number of Patients (Glycopyrrolate) |
Number of Patients (Placebo) |
|---|---|---|---|---|---|---|---|
|
40% |
11% |
Pediatric patients 3 to 16 years |
20 mcg/kg/dose 3 times daily, titrate in increments of 20 mcg/kg/dose every 5 to 7 days up to a maximum dose of 100 mcg/kg/dose 3 times daily |
Oral solution |
Chronic drooling |
20 |
18 |
Genitourinary: Urinary retention (15%) (table 3)
|
Drug (Glycopyrrolate) |
Placebo |
Population |
Dose |
Dosage Form |
Indication |
Number of Patients (Glycopyrrolate) |
Number of Patients (Placebo) |
|---|---|---|---|---|---|---|---|
|
15% |
0% |
Pediatric patients 3 to 16 years |
20 mcg/kg/dose 3 times daily, titrate in increments of 20 mcg/kg/dose every 5 to 7 days up to a maximum dose of 100 mcg/kg/dose 3 times daily |
Oral solution |
Chronic drooling |
20 |
18 |
Nervous system: Headache (15%) (table 4)
|
Drug (Glycopyrrolate) |
Placebo |
Population |
Dose |
Dosage Form |
Indication |
Number of Patients (Glycopyrrolate) |
Number of Patients (Placebo) |
|---|---|---|---|---|---|---|---|
|
15% |
6% |
Pediatric patients 3 to 16 years |
20 mcg/kg/dose 3 times daily, titrate in increments of 20 mcg/kg/dose every 5 to 7 days up to a maximum dose of 100 mcg/kg/dose 3 times daily |
Oral solution |
Chronic drooling |
20 |
18 |
Respiratory: Nasal congestion (30%), sinusitis (15%), upper respiratory tract infection (15%)
Postmarketing (all routes of administration and ages):
Cardiovascular: Cardiac arrhythmia (including bradycardia, ventricular fibrillation, ventricular tachycardia), hypertension, hypotension, palpitations (Cruddas 2017)
Dermatologic: Cheilosis (Eiland 2012)
Gastrointestinal: Ageusia, diarrhea (Eiland 2012), gastrointestinal pseudo-obstruction (Eiland 2012), halitosis (Eiland 2012)
Genitourinary: Lactation insufficiency (suppression)
Hypersensitivity: Facial swelling (Cruddas 2017)
Local: Injection-site reaction (including erythema at injection site, injection-site pruritus, localized edema, pain at injection site)
Nervous system: Agitation (Eiland 2012), behavioral changes (Eiland 2012), dizziness (Cruddas 2017), irritability (Eiland 2012), personality changes (Eiland 2012), seizure
Ophthalmic: Blurred vision (Cruddas 2017), mydriasis (Eiland 2012)
Respiratory: Epistaxis (Eiland 2012)
Miscellaneous: Fever (Chabicovsky 2019), malignant hyperthermia
Hypersensitivity to glycopyrrolate or any component of the formulation; medical conditions that preclude use of anticholinergic medication (eg, severe ulcerative colitis, toxic megacolon complicating ulcerative colitis, paralytic ileus, obstructive disease of GI tract [eg, achalasia, pyloroduodenal stenosis, strictures], bleeding GI ulcer, intestinal atony in older adult or debilitated patients, unstable cardiovascular status in acute hemorrhage, glaucoma, obstructive uropathy [eg, bladder neck obstruction due to prostatic hypertrophy], myasthenia gravis)
Oral solution: Additional contraindication: Concomitant use of potassium chloride in a solid oral dosage form.
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Canadian labeling: Additional contraindications (not in US labeling): Injection: Use in newborns; chronic lung disease in older adult or debilitated patients.
Concerns related to adverse effects:
• CNS effects: May cause drowsiness and/or blurred vision, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).
• GI transit: Slowing of GI muscular action can occur resulting in constipation or intestinal pseudo-obstruction. Constipation is a common dose-limiting adverse event. Intestinal pseudo-obstruction can result in abdominal distention, pain, nausea, or vomiting; discontinue if these symptoms develop or worsen during treatment.
• Heat prostration: May occur in the presence of fever, increased environmental temperature, and/or during physical exercise, particularly in children and the elderly; use caution in hot weather and/or exercise. Avoid exertion and high environmental temperature after administration.
• Mechanical obstruction (incomplete): Diarrhea may be an early sign of incomplete intestinal obstruction, especially in patients with an ileostomy or colostomy; avoid use in these patients. Discontinue treatment if incomplete mechanical intestinal obstruction is suspected or if diarrhea occurs.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with coronary artery disease, arrhythmias, heart failure, hypertension, or tachycardia; evaluate tachycardia prior to administration.
• Hepatic impairment: Use with caution in patients with hepatic impairment; consider dosage reduction.
• Hiatal hernia: Use with caution in patients with hiatal hernia with reflux esophagitis; consider dosage reduction.
• Hyperthyroidism: Use with caution in patients with hyperthyroidism.
• Neuropathy: Use with caution in patients with autonomic neuropathy; consider dosage reduction.
• Prostatic hyperplasia/bladder neck obstruction: May worsen the symptoms (eg, urinary retention) of prostatic hyperplasia and/or bladder neck obstruction; use with caution; consider dosage reduction in patients with prostatic hypertrophy.
• Renal impairment: Use with caution in patients with renal impairment; elimination is severely impaired in renal failure; dosage adjustment may be necessary.
• Ulcerative colitis: Use with caution in patients with ulcerative colitis; large doses may suppress intestinal motility; consider dosage reduction; may precipitate/exacerbate an ileus or toxic megacolon. Use is contraindicated in patients with severe ulcerative colitis.
Special populations:
• Older adult: Use with caution in the elderly; increased risk for anticholinergic effects, confusion, and hallucinations; consider dosage reduction.
• Pediatric: Infants, patients with Down syndrome, and pediatric patients with spastic paralysis or brain damage may experience an increased response to anticholinergics, increasing the potential for adverse events. A paradoxical reaction characterized by hyperexcitability may occur in pediatric patients taking large doses. Infants and young children are especially susceptible to the toxic effects of anticholinergics.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
• Injection: Sensitivity of the eyes to light may occur. Protect eyes from light after administration.
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Zar 2007).
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Dartisla ODT has been discontinued in the United States for >1 year.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Injection:
Glyrx-PF: 0.2 mg/mL (1 mL); 0.4 mg/2 mL (2 mL)
Generic: 0.2 mg/mL (1 mL); 0.4 mg/2 mL (2 mL); 1 mg/5 mL (5 mL); 4 mg/20 mL (20 mL)
Solution, Injection [preservative free]:
Generic: 0.2 mg/mL (1 mL); 0.4 mg/2 mL (2 mL)
Solution, Oral:
Cuvposa: 1 mg/5 mL (473 mL) [contains methylparaben, propylene glycol, propylparaben, saccharin sodium; cherry flavor]
Generic: 1 mg/5 mL (473 mL)
Solution Prefilled Syringe, Injection:
Generic: 0.6 mg/3 mL (3 mL)
Solution Prefilled Syringe, Injection [preservative free]:
Glyrx-PF: 0.6 mg/3 mL (3 mL); 1 mg/5 mL (5 mL)
Generic: 0.2 mg/mL (1 mL); 0.4 mg/2 mL (2 mL); 0.6 mg/3 mL (3 mL)
Tablet, Oral:
Glycate: 1.5 mg [DSC]
Glycate: 1.5 mg [dye free]
Robinul: 1 mg [DSC] [scored; dye free]
Robinul-Forte: 2 mg [DSC] [scored; dye free]
Generic: 1 mg, 1.5 mg, 2 mg
Tablet Disintegrating, Oral:
Dartisla ODT: 1.7 mg [DSC] [contains gelatin (fish)]
May be product dependent
Solution (Cuvposa Oral)
1 mg/5 mL (per mL): $1.27
Solution (Glycopyrrolate Injection)
0.2 mg/mL (per mL): $0.84 - $16.25
0.4 mg/2 mL (per mL): $0.75 - $14.38
1 mg/5 mL (per mL): $0.66 - $11.00
4 mg/20 mL (per mL): $1.44 - $8.93
Solution (Glycopyrrolate Oral)
1 mg/5 mL (per mL): $0.96 - $1.14
Solution (Glyrx-PF Injection)
0.2 mg/mL (per mL): $4.56
0.4 mg/2 mL (per mL): $3.96
Solution Prefilled Syringe (Glycopyrrolate PF Injection)
0.2 mg/mL (per mL): $8.38 - $8.50
0.4 mg/2 mL (per mL): $8.33
0.6 mg/3 mL (per mL): $6.11 - $6.15
Solution Prefilled Syringe (Glyrx-PF Injection)
0.6 mg/3 mL (per mL): $4.00
1 mg/5 mL (per mL): $3.84
Tablets (Glycate Oral)
1.5 mg (per each): $19.90
Tablets (Glycopyrrolate Oral)
1 mg (per each): $1.06 - $1.31
1.5 mg (per each): $41.39
2 mg (per each): $1.76 - $2.20
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Injection:
Generic: 0.2 mg/mL (1 mL, 2 mL, 20 mL); 0.4 mg/2 mL (2 mL); 4 mg/20 mL (20 mL)
Solution, Oral:
Cuvposa: 1 mg/5 mL (473 mL) [contains methylparaben, propylene glycol, propylparaben, saccharin sodium, sorbitol]
Note: A glycopyrrolate oral solution (0.2 mg/mL) is commercially available.
0.5 mg/mL Oral Suspension
A 0.5 mg/mL oral suspension may be made with 1 mg tablets and a 1:1 mixture of Ora-Plus and either Ora-Sweet or Ora-Sweet SF. Crush thirty 1 mg tablets in a mortar and reduce to a fine powder. Prepare diluent by mixing 30 mL of Ora-Plus with 30 mL of either Ora-Sweet or Ora-Sweet SF and stir vigorously. Add 30 mL of diluent (via geometric dilution) to powder until smooth suspension is obtained. Transfer suspension to 60 mL amber bottle. Rinse contents of mortar into bottle with sufficient quantity of remaining diluent to obtain 60 mL (final volume). Label “shake well”. Stable at room temperature for 90 days. Due to bitter aftertaste, chocolate syrup may be administered prior to or mixed (1:1 v/v) with suspension immediately before administration (Cober 2011).
A 0.5 mg/mL oral solution can be made from tablets. Crush fifty 1 mg tablets in a mortar and reduce to a fine powder. Add enough distilled water to make about 90 mL, mix well. Transfer to a bottle, rinse mortar with water, and add a quantity of water sufficient to make 100 mL. Label “shake well” and “protect from light”. Stable at room temperature for 25 days (Gupta 2001).
0.1 mg/mL Oral Solution
A 0.1 mg/mL oral solution may be made using glycopyrrolate 0.2 mg/mL injection without preservatives. Withdraw 50 mL from vials with a needle and syringe, add to 50 mL of a 1:1 mixture of Ora-Sweet and Ora-Plus in a bottle. Label “shake well”, “protect from light,” and “refrigerate”. Stable refrigerated for 35 days (Landry 2005).
Oral:
Tablets: Administer without regard to meals.
Oral solution: Administer on an empty stomach, 1 hour before or 2 hours after meals; measure with an accurate measuring device (eg, dosing cup, oral syringe).
Parenteral: May be administered IM (undiluted) or by slow IV injection (with or without dilution in a compatible fluid); in perioperative setting, usually administered over 1 to 2 minutes (eg, in adults: 0.2 mg over 1 to 2 minutes). May also be administered via the tubing of a running IV infusion of NS. May be administered IV in the same syringe with neostigmine or pyridostigmine for reversal of neuromuscular blockade.
IM: May administer undiluted.
IV: May be administered IV without dilution or may dilute in a compatible solution. In perioperative setting, usually administered over 1 to 2 minutes (eg, in adults: 0.2 mg over 1 to 2 minutes). May also be administered via the tubing of a running IV infusion of a NS. May be administered IV in the same syringe with neostigmine or pyridostigmine for reversal of neuromuscular blockade.
Oral:
Orally disintegrating tablet: Administer at least 1 hour before or 2 hours after food. Remove tablet from blister packaging immediately prior to administration; do not push tablet through foil. Place tablet on tongue and allow to disintegrate then swallow without water. Tablets should not be broken or cut.
Oral solution: Administer 1 hour before or 2 hours after meals. Measure oral solution with an accurate measuring device (eg, dosing cup, oral syringe).
SUBQ (off-label route): May administer SUBQ (Ref).
Injection: Store at 20°C to 25°C (68°F to 77°F).
Oral: Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).
Oral: Treatment of severe chronic drooling in association with neurologic conditions (eg, cerebral palsy) (Cuvposa: FDA approved in ages 3 to 16 years); adjunct treatment of peptic ulcer to reduce symptoms of peptic ulcer (Dartisla ODT; Robinul: FDA approved in adults); has also been used for control of upper airway secretion in the palliative care setting.
Parenteral: Reduction of salivary, tracheobronchial, and pharyngeal secretions, reduction of volume and acidity of gastric secretions, and blockade of cardiac inhibitory reflexes during induction of anesthesia and intubation (FDA approved in ages ≥1 month and adults); intraoperative use to counteract surgically, drug-induced, or vagal-mediated arrhythmias (FDA approved in ages ≥1 month and adults); protection against the peripheral muscarinic effects (eg, bradycardia, excessive secretions) of cholinergic agents (eg, neostigmine, pyridostigmine) given to reverse the neuromuscular blockade due to non-depolarizing muscle relaxants (FDA approved in ages ≥1 month and adults).
Note: Although included as an FDA-approved use in the manufacturer's prescribing information as an adjunct in the treatment of peptic ulcer in adults, glycopyrrolate currently has no place in management of peptic ulcer disease.
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs (pediatric liquid medications requiring measurement) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Community/Ambulatory Care Settings).
Robinul [US and multiple international markets] may be confused with Reminyl brand name for galantamine [Canada and multiple international markets]
Substrate of MATE1/2-K;
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Acetylcholinesterase Inhibitors: May decrease therapeutic effects of Agents with Clinically Relevant Anticholinergic Effects. Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Acetylcholinesterase Inhibitors. Risk C: Monitor
Aclidinium: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid
Acrivastine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Agents with Clinically Relevant Anticholinergic Effects: May increase anticholinergic effects of Glycopyrrolate (Systemic). Risk C: Monitor
Amantadine: May increase anticholinergic effects of Glycopyrrolate (Systemic). Risk C: Monitor
Atenolol: Glycopyrrolate (Systemic) may increase serum concentration of Atenolol. Risk C: Monitor
Benperidol: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Benperidol. Risk C: Monitor
Benztropine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Benztropine. Risk C: Monitor
Biperiden: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Biperiden. Risk C: Monitor
Bornaprine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Bornaprine. Risk C: Monitor
Botulinum Toxin-Containing Products: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Bromperidol: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Bromperidol. Risk C: Monitor
Buclizine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Buclizine. Risk C: Monitor
Cannabinoid-Containing Products: Agents with Clinically Relevant Anticholinergic Effects may increase tachycardic effects of Cannabinoid-Containing Products. Risk C: Monitor
Chlorprothixene: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Chlorprothixene. Risk C: Monitor
Cimetropium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Cimetropium. Risk X: Avoid
CloZAPine: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of CloZAPine. Management: Consider alternatives to this combination whenever possible. If combined, monitor closely for signs and symptoms of gastrointestinal hypomotility and consider prophylactic laxative treatment. Risk D: Consider Therapy Modification
Cyclizine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Darifenacin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Darifenacin. Risk C: Monitor
Dicyclomine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Dicyclomine. Risk C: Monitor
Digoxin: Glycopyrrolate (Systemic) may increase serum concentration of Digoxin. Risk C: Monitor
Dimethindene (Systemic): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Dimethindene (Systemic). Risk C: Monitor
DroNABinol: Agents with Clinically Relevant Anticholinergic Effects may increase tachycardic effects of DroNABinol. Risk X: Avoid
Eluxadoline: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of Eluxadoline. Risk X: Avoid
Fesoterodine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Fesoterodine. Risk C: Monitor
FluPHENAZine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Gastrointestinal Agents (Prokinetic): Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Gastrointestinal Agents (Prokinetic). Risk C: Monitor
Gepotidacin: May decrease anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Glucagon: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor
Glycopyrrolate (Oral Inhalation): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Glycopyrrolate (Oral Inhalation). Risk X: Avoid
Glycopyrronium (Topical): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid
Haloperidol: Glycopyrrolate (Systemic) may decrease serum concentration of Haloperidol. Management: Consider avoiding concurrent use of glycopyrrolate and haloperidol.Monitor patients closely for signs/symptoms of reduced clinical response to haloperidol if concurrent use with glycopyrrolate is required. Risk D: Consider Therapy Modification
Ipratropium (Nasal): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Ipratropium (Oral Inhalation): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid
Itopride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Itopride. Risk C: Monitor
Levodopa-Foslevodopa: Glycopyrrolate (Systemic) may decrease serum concentration of Levodopa-Foslevodopa. Risk C: Monitor
Levosulpiride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Levosulpiride. Risk X: Avoid
Maprotiline: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Maprotiline. Risk C: Monitor
Melperone: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
MetFORMIN: Glycopyrrolate (Systemic) may increase serum concentration of MetFORMIN. Risk C: Monitor
Methotrimeprazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Methotrimeprazine. Risk C: Monitor
Methscopolamine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Methscopolamine. Risk C: Monitor
Mirabegron: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Mirabegron. Risk C: Monitor
Nitroglycerin: Agents with Clinically Relevant Anticholinergic Effects may decrease absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Risk C: Monitor
OLANZapine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of OLANZapine. Risk C: Monitor
Opioid Agonists: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. Risk C: Monitor
Opipramol: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Oxatomide: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid
OxyBUTYnin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of OxyBUTYnin. Risk C: Monitor
Perazine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Perphenazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Perphenazine. Risk C: Monitor
Potassium Chloride: Agents with Clinically Relevant Anticholinergic Effects may increase ulcerogenic effects of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid
Potassium Citrate: Agents with Clinically Relevant Anticholinergic Effects may increase ulcerogenic effects of Potassium Citrate. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium citrate. Risk X: Avoid
Pramlintide: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. These effects are specific to the GI tract. Risk X: Avoid
Promethazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Promethazine. Risk C: Monitor
Propantheline: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Propantheline. Risk C: Monitor
Propiverine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
QuiNIDine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor
Ramosetron: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of Ramosetron. Risk C: Monitor
Revefenacin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Revefenacin. Risk X: Avoid
Rivastigmine: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Rivastigmine. Rivastigmine may decrease therapeutic effects of Agents with Clinically Relevant Anticholinergic Effects. Management: Use of rivastigmine with an anticholinergic agent is not recommended unless clinically necessary. If the combination is necessary, monitor for reduced anticholinergic effects. Risk D: Consider Therapy Modification
Scopolamine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Scopolamine. Risk C: Monitor
Secretin: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Risk D: Consider Therapy Modification
Sofpironium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Sofpironium. Risk X: Avoid
Thiazide and Thiazide-Like Diuretics: Agents with Clinically Relevant Anticholinergic Effects may increase serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor
Thiothixene: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Thiothixene. Risk C: Monitor
Tiapride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Tiapride. Risk C: Monitor
Tiotropium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tiotropium. Risk X: Avoid
Tolterodine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tolterodine. Risk C: Monitor
Topiramate: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Topiramate. Risk C: Monitor
Trimethobenzamide: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Trimethobenzamide. Risk C: Monitor
Trospium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Trospium. Risk C: Monitor
Umeclidinium: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid
Zuclopenthixol: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Zuclopenthixol. Risk C: Monitor
Administration with a high-fat meal significantly reduced absorption. Management: Administer at least 1 hour before or 2 hours after meals.
When given as a single maternal injection prior to delivery, glycopyrrolate was not found to cross the placenta in significant amounts. In addition, fetal heart rate, fetal heart rate variability, and Apgar scores were not significantly affected (Abboud 1981; Abboud 1983; Ali-Melkkilä 1990; Ure 1999).
Use of topical glycopyrrolate for the treatment of hyperhidrosis in a pregnant patient diagnosed with herpetic neuralgia has been described in a case report (Ladjevic 2009).
Heart rate; anticholinergic effects; bowel sounds; bowel movements.
Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS; indirectly reduces the rate of salivation by preventing the stimulation of acetylcholine receptors
Onset of action: IM: 15 to 30 minutes; IV: Within 1 minute.
Peak effect: IM: Within ~30 to 45 minutes.
Duration: Vagal effect: 2 to 3 hours; Inhibition of salivation: Up to 7 hours; Parenteral: 7 hours.
Absorption: Oral tablet: Poor (~3%); variable and erratic; Oral solution: 23% lower compared to tablet; high-fat meal markedly reduces the oral bioavailability.
Distribution: Vd: IV: Children and Adolescents ≤14 years: 1.3 to 1.8 L/kg (range: 0.7 to 3.9 L/kg); Adults: 0.42 ± 0.22 L/kg.
Bioavailability: Tablet: 3%.
Half-life elimination: IV: Infants: 21.6 to 130 minutes; Children: 19.2 to 99.2 minutes; IM: Adults: 0.55 to 1.25 hours; IV: 0.83 ± 0.27 hour; Oral solution: Adults: 3 hours; Orally disintegrating tablet: Adults: 2.8 hours.
Time to peak, plasma: IM: ~30 minutes; Oral solution: 3.1 hours; Orally disintegrating tablet: Median: 3 hours.
Excretion: Urine (as unchanged drug, IM: >80%, IV: 85%); bile (as unchanged drug, <5%).
Clearance: Children and Adolescents ≤14 years: Mean range: 1.01 to 1.41 L/kg/hour (range: 0.32 to 2.22 L/kg/hour); Adults: 0.54 ± 0.14 L/kg/hour.
Altered kidney function: Elimination is severely impaired in patients with renal failure.
