Glycopyrrolate (Oral)

Overview

Glycopyrrolate is commonly used before surgeries so as to lower the fluid levels which are normally generated in various locations around the body such as the stomach, airways, mouth and throat so that it does not interfere with the surgical procedure. It is also useful both before and after surgery because it can help to control undesirable reflex actions during surgery, and it can provide some measure of protection against the side effects imparted by some medications used during the surgical process.

The medication is also used to control the amount of saliva produced in the mouth by a patient for whom this is not controlled normally, for instance, a patient suffering from cerebral palsy. Belonging to a class of drugs known as anticholinergics, glycopyrrolate works by the activities of a specific neurotransmitter known as acetylcholine.

When used as a treatment for ulcers, this medicine helps to block the production of stomach acid, which is one of the main causes of ulcers to begin with. By lowering the production of stomach acid, an existing ulcer can be quieted, and the likelihood of the formation of new ulcers can be reduced.

It is marketed commercially by a number of pharmaceutical companies and under a variety of names, but some of the most well known are Robinul, Glycate, and Cuvposa. This medication is generally taken three times daily, although your doctor will provide specific instructions for your own dosage level, it should always be taken without food. It is most effective when taken at least an hour before having a meal, and as much as two hours after the previous meal.

The medicine should be dosed with a dosing spoon for greatest accuracy, and not a household kitchen spoon because that will not give accurate measurements. Your doctor's dosing instructions should be followed very closely, no more than is indicated should be ingested during any one dosage, as that will not improve existing symptoms in any way.

Condition treated

  • Management of excessive drooling, Treatment of ulcers

Type Of Medicine

  • Anticholinergics

Side Effects

In addition to the beneficial effects of helping to manage body fluids, glycopyrrolate may also impart some unwanted side effects to patients using the medication. While some patients will experience very few side effects or none whatsoever, others may experience several side effects ranging in severity from mild to moderate to potentially severe. If you should experience any of the side effects listed below, and they are severe enough that they make you uncomfortable, you should contact your family doctor at the earliest opportunity and describe whatever symptoms you are observing.

The first and possibly the most serious side effect to look out for is an allergic reaction, and if you should experience the side effects from an allergic reaction, you should seek medical attention right away, because there is a potential for these symptoms to become very severe and possibly even life-threatening. The most common symptoms to look for during an allergic reaction are the following:

  • Hives and or rashes appearing at various locations around the body
  • Extreme itchiness
  • Tightness in the chest, sometimes accompanied by difficulty with breathing
  • Puffiness or swelling in the area around the face, especially in the eyelids, lips, tongue and throat
  • Dizziness or lightheadedness, as though you are about to faint.

Apart from the relatively rare occurrence of an allergic reaction, there are some other side effects which can occur with greater frequency, and with varying degrees of severity. Those side effects can include any or several of the following, either alone or in combination:

  • Drowsiness or a sense of fatigue
  • Blurred vision or other vision problems
  • Dizziness or disorientation
  • Stuffy or runny nose
  • Dry mouth or increased thirst
  • Constipation
  • Stomach bloating or pain
  • Abdominal bloating or pain
  • Cramps in the stomach or abdomen
  • Persistent nausea
  • Vomiting and or sore throat
  • Diarrhea
  • Reduced tendency to sweat
  • Hallucinations
  • Skin which may be flushed, dry or hot
  • Irregular or fast heartbeat
  • Mood swings or changes in mental attitude, including confusion, agitation, abnormal excitement and nervousness
  • Difficulty with urination or inability to urinate at all
  • Pain or redness around the eyes
  • Seeing rainbows or halos around lights
  • Swelling of the eyes, which may or may not hinder vision.

Dosage

Proper dosage level for this medication will be determined by your family doctor, and there is a possibility that it may need to be changed a few times in the early period of treatment, so as to find the optimal dosage level for your circumstances. You should never use any more of this medicine than is recommended by your doctor. When you receive this medication, it will contain an insert which contains information about its usage and instructions, and this insert is intended for the patient. You should read this carefully, then ask your doctor if there are any questions which you still have.

When measuring out the dosage amount of this medication, be sure to use an actual dosing spoon rather than a kitchen spoon, since only a dosing spoon can be accurately measured out. Be sure to take your glycopyrrolate at least an hour before having a meal, and at least two hours after having a previous meal. Your doctor will make a determination of the dosage level which is appropriate for you based on your medical condition, your body's tolerance to the medication, the number of times you are taking it daily and the specific medical condition which is being treated.

When using the oral dosage in its solution form, and treating severe drooling:

  • Children at three years of age or younger must have a proper dosage level determined by a pediatrician
  • Children between the ages of three and 16 will have dosage level calculated on body weight, although a standard dosage for people in this grouping would be .02mg per kilogram of body weight, delivered as many as three times in a day. If additional medicine is needed, your doctor may prescribe a higher dosage, although this will probably not exceed 3mg at the most

For an oral dosage in the tablet form, and treating peptic ulcers:

  • Children younger than 12 years of age are not recommended for taking glycopyrrolate for this medical condition
  • Children aged at least 12 and adults would normally be prescribed an initial dosage of 1mg to be taken three times in a day. It is fairly likely that your doctor will want to adjust this medication level once its effectiveness can be determined, but in most cases, the total dosage amountinany given day will not exceed 8mg.

If you should miss taking a dosage of glycopyrrolate, take it as soon as you remember to unless you are approaching the time of your next regularly scheduled dosage. In that case, it's better to skip the dosage which you missed, and simply wait until the next scheduled dosage. You should never double up on doses to get back on schedule, and you should never take more medication than is prescribed for you simply because you feel like you need more at any given time.

Interactions

There is a potential for glycopyrrolate to interact with other medications, and that can impart unwanted side effects to the patient, or it can reduce the effectiveness of one of the two drugs interacting. In either case, drug interactions are to be avoided if at all possible, so your doctor will want to have an understanding of all other medications which you are currently taking. To facilitate this consultation, you should prepare a list of all the vitamins, over-the-counter drugs, herbal supplements, and other prescription drugs which you are currently taking, as well as the dosage levels of each one of these.

After a careful review of this list, your doctor can advise you on whether any of your current medications need to be discontinued temporarily, or if their dosage levels need to be reduced while you are concurrently taking glycopyrrolate. You can also use this list of medications if you should have a need to go to an emergency room, or any other healthcare clinic where your primary care doctor is not in residence. Any doctor should be able to look at your list of medications and make a determination on whether there could be drug interactions with a medication that might be used to treat your emergency condition. The most commonly checked medications for the potential of any kind of drug interactions include the following:

  • Potassium
  • Bupropion
  • Donepezil
  • Oxymorphone
  • Tiotropium.

It is not advisable for you to be using alcohol or tobacco at the same time you are being treated with glycopyrrolate. There is a potential for any of the side effects from your medication to be exacerbated by the usage of these two substances, so they should be avoided for that reason.

There are also certain medical conditions which can be significantly impacted by taking glycopyrrolate. Make sure to review your medical history with your doctor for this reason, and if you have had any history of medical conditions on the list below, be sure to point these out to your doctor before taking glycopyrrolate.

  • Trouble with urination
  • Intestinal or stomach problems such as ulcerative colitis, bowel obstruction or toxic megacolon
  • Paralytic ileus
  • Obstructive uropathy
  • Colostomy
  • Hyperthyroidism
  • Hypertension
  • Ileostomy
  • Liver disease
  • Nerve problems
  • Congestive heart failure
  • Heart disease
  • Problems with heart rhythm
  • Hiatal hernia with gastroesophageal reflux disease
  • Prostatic hypertrophy
  • Glaucoma
  • Myasthenia gravis
  • Kidney disease

Warnings

Any patient taking glycopyrrolate should observe the precautions and warnings which are described below, in order to avoid exacerbating any existing medical condition or triggering a new one. It is extremely important that the family doctor regularly checks on your status while taking this medication, in order to evaluate its effectiveness and your body's tolerance to the medicine.

It is highly inadvisable to take potassium chloride tablets or capsules, or any other kind of supplements containing potassium, during the period of treatment with glycopyrrolate. Any combination of these medicines with glycopyrrolate can result in a much slower movement of the potassium as it navigates through the esophagus and stomach.

It is possible for this medication to instigate either constipation or diarrhea in a patient, and in some cases also possibly distention of the stomach or abdomen. Some patients have also reported pain in the stomach or abdominal areas in addition to severe nausea and/or vomiting. If any of these symptoms are manifested in your own case, you should report them immediately to your doctor for advice.

You should discontinue using glycopyrrolate if you find that you are unable to urinate or have extreme difficulty with urination. In some cases, patients also experience pain during urination, if this gets to the point where it's extremely uncomfortable, you should contact your doctor for relief.

Notify your doctor right away if you develop a skin rash, hives, or anything that you suspect is an allergic reaction to the medication, and in the meantime, make sure to stop using glycopyrrolate until your doctor advises a resumption.

It's possible for glycopyrrolate to cause a significant reduction in sweating, and since sweating is your body's mechanism for cooling off, this can cause a serious problem with body temperature. For this reason, it is highly advisable to avoid becoming overheated, either by being outside in extreme temperatures or through vigorous athletic activity. In the most extreme cases, heatstroke may be indicated for a patient who is unable to sweat freely in an overheated condition.

There is a potential for glycopyrrolate to cause drowsiness or blurred vision, and for this reason, it should not be taken when you have to drive a motor vehicle, or when you are operating machinery. This can cause a danger to yourself and to others around you, so the medicine should only be taken when you are sure that you don't have to drive or operate heavy machinery.

There are no definitive studies which have been conducted to determine any kind of relationship between glycopyrrolate and adverse effects on fetuses. However, it is still highly advisable that you consult with your doctor if you are pregnant or thinking of becoming pregnant while being treated with glycopyrrolate. You should also let your doctor know if you intend to breastfeed while concurrently taking glycopyrrolate, as it is not known for certain whether any harm can be passed on to a nursing infant when taking his medication.

Storage

This medicine should be stored in a sealed container at room temperature, in a location which is well out of the reach of pets and curious children. There should be no excessive heat, cold, moisture, or direct lighting which the room is subject to where glycopyrrolate is stored. Expired or unused medication should not be kept around, and should instead be disposed of using proper methods recommended by your doctor or pharmacist. If you have no guidelines for disposing of unused glycopyrrolate, you can look it up on the FDA website for safe disposal of medicines.

Summary

Glycopyrrolate belongs to the class of drugs known as anticholinergics, and its primary medical uses are for the reduction of salivating among cerebral palsy patients, and the reduction of stomach acid in patients who have ulcers.

It works by blocking the production of these fluids in the body, but that can have some undesirable side effects such as impeding urination and blocking the sweating function. Patients using this medication must be careful to take only as much as is prescribed by a qualified doctor since it can trigger some side effects which may be fairly severe.