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Anticholinergic Pregnancy: US label reports no adequate/well-controlled data; animal studies (oral rat, IV rabbit) showed no increased malformations, though reduced fetal weight at high oral doses. Not stated for this UK product (no eMC record).

Glycopyrrolate

Brand names: Robinul, Glycopyrronium Bromide

Glycopyrrolate (glycopyrronium) is a quaternary ammonium antimuscarinic agent used perioperatively to reduce secretions and to attenuate bradycardia, commonly co-administered with neostigmine during reversal of neuromuscular blockade.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Preanaesthetic medication: 0.004 mg/kg IM. Intraoperative (vagal reflexes/bradycardia): 0.1 mg IV. Reversal of neuromuscular blockade: 0.2 mg per 1 mg neostigmine (or per 5 mg pyridostigmine). Peptic ulcer: 0.1 mg IV or IM
Route: Intramuscular (IM) or intravenous (IV), without dilution
Frequency: Indication-dependent — see notes
Glycopyrrolate injection (US labelling — verify vs UK SPC). Preanaesthetic: 0.004 mg/kg IM given 30–60 minutes before induction. Intraoperative for drug-induced/vagal reflexes and associated arrhythmias (e.g. bradycardia): 0.1 mg IV, repeat as needed at 2–3 minute intervals. Reversal of neuromuscular blockade: 0.2 mg IV for each 1 mg of neostigmine or 5 mg of pyridostigmine (may be given simultaneously by IV injection). Peptic ulcer (adults): 0.1 mg IV or IM at 4-hourly intervals, 3 or 4 times daily; where a more profound effect is required 0.2 mg may be given (maximum four times daily). Paediatric injection dosing also stated: preanaesthetic 0.004 mg/kg IM (patients <2 years may require up to 0.009 mg/kg); intraoperative 0.004 mg/kg IV not to exceed 0.1 mg per single dose; reversal of neuromuscular blockade 0.2 mg IV per 1 mg neostigmine/5 mg pyridostigmine. Not indicated for peptic ulcer in paediatric patients.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Known hypersensitivity to glycopyrrolate or any of its inactive ingredients
  • Peptic ulcer patients with: glaucoma; obstructive uropathy (e.g. bladder-neck obstruction from prostatic hypertrophy); obstructive GI disease (achalasia, pyloroduodenal stenosis); paralytic ileus; intestinal atony in the elderly/debilitated
  • Unstable cardiovascular status in acute haemorrhage
  • Severe ulcerative colitis; toxic megacolon complicating ulcerative colitis
  • Myasthenia gravis

Side effects

  • Xerostomia (dry mouth)
  • Urinary hesitancy and retention
  • Blurred vision and photophobia due to mydriasis; increased ocular tension
  • Tachycardia; palpitation
  • Decreased sweating; headache; drowsiness; constipation

Interactions

  • Other anticholinergics / drugs with anticholinergic activity (phenothiazines, antiparkinson drugs, tricyclic antidepressants) — intensify antimuscarinic effects
  • Potassium chloride in a wax matrix — may increase severity of KCl-induced GI lesions

Clinical monograph

How it works

It competitively antagonises acetylcholine at peripheral muscarinic receptors, reducing vagal tone and exocrine (salivary and bronchial) secretions; its quaternary structure limits central nervous system penetration.

Prescribing in practice

  • Because it does not cross the blood–brain barrier appreciably, it lacks the central sedative and anti-emetic effects of atropine but still causes tachycardia and antimuscarinic effects.
  • When used to counter the muscarinic effects of an anticholinesterase, the onset of the two agents should be matched to avoid transient bradycardia or tachycardia.
  • Use with caution in patients with glaucoma, prostatic enlargement, or significant tachyarrhythmia.

Monitoring

Monitor heart rate and rhythm during administration, particularly when given alongside an anticholinesterase for neuromuscular block reversal.

Counselling the patient

  • Expect a dry mouth and possible blurred vision shortly after the injection.
  • Tell the anaesthetic team about glaucoma, urinary difficulties, or heart rhythm problems.

Evidence & guidelines

Use is supported by established anaesthetic practice and product information; consult current prescribing references and the SPC for full detail.

Reference: AAGBI Reversal of Neuromuscular Block; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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