Anticholinergic
Pregnancy: B — does not cross placenta (charged molecule)
Glycopyrrolate
Brand names: Robinul, Glycopyrronium Bromide
Adult dose
Dose: Premedication: 200 micrograms IM/IV. Reversal adjunct with neostigmine: 200–400 mcg IV (or 0.2mg per 1mg neostigmine)
Route: IV or IM
Frequency: Single dose or as required
Bradycardia treatment: 200–400 mcg IV. Secretion reduction: 200–400 mcg IV/IM.
Paediatric dose
Dose: 0.01 mg/kg
Route: IV
Frequency: Single dose (with neostigmine)
Max: 0.2 mg
BNFc child 1 month–18 years: 10 micrograms/kg (max per dose 200 micrograms) IV with neostigmine for reversal. Premedication: 4–8 micrograms/kg IM/IV.
Paediatric weight-based calculator
BNFc child 1 month–18 years: 10 micrograms/kg (max per dose 200 micrograms) IV with neostigmine for reversal. Premedication: 4–8 micrograms/kg IM/IV.
Clinical pearls
- PREFERRED over atropine as neostigmine reversal partner — does NOT cross blood-brain barrier (no CNS effects)
- Does not cause initial bradycardia seen with atropine (which crosses BBB)
- Quaternary ammonium compound — charged, does not cross BBB or placenta
- Dose ratio with neostigmine: 0.2mg glycopyrrolate per 1mg neostigmine (commonly)
- Inhaled glycopyrronium (Seebri): used for COPD — completely different route and indication
Contraindications
- Glaucoma (narrow-angle)
- Myasthenia gravis (blocks nicotinic receptors)
- Paralytic ileus
- Urinary retention
Side effects
- Dry mouth
- Tachycardia
- Urinary retention
- Blurred vision
- Constipation
Interactions
- Antihistamines, TCAs — additive anticholinergic effects
Monitoring
- Heart rate
- Urinary output (postoperative retention risk)
Reference: BNFc; AAGBI Reversal of Neuromuscular Block; BNF. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.