Glycopyrronium bromide

How it works

It competitively blocks muscarinic acetylcholine receptors, reducing salivary and bronchial secretions and increasing heart rate by opposing vagal tone; as a quaternary ammonium compound it does not readily cross the blood-brain barrier.

Prescribing in practice

• Its vagolytic effect produces tachycardia, so use cautiously in patients with cardiovascular disease where an increased heart rate is undesirable.
• Avoid in conditions worsened by antimuscarinic action such as untreated narrow-angle glaucoma, significant bladder outflow obstruction and gastrointestinal obstruction.
• Because it poorly penetrates the central nervous system, it causes less central antimuscarinic effect than tertiary agents such as atropine.

Monitoring

Monitor heart rate and rhythm during administration in the perioperative setting.

Counselling the patient

• Team: expect tachycardia and reduced secretions following administration.
• Patient: a dry mouth and blurred vision may occur transiently.

Evidence & guidelines

Its use as an antisialagogue and as a co-agent with neostigmine to limit muscarinic effects during reversal is well-established anaesthetic practice.