COPD Pregnancy: Use with caution — no adequate human data; COPD management in pregnancy requires specialist input

Glycopyrronium

Brand names: Seebri Breezhaler, Tovanor Breezhaler

Adult dose

Dose: 44 micrograms once daily (one 44 mcg capsule inhaled)

Route: Inhalation via Breezhaler device

Frequency: Once daily

Max: 44 micrograms once daily

Long-acting muscarinic antagonist (LAMA). GOLD-recommended bronchodilator for COPD maintenance. Do not swallow capsule — pierce in device only. Use at same time each day.

Paediatric dose

Route: Inhalation

Seek specialist opinion — not licensed in children

Dose adjustments

Renal

Use with caution in severe renal impairment (eGFR <30) — primarily renally excreted; may accumulate

Hepatic

No dose adjustment required

Clinical pearls

GLOW2 trial: glycopyrronium 44 mcg OD vs tiotropium 18 mcg OD — non-inferior; faster onset of action in first 4 hours post-dose
Available in fixed-dose combinations: indacaterol/glycopyrronium (Ultibro — FLAME trial) and beclometasone/formoterol/glycopyrronium (Trimbow — KRONOS trial)
GOLD 2024: all once-daily LAMAs (tiotropium, glycopyrronium, umeclidinium, aclidinium BD) equally preferred for COPD group B/E initial maintenance
Breezhaler capsules: patient must hear click/rattle during inhalation — confirms capsule pierced and drug being inhaled. Common error: swallowing the capsule.
Renal caution: glycopyrronium data in severe renal impairment limited — extra monitoring warranted

Contraindications

Hypersensitivity to glycopyrronium bromide or lactose
Severe hypersensitivity to atropine or its derivatives

Side effects

Dry mouth (class effect)
Urinary retention (caution in BPH)
Constipation
Sinusitis/nasopharyngitis
Tachycardia
Paradoxical bronchospasm (rare)

Interactions

Other anticholinergics — additive effect; avoid concomitant tiotropium, aclidinium, umeclidinium
Drugs that prolong QTc — theoretical concern

Monitoring

FEV1 and FVC
Symptoms (mMRC/CAT score)
Exacerbation frequency
Urinary symptoms in men with BPH

Reference: BNFc; BNF 90; GLOW2 Trial (Kerwin et al. COPD 2012); GOLD 2024; NICE NG115; SPC Seebri Breezhaler. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways