COPD Pregnancy: No data from use in pregnant women; animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. Glycopyrronium should only be used during pregnancy if the expected benefit to the patient justifies the potential risk to the foetus. Breast-feeding: it is unknown whether glycopyrronium bromide is excreted in human milk (it was excreted in the milk of lactating rats) - use only if the expected benefit to the woman is greater than any possible risk to the infant. Fertility: animal data do not indicate a concern.

Glycopyrronium

Brand names: Seebri Breezhaler, Tovanor Breezhaler

Glycopyrronium (glycopyrronium bromide) is an inhaled long-acting muscarinic antagonist used as once- or twice-daily maintenance bronchodilator therapy in COPD.

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: Inhalation of the content of one capsule once daily using the Seebri Breezhaler inhaler (the fetched SPC is Seebri Breezhaler 44 micrograms inhalation powder, hard capsules)

Route: Inhalation use only - the capsules must be administered only using the Seebri Breezhaler inhaler and must not be swallowed; remove capsules from the blister only immediately before use

Frequency: Once daily, recommended to be administered at the same time of the day each day

Max: Patients should be instructed not to take more than one dose (one capsule) in a day

SOURCE NOW MATCHES THIS PAGE: an earlier fetch for this id returned an oral glycopyrronium bromide tablet (sialorrhoea in children) and was held for product/route mismatch; the current bundle is the inhaled COPD product, so the dose has been extracted. Indication of the fetched SPC is COPD maintenance treatment. If a dose is missed, the next dose should be taken as soon as possible. NOT FOR ACUTE USE - this is a once-daily long-term maintenance treatment and is not indicated for the initial treatment of acute episodes of bronchospasm, i.e. as rescue therapy (§4.4). Elderly: can be used at the recommended dose in patients 75 years of age and older. Hepatic impairment: no studies conducted; no dose adjustment is required. Paediatric population: there is no relevant use in the paediatric population (under 18 years) in the indication COPD - hence paedDose is null. Patients who do not experience improvement in breathing should be asked whether they are swallowing the medicinal product rather than inhaling it. NOTE ON US LABEL: the openFDA record in this bundle is Qbrexza (single-use cloth pre-moistened with 2.4% glycopyrronium solution, applied topically to both axillae once daily for primary axillary hyperhidrosis) - a different route and indication; it was NOT used for this respiratory page.

Dose adjustments

Renal

Can be used at the recommended dose in patients with mild to moderate renal impairment. In patients with severe renal impairment (estimated glomerular filtration rate below 30 mL/min/1.73 m2) or end-stage renal disease requiring dialysis, use only if the expected benefit outweighs the potential risk, since systemic exposure to glycopyrronium may be increased (up to 2.2-fold); monitor these patients closely for potential adverse reactions.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; 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

Hypersensitivity to the active substance or to any of the excipients
Excipient warning: patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicinal product (§4.4)

Side effects

Dry mouth (common; the most frequent anticholinergic reaction, 2.4%, mostly mild)
Nasopharyngitis (common); gastroenteritis (common)
Insomnia (common)
Headache (common)
Urinary tract infection (common); urinary retention and dysuria (uncommon)
Musculoskeletal pain (common); atrial fibrillation and palpitations (uncommon); paradoxical bronchospasm (not known)

Interactions

Other anticholinergic-containing medicinal products - co-administration has not been studied and is therefore not recommended (§4.5; the remainder of §4.5 was truncated in the fetched bundle)

Clinical monograph

How it works

It produces sustained bronchodilation by competitively blocking muscarinic acetylcholine receptors on airway smooth muscle, reducing cholinergic bronchoconstrictor tone.

Prescribing in practice

Antimuscarinic activity means it should be used with caution and can worsen closed-angle glaucoma, urinary retention and bladder outflow obstruction.
It is a maintenance treatment and not intended for relief of acute bronchospasm.
Local effects include dry mouth, and it should not be combined with other long-acting muscarinic antagonists.

Monitoring

Monitor COPD symptom control and inhaler technique, and review for antimuscarinic effects such as dry mouth, urinary difficulty or worsening glaucoma.

Counselling the patient

Use regularly as a maintenance treatment, not for sudden breathlessness.
Report eye pain, blurred vision or difficulty passing urine.
Dry mouth is common and can be eased with sips of water.

Evidence & guidelines

An established inhaled long-acting muscarinic antagonist for COPD supported by bronchodilator trial data and recommended within NICE COPD treatment pathways.

Reference: GLOW2 Trial (Kerwin et al. COPD 2012); GOLD 2024; NICE NG115; SPC Seebri Breezhaler; 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways