COPD Pregnancy: Contraindicated in pregnancy (no data; assessment of reproductive endpoints limited). Contraindicated in breast-feeding. Consider effective contraception in women of childbearing potential where appropriate.

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: Not indicated in adults — Glycopyrronium bromide tablets are indicated for the paediatric population only (see paedDose)

Route: Oral

Frequency: Not applicable to adults

Based on Glycopyrronium Bromide tablets (SPC) for symptomatic treatment of severe sialorrhoea (chronic pathological drooling) in children/adolescents aged 3 years and older with chronic neurological conditions. There is only limited clinical trial evidence in adults with pathological drooling, and the tablets should NOT be used in patients over 65 years (longer elimination half-life, reduced clearance, limited efficacy data). Recommended for short-term intermittent use; should be prescribed by physicians experienced in treating neurological disorders. For oral administration only; give at least 1 hour before or 2 hours after meals (food markedly reduces exposure); avoid high-fat food. Note: the US openFDA record retrieved for this id is Qbrexza (topical glycopyrronium cloth for axillary hyperhidrosis, 2.4% solution once daily) — a different formulation/indication and not used for this oral posology.

Paediatric dose

Dose: 0.02 mg/kg

Route: Oral

Frequency: Three times daily (initial); titrate in increments of 0.02 mg/kg every 7 days

Max: 0.1 mg/kg three times daily, not to exceed 1.5–3 mg per dose based on weight

Children and adolescents aged 3 years and older. Initial dose 0.02 mg/kg orally three times daily, titrated in 0.02 mg/kg increments no more frequently than weekly over a four-week period based on therapeutic response and tolerability, up to a maximum of 0.1 mg/kg three times daily (per-dose cap 1.5–3 mg by weight band per SPC dosing table). Not recommended in children younger than 3 years. Mild-to-moderate renal impairment (eGFR 90–≥30 ml/min/1.73m2): reduce dose by 30%. Contraindicated in severe renal impairment (eGFR <30). Verify against a children's formulary.

Dose adjustments

Renal

Mild to moderate renal impairment (eGFR 90–≥30 ml/min/1.73m2): reduce dose by 30%. Severe renal impairment (eGFR <30): contraindicated.

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.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

Contraindications

Hypersensitivity to the active substance or any excipient
Glaucoma
Urinary retention
Severe renal impairment (eGFR <30 ml/min/1.73m2, including end-stage renal disease requiring dialysis)
History of intestinal obstruction, ulcerative colitis, paralytic ileus, pyloric stenosis, myasthenia gravis
Pregnancy and breast-feeding
Concomitant potassium chloride solid oral dose; concomitant anticholinergics

Side effects

Dry mouth (very common)
Constipation (very common)
Diarrhoea and vomiting (very common)
Flushing; nasal congestion; reduced bronchial secretions (very common)
Irritability (very common); urinary retention

Interactions

Potassium chloride solid oral dose — contraindicated
Other anticholinergics — contraindicated (additive anticholinergic effects)

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