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Anticholinergic (Muscarinic Antagonist) — Perioperative

Glycopyrronium (Perioperative — Anticholinergic)

Brand names: Robinul

Glycopyrronium is a quaternary antimuscarinic (anticholinergic) used perioperatively to reduce airway and salivary secretions and to counteract vagally mediated bradycardia.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It competitively blocks muscarinic acetylcholine receptors, reducing secretions and increasing heart rate; its quaternary structure limits central nervous system penetration.

Prescribing in practice

  • Use with caution in patients with tachyarrhythmias, ischaemic heart disease, glaucoma, prostatic enlargement or bowel obstruction, as antimuscarinic effects may be harmful.
  • Frequently co-administered with neostigmine during neuromuscular blockade reversal to offset muscarinic effects such as bradycardia.
  • It crosses the placenta poorly and causes less central effect than tertiary antimuscarinics such as atropine.

Monitoring

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

Counselling the patient

  • A dry mouth and transient blurred vision may occur after the procedure.
  • Inform the anaesthetic team of any heart rhythm problems or glaucoma.

Evidence & guidelines

Antimuscarinics are standard perioperative agents for antisialagogue effect and as part of neuromuscular blockade reversal, supported by established anaesthetic practice.

Reference: AAGBI Reversal of Neuromuscular Block Guidelines; RCoA Anaesthetic Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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