Formulary
Glycopyrronium bromide: Indications, Dosing, Side Effects and Interactions
Glycopyrronium bromide clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 7 min read
Glycopyrronium bromide: Indications, Dosing, Side Effects and Interactions
Glycopyrronium bromide clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Iontophoretic treatment of hyperhidrosis**
- **Adult** (To The Skin): Only 1 site to be treated at a time, maximum 2 sites treated in any 24 hours, treatment not to be repeated within 7 days (consult product literature).
**Premedication at induction**
- **Adult** (By Intramuscular Injection, Or By Intravenous Injection): 200-400 micrograms, alternatively 4-5 micrograms/kg (max. per dose 400 micrograms).
**Intra-operative bradycardia**
- **Adult** (By Intravenous Injection): 200-400 micrograms, alternatively 4-5 micrograms/kg (max. per dose 400 micrograms), repeated if necessary.
**Control of muscarinic side-effects of neostigmine in reversal of non-depolarising neuromuscular block**
- **Adult** (By Intravenous Injection): 10-15 micrograms/kg, alternatively, 200 micrograms per 1 mg of neostigmine to be administered.
**Bowel colic in palliative care,Excessive respiratory secretions in palliative care**
- **Adult** (By Subcutaneous Injection): 200 micrograms every 4 hours and when required, hourly use is occasionally necessary, particularly in excessive respiratory secretions.
- **Adult** (By Subcutaneous Infusion): 0.6-1.2 mg/24 hours.
**Maintenance treatment of chronic obstructive pulmonary disease**
- **Adult** (By Inhalation Of Powder): 1 capsule once daily, each capsule delivers 55 micrograms of glycopyrronium bromide (equivalent to 44 micrograms of glycopyrronium).
**Iontophoretic treatment of hyperhidrosis for glycopyrronium bromide**
- **Child** (To the skin): Only 1 site to be treated at a time, maximum 2 sites treated in any 24 hours, treatment not to be repeated within 7 days (consult product literature).
**Premedication at induction for glycopyrronium bromide**
- **Neonate** (By intramuscular injection, or by intravenous injection): 5 micrograms/kg.
- **Child 1 month-11 years** (By intramuscular injection, or by intravenous injection): 4-8 micrograms/kg (max. per dose 200 micrograms).
- **Child 12-17 years** (By intramuscular injection, or by intravenous injection): 200-400 micrograms, alternatively 4-5 micrograms/kg (max. per dose 400 micrograms).
**Intra-operative bradycardia for glycopyrronium bromide**
- **Neonate** (By intravenous injection): 10 micrograms/kg, repeated if necessary.
- **Child** (By intravenous injection): 4-8 micrograms/kg (max. per dose 200 micrograms), repeated if necessary.
**Control of muscarinic side-effects of neostigmine in reversal of non-depolarising neuromuscular block for glycopyrronium bromide**
- **Neonate** (By intravenous injection): 10 micrograms/kg.
- **Child 1 month-11 years** (By intravenous injection): 10 micrograms/kg (max. per dose 500 micrograms).
- **Child 12-17 years** (By intravenous injection): 10-15 micrograms/kg, alternatively, 200 micrograms per 1 mg of neostigmine to be administered.
**Control of upper airways secretion, Hypersalivation for glycopyrronium bromide**
- **Child 1 month-11 years** (By subcutaneous infusion): 12-40 micrograms/kg (max. per dose 1.2 mg) over 24 hours.
- **Child 12-17 years** (By subcutaneous infusion): 0.6-1.2 mg/24 hours.
- **Child 1 month-11 years** (By subcutaneous injection, or by intramuscular injection, or by intravenous injection): 4-10 micrograms/kg 4 times a day (max. per dose 200 micrograms) as required.
- **Child 12-17 years** (By subcutaneous injection, or by intramuscular injection, or by intravenous injection): 200 micrograms every 4 hours as required.
**Control of upper airways secretion (using Sialanar 400 micrograms/mL oral solution), Hypersalivation (using Sialanar 400 micrograms/mL oral solution) for glycopyrronium bromide**
- **Child** (By mouth): Initially 16 micrograms/kg 3 times a day, increased in steps of 16 micrograms/kg 3 times a day, every 7 days, adjusted according to response; maximum 80 micrograms/kg 3 times a day (max. per dose 2.4 mg).
**Control of upper airways secretion (using generic 1 mg/5mL oral solution), Hypersalivation (using generic 1 mg/5mL oral solution) for glycopyrronium bromide**
- **Child** (By mouth): Initially 20 micrograms/kg 3 times a day, increased in steps of 20 micrograms/kg 3 times a day, every 7 days, adjusted according to response; maximum 100 micrograms/kg 3 times a day (max. per dose 3 mg).
**Chronic pathological drooling in chronic neurological disorders (using Sialanar 400 micrograms/mL oral solution) (under expert supervision) for glycopyrronium bromide**
- **Child 3-17 years** (By mouth): Initially 16 micrograms/kg 3 times a day, increased in steps of 16 micrograms/kg 3 times a day, every 5-7 days, adjusted according to response; maximum 80 micrograms/kg 3 times a day (max. per dose 2.4 mg).
**Chronic pathological drooling in chronic neurological disorders (using generic 1 mg/5mL oral solution) (under expert supervision) for glycopyrronium bromide**
- **Child 3-17 years** (By mouth): Initially 20 micrograms/kg 3 times a day, increased in steps of 20 micrograms/kg 3 times a day, every 5-7 days, adjusted according to response; maximum 100 micrograms/kg 3 times a day (max. per dose 3 mg).
**Chronic pathological drooling in chronic neurological disorders (using tablets) (under expert supervision) for glycopyrronium bromide**
- **Child 3-17 years** (By mouth): Initially 20 micrograms/kg 3 times a day, increased in steps of 20 micrograms/kg 3 times a day, every 5-7 days, adjusted according to response; maximum 100 micrograms/kg 3 times a day (max. per dose 3 mg).
Cautions
For all antimuscarinics (inhaled) Bladder outflow obstruction; paradoxical bronchospasm; prostatic hyperplasia; susceptibility to angle-closure glaucoma Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate with a history of angle-closure glaucoma (may exacerbate glaucoma) or bladder outflow obstruction (may cause urinary retention). Cautions For all antimuscarinics (systemic) Acute myocardial infarction; arrhythmias (may be worsened); autonomic neuropathy; cardiac insufficiency (due to association with tachycardia); cardiac surgery (due to association with tachycardia); conditions characterised by tachycardia; congestive heart failure (may be worsened); coronary artery disease (may be worsened); diarrhoea; elderly (especially if frail); gastro-oesophageal reflux disease; hiatus hernia with reflux oesophagitis; hypertension; hyperthyroidism (due to association with tachycardia); individuals susceptible to angle-closure glaucoma; prostatic hyperplasia; pyrexia; ulcerative colitis Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: if treating extrapyramidal side-effects of antipsychotic medications (risk of antimuscarinic toxicity) with delirium or dementia (risk of exacerbation of cognitive impairment), angle-closure glaucoma (contra-indicated; risk of acute exacerbation of glaucoma), or chronic prostatism (risk of urinary retention) if two or more antimuscarinic drugs prescribed concomitantly (risk of increased antimuscarinic toxicity) Cautions For glycopyrronium bromide When used by inhalation Arrhythmia (excluding chronic stable atrial fibrillation); history of myocardial infarction; history of QT-interval prolongation; left ventricular failure; unstable ischaemic heart disease Cautions, further information Topical use With topical use: Cautions applicable to systemic use should be considered; however, glycopyrronium is poorly absorbed and systemic effects unlikely with topical use.
Contraindications
For all antimuscarinics (systemic) Angle-closure glaucoma; gastro-intestinal obstruction; intestinal atony; myasthenia gravis (but some antimuscarinics may be used to decrease muscarinic side-effects of anticholinesterases); paralytic ileus; pyloric stenosis; severe ulcerative colitis; significant bladder outflow obstruction; toxic megacolon; urinary retention Contra-indications For glycopyrronium bromide With topical use Infections affecting the treatment site Contra-indications, further information Topical use With topical use: Contra-indications applicable to systemic use should be considered; however, glycopyrronium is poorly absorbed and systemic effects unlikely with topical use.
Side effects
Control of muscarinic side-effects of neostigmine in reversal of non-depolarising neuromuscular block for glycopyrronium bromide By intravenous injection Adult 10-15 micrograms/kg, alternatively, 200 micrograms per 1 mg of neostigmine to be administered.
Interactions
**Severe interactions:**
- Opioids: active substances such as pethidine and codeine may result in additive central nervous system and gastrointestinal adverse effects, and increase the risk of severe constipation or paralytic...
**Other interactions (8):**
- Concomitant use to be considered with caution Concomitant use of the following medicinal products should be considered with caution: Antispasmodics: glycopyrronium may antagonize the pharmacologic...
- Topiramate: glycopyrronium may potentiate the effects of oligohidrosis and hyperthermia associated with the use of topiramate, particularly in pediatric patients.
- Sedating antihistamines: may have additive anticholinergic effects.
- Neuroleptics/antipsychotics: the effects of active substances such as phenothiazines, clozapine and haloperidol may be potentiated.
- Tricyclic antidepressants and MAOIs: may have additive anticholinergic effects.
- A reduction in anticholinergic and/or tricyclic antidepressants and MAOIs dosage may be necessary.
Pregnancy
When used by inhalation: Manufacturer advises use only if potential benefit outweighs risk.
Breast feeding
When used by inhalation: Manufacturer advises use only if potential benefit outweighs risk.
Renal impairment
See Prescribing in renal impairment . With systemic use: Caution in renal impairment-duration of action may be prolonged. Repeated or large doses should be avoided in patients with uraemia due to risk of accumulation. M When used by inhalation: Manufacturer advises use only if potential benefit outweighs risk if eGFR less than 30 mL/minute/1.73 m 2 .
Medicinal forms
Solution,Powder
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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