Yes

Anticholinergic Agent

Adjunct in treatment of peptic ulcer disease; inhibit salivation and excessive secretions of the respiratory tract preoperatively; reversal of neuromuscular blockade; control of upper airway secretions

B

Narrow-angle glaucoma, acute hemorrhage, tachycardia, hypersensitivity to glycopyrrolate or any component; ulcerative colitis, obstructive uropathy, paralytic ileus, obstructive disease of GI tract

Not recommended in children <12 years of age for the management of peptic ulcer; infants, patients with Down syndrome, and children with spastic paralysis or brain damage may be hypersensitive to antimuscarine effects. Use caution in elderly, patients with autonomic neuropathy, hepatic or renal disease, ulcerative colitis may predispose megacolon, hyperthyroidism, CAD, CHF, arrhythmias, tachycardia, BPH, hiatal hernia, with reflux.

>10%:

Dermatologic: Dry skin

Gastrointestinal: Constipation, dry throat, xerostomia

Local: Irritation at injection site

Respiratory: Dry nose

Miscellaneous: Diaphoresis (decreased)

1% to 10%:

Dermatologic: Increased sensitivity to light

Endocrine & metabolic: Decreased flow of breast milk

Gastrointestinal: Dysphagia

<1%: Orthostatic hypotension, ventricular fibrillation, tachycardia, palpitations, confusion, drowsiness, headache, loss of memory, fatigue, ataxia, rash, bloated feeling, nausea, vomiting, dysuria, weakness, increased intraocular pain, blurred vision

Symptoms of overdose include blurred vision, urinary retention, tachycardia, absent bowel sounds

Anticholinergic toxicity is caused by strong binding of the drug to cholinergic receptors. For anticholinergic overdose with severe life-threatening symptoms, physostigmine 1-2 mg (0.5 mg or 0.02 mg/kg for children) S.C. or I.V., slowly may be given to reverse these effects.

Decreased effect of levodopa

Increased toxicity with amantadine, cyclopropane

Unstable at pH >6; incompatible with secobarbital (immediate precipitation), sodium bicarbonate (gas evolves), thiopental (immediate precipitation)

Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS

Oral: Onset of action: Within 50 minutes; Peak effect: Within 1 hour

I.M.: Onset of action: 20-40 minutes

I.V.: Onset of action: 10-15 minutes

Duration:

Vagal effects: 2-3 hours

Inhibition of salivation: Up to 7 hours

Anticholinergic effects (after oral administration): 8-12 hours

Absorption: Oral: Poor and erratic

Bioavailability: ~10%

Children:

Control of secretions:

Oral: 40-100 mcg/kg/dose 3-4 times/day

I.M., I.V.: 4-10 mcg/kg/dose every 3-4 hours; maximum: 0.2 mg/dose or 0.8 mg/24 hours

Intraoperative: I.V.: 4 mcg/kg not to exceed 0.1 mg; repeat at 2- to 3-minute intervals as needed

Preoperative: I.M.:

<2 years: 4.4-8.8 mcg/kg 30-60 minutes before procedure

>2 years: 4.4 mcg/kg 30-60 minutes before procedure

Children and Adults: Reverse neuromuscular blockade: I.V.: 0.2 mg for each 1 mg of neostigmine or 5 mg of pyridostigmine administered

Adults:

Intraoperative: I.V.: 0.1 mg repeated as needed at 2- to 3-minute intervals

Preoperative: I.M.: 4.4 mcg/kg 30-60 minutes before procedure

Peptic ulcer:

Oral: 1-2 mg 2-3 times/day

I.M., I.V.: 0.1-0.2 mg 3-4 times/day

May rarely cause drowsiness, confusion, amnesia

Concurrent use with other psychotropics may produce additive sedation and dry mouth

No information available to require special precautions

>10% of patients will experience significant dry mouth (reversible with cessation of drug therapy)

Take as directed before meals; do not increase dose and do not discontinue without consulting prescriber. Void before taking medication. You may experience dizziness or blurred vision (use caution when driving or engaging in tasks that require alertness until response to drug is known); dry mouth (sucking on lozenges may help); photosensitivity (wear dark glasses in bright sunlight); or impotence (temporary). Report excessive and persistent anticholinergic effects (blurred vision, headache, flushing, tachycardia, nervousness, constipation, dizziness, insomnia, mental confusion or excitement, dry mouth, altered taste perception, dysphagia, palpitations, bradycardia, urinary hesitancy or retention, impotence, decreased sweating). Breast-feeding precautions: Consult prescriber if breast-feeding.

Dilute to a concentration of 2 mcg/mL (maximum concentration: 200 mcg/mL); infuse over 15-20 minutes; may be administered direct I.V. at a maximum rate of 20 mcg/minute

Monitor heart rate; anticholinergic effects

Injection, as bromide: 0.2 mg/mL (1 mL, 2 mL, 5 mL, 20 mL)

Robinul®: 0.2 mg/mL (1 mL, 2 mL, 5 mL, 20 mL)

Tablet, as bromide:

Robinul®: 1 mg

Robinul® Forte: 2 mg