Parenteral Manual

Glycopyrrolate

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
ROBINUL®
Classification: 
Anticholinergic, antispasmodic agent
Original Date: 
August 2005
Revised Date: 
January 2010
Indications: 
  • Preoperatively to reduce secretions of the respiratory tract and inhibit salivation
  • Reversal of neuromuscular blockade
  • Control of upper airway secretions
Reconstitution and Stability: 
  • Available as a clear colourless solution (200 mcg/mL). Store at room temperature
  • Diluted solutions stable for 48 hours at room temperature
  • Unstable at a pH >6
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl, D5-0.45NaCl, ringers solution

- Additives/Above Cassette Compatible: atropine, chlorpromazine, codeine, diphenhydramine, droperidol, fentanyl, hydromorphone, hydroxyzine, lidocaine, meperidine, morphine, neostigmine, procaine, prochlorperazine, pyridostigmine, scopolamine

- Y-site Compatible: propofol

- Incompatible: alkaline drugs (sodium bicarbonate, pentobarbital), dimenhydrinate, diazepam

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES
IM YES
Usual dilution: 200 mcg/mL
IV Direct

YES, for reversal of neuromuscular blockade only
Usual dilution: 200 mcg/mL
Infusion time: 5-10 seconds
Infusion rate: do not exceed 20 mcg/minute
IV Intermittent Infusion

Yes
Usual dilution: 2 mcg/mL
Infusion time: 15-20 minutes
Infusion rate: do not exceed 20 mcg/minute
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:
- Reversal of neuromuscular blockade:

  • 200 mcg IV for each 1 mg of neostigmine or 5 mg of pyridostigmine administered

- Control of secretions:

  • 4-10 mcg/kg/dose IV/IM Q 3-4 hours
  • Maximum: 200 mcg/dose

- Preoperative:      

  • <2 years:  4-9 mcg/kg/dose IM 30-60 minutes before procedure
  • >2 years:  4 mcg/kg/dose IM 30-60 minutes before procedure

Adult:
- Reversal of neuromuscular blockade:

  • 200 mcg IV for each 1 mg of neostigmine or 5 mg of pyridostigmine administered

- Control of secretions (palliative care):

  • 200-600 mcg SC Q 2-4 hours PRN

- Preoperative:

  • 4 mcg/kg IM 30-60 minutes before procedure
Potential hazards of parenteral administration: 
  • Tachycardia, orthostatic hypotension, palpitations, arrhythmias
  • Drowsiness, headache, blurred vision, dizziness, confusion,
  • Urinary retention, dry mouth and constipation
  • Burning at site of injection
Notes: 
  • Infants, patients with Down's syndrome and children with spastic paralysis or brain damage may be hypersensitive to the antimuscarinic effects
  • Use with caution in patients with fever, hyperthyroidism, hepatic renal disease, hypertension, CHF, GI infections, diarrhea, reflux esophagitis
  • Monitor HR

 

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