ADMINISTRATION ROUTES:
IV
ALTERNATIVE NAMES:
Robinul
ICU INDICATIONS:
- Protection against the peripheral muscarinic effects of cholinergics given to reverse neuromuscular blockade
- To reduce secretions
PRESENTATION AND ADMINISTRATION:
IV:
Robinul contains 0.2mg of glycopyrrolate in a 1 mL vial
In order to minimise the appearance of cardiac side effects, glycopyrrolate and neostigmine may be administered simultaneously by IV injection and may be mixed in the same syringe when given for reversal of neuromuscular paralysis
Compatible with the following IV fluids:
Dextrose 5% and 10% in water or saline, dextrose 5% in sodium chloride 0.45% or sodium chloride 0.9%
Store at room temperature
DOSAGE:
IV:
To prevent bradycardia during reversal of neuromuscular blockade
0.2 mg for each 1.0 mg of neostigmine
To reduce secretions & or treat bradycardia
0.2 mg given 6-8 hourly
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Glycopyrrolate is renally excreted and its effect is significantly prolonged by renal impairment. However, dosage adjustment is generally not required
DOSAGE IN PAEDIATRICS:
Reversal of neuromuscular blockade:
10 mcg/kg of glycopyrrolate with 0.05 mg/kg neostigmine
To reduce secretions or treat bradycardia:
5-10 mcg/kg 6-8 hourly IV
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Glycopyrrolate is renally excreted and its effect is significantly prolonged by renal impairment. However, dosage adjustment is generally not required
DOSAGE IN PAEDIATRICS:
Reversal of Neuromuscular Blockade:
10 mcg/kg of glycopyrrolate with 0.05 mg/kg neostigmine
To Reduce Secretions or Treat Bradycardia:
5-10 mcg/kg 6-8 hourly IV
CLINICAL PHARMACOLOGY:
Glycopyrrolate is a synthetic anticholinergic agent. Glycopyrrolate, like other anticholinergic (antimuscarinic) agents, inhibits the action of acetylcholine on structures innervated by postganglionic cholinergic nerves and on smooth muscles that respond to acetylcholine but lack cholinergic innervation.
CONTRAINDICATIONS:
- Hypersensitivity to glycopyrrolate
WARNINGS:
Should be used with great caution, if at all, in patients with glaucoma. Exposure to excessive amounts of benzyl alcohol has been associated with toxicity (hypotension, metabolic acidosis), particularly in neonates
PRECAUTIONS:
General:
Investigate any tachycardia before giving glycopyrrolate injection since an increase in the heart rate may occur.
Use with caution in patients with coronary artery disease, congestive heart failure, cardiac arrhythmias, hypertension or hyperthyroidism
Infants, patients with trisomy 21 (Down syndrome), and paediatric patients with spastic paralysis or brain damage may experience an increased response to anticholinergics, thus increasing the potential for side effects
Laboratory Tests:
No tests in addition to routine ICU tests are required
Drug/Laboratory Test Interactions:
None noted
IMPORTANT DRUG INTERACTIONS IN ICU:
The concurrent use of glycopyrrolate injection with other anticholinergics or medications with anticholinergic activity, such as phenothiazines, antiparkinson drugs, or tricyclic antidepressants, may intensify the antimuscarinic effects and may result in an increase in anticholinergic side effects
ADVERSE REACTIONS:
Body as a Whole:
Anaphylactic/anaphylactoid reactions, malignant hyperthermia
Cardiovascular System:
Tachycardia, cardiac arrhythmias (including bradycardia, ventricular tachycardia, ventricular fibrillation)
Gastrointestinal System:
Nausea, vomiting, dry mouth, constipation
Renal System:
Urinary hesitancy and retention