Glycopyrrolate Use in Malignant Bowel Obstruction

Clinical Context

The National Comprehensive Cancer Network recommends glycopyrrolate to reduce gastrointestinal secretions and decrease nausea/vomiting in patients with malignant bowel obstruction, when the goal is symptom control and not resolution of obstruction 1, 2
Glycopyrrolate is used in complete malignant obstruction when the therapeutic goal has shifted from maintaining gut function to reducing secretions and providing comfort, and should never be used when there is potential for resolution of obstruction or when maintaining gut motility is the goal 1, 2

In cases of suspected or confirmed obstruction, the National Comprehensive Cancer Network suggests assessing completeness of obstruction, and avoiding glycopyrrolate in incomplete obstruction, considering prokinetics if appropriate 1, 2
For complete obstruction, determining if surgical or endoscopic intervention is possible is crucial, and glycopyrrolate may be appropriate for palliative symptom control in irreversible complete obstruction 1, 2, 3