Glycopyrrolate in Clinical Practice

Clinical Applications

• The American Society of Anesthesiologists recommends glycopyrrolate for reduction of secretions and minimization of vagal response, particularly in infants and neonates, with a dosage of 0.004 mg/kg intramuscularly, given 30-60 minutes before anesthesia induction 1, 2
• The National Comprehensive Cancer Network recommends glycopyrrolate for management of excessive secretions in palliative care patients, with a typical dosage of 0.2-0.4 mg IV every 4 hours as needed or 0.2 mg subcutaneously every 4 hours 3, 4, 6
• Glycopyrrolate is used as an adjunct to ketamine anesthesia to attenuate increased upper airway secretions, as recommended by the American Society of Anesthesiologists 7

Advantages Over Other Anticholinergics

• The National Comprehensive Cancer Network notes that glycopyrrolate is less likely to cause delirium compared to scopolamine or atropine due to minimal central nervous system penetration 3, 5

Clinical Pearls and Considerations

• The American Society of Anesthesiologists suggests that glycopyrrolate can be used to counteract cholinomimetic activity and reduce salivation or bronchial secretions in nerve agent intoxication 1, 2
• The American Society of Anesthesiologists recommends that when used with ketamine, glycopyrrolate can attenuate the increased upper airway secretions that might otherwise lead to severe dyspnea or sense of "suffocation" 7