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glycopyrrolate (Robinul, Cuvposa, Qbrexza)

Tradenames: Robinul, Cuvposa, Qbrexza. (glycopyrronium bromide) Indications: - used preoperatively to reduce salivary, tracheobronchial & pharyngeal secretions - used to prevent cholinergic effects during surgery, i.e. cardiac arrhythmias, hypotension, bradycardia - adjunct agent in management of peptic ulcer disease - reversal of neuromuscular blockade - drooling - irritable bowel syndrome, diarrhea [5] - axillary hyperhidrosis (topical) Contraindications: - myasthenia gravis [7] - unstable cardiovascular status - acute hemorrhage - glaucoma - paralytic ileus - severe ulcerative colitis - Sjogren syndrome [7] - when anticholinergic agents (parasympatholytics) are contraindicated Dosage: 1) induction (intraoperative) a) 0.1-0.2 mg IV/IM b) 4 ug/kg up to 0.1 mg c) may repeat at 2-3 min intervals PRN 2) control of secretions a) 4-10 ug/kg every 3-4 hours b) maximum: 0.2 mg/dose or 0.8 mg/day 3) 1-2 mg PO BID/TID Tabs: 1 & 2 mg. Injection: 0/2 mg/mL (1 mL, 5 mL, 20 mL) Solution: Cuvposa is a flavored oral solution for children Topical: Qbrexza (anticholinergic cloth) Pharmacokinetics: 1) following IV administration, onset of action is 1 minute 2) after IM or SC administration, onset of action is 15-30 min 3) inhibition of salivation persists for up to 7 hours 4) does NOT reach significant levels in CSF 5) excreted largely unchanged in the bile & feces 6) also eliminated in the urine Adverse effects: 1) common (> 10%) - constipation - decreased sweating - dry mouth, nose, throat or dry skin - urinary retention [2] - irritation at site of injection 2) less common (1-10%) - decreased flow of breast milk - difficulty swallowing - photosensitivity 2) uncommon (< 1%) - rash, confusion, increased intraocular pain, orthostatic hypotension, bloating, difficult urination [3], blurred vision, drowsiness, headache, loss of memory, nausea/vomiting, weakness, tiredness, ventricular fibrillation, tachycardia, palpitations, ataxia Mechanism of action: 1) quaternary ammonium muscarinic antagonist 2) less CNS anticholinergic effects than scopalamine

Interactions

drug interactions drug adverse effects of parasympatholytics

General

dissociative anesthetic parasympatholytic (anticholinergic, antimuscarinic agent) topical agent

Properties

MISC-INFO: elimination route KIDNEY pregnancy-category B safety in lactation -

Database Correlations

PUBCHEM correlations

References

  1. Clinical Guide to Laboratory Tests, 3rd edition, NW Tietz ed, WB Saunders, Philadelphia, 1998
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. FDA NEWS RELEASE, July 28, 2010 FDA Approves Drug for Chronic Drooling in Children http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm220444.htm
  5. Deprecated Reference
  6. Brooks M FDA OKs New Topical Treatment for Excessive Underarm Sweating. Medscape - Jun 29, 2018 https://www.medscape.com/viewarticle/898719
  7. James W Fast Five Quiz: Hyperhidrosis Medscape. July 5, 2023 https://reference.medscape.com/viewarticle/992459

Component-of

budesonide/formoterol/glycopyrrolate (Breztri Aerosphere) formoterol/glycopyrrolate (Bevespi Aerosphere) glycopyrrolate/indacaterol