From the Guidelines
Glycopyrrolate can cause tachycardia as a side effect due to its anticholinergic properties, and patients with pre-existing cardiovascular conditions, the elderly, and those taking other medications that affect heart rate are at increased risk. This medication blocks muscarinic acetylcholine receptors, which inhibits the parasympathetic nervous system's ability to slow heart rate. When the parasympathetic influence is reduced, the sympathetic nervous system's effects become more dominant, resulting in increased heart rate. Tachycardia (heart rate >100 beats per minute) is a common adverse effect, especially at higher doses. Some key points to consider when using glycopyrrolate include:
- The typical dosage of glycopyrrolate varies by indication: 1-2 mg orally two to three times daily for peptic ulcer disease, 0.1-0.2 mg IV/IM for preoperative use, or 1-2 mg/mL solution for inhalation.
- If a patient develops significant tachycardia while taking glycopyrrolate, dosage reduction may be necessary, or an alternative medication might be considered.
- Patients should be monitored for other anticholinergic effects such as dry mouth, blurred vision, urinary retention, and constipation.
- Those with glaucoma, prostatic hypertrophy, or certain cardiac conditions should use glycopyrrolate with caution, as noted in studies such as 1. It is essential to weigh the benefits and risks of glycopyrrolate in each patient, considering their individual medical history and current health status, to minimize the risk of tachycardia and other adverse effects.
From the FDA Drug Label
ADVERSE REACTIONS Anticholinergics, including glycopyrrolate injection, can produce certain effects, most of which are extensions of their pharmacologic actions Adverse reactions may include ... tachycardia; In addition, the following adverse events have been reported from post-marketing experience with glycopyrrolate injection: ... cardiac arrhythmias (including ... ventricular tachycardia,
Tachycardia is listed as a potential adverse reaction to glycopyrrolate.
- Key points:
- Tachycardia is a possible side effect of glycopyrrolate.
- Cardiac arrhythmias, including ventricular tachycardia, have been reported in post-marketing experience with glycopyrrolate injection. 2
From the Research
Glycopyrrolate and Tachycardia
- Glycopyrrolate is a muscarinic antagonist that can affect heart rate variability, as seen in a study published in Acta anaesthesiologica Scandinavica 3.
- At higher doses, glycopyrrolate can produce a vagal cardiac blockade, characterized by significant tachycardia and a decrease in overall and beat-to-beat heart rate variability 3.
- In geriatric patients, the use of glycopyrrolate to reverse neuromuscular blockade was associated with a 16% incidence of new postoperative cardiac dysrhythmias, although this was not statistically significant 4.
- Glycopyrrolate has been used in combination with other agents, such as dexmedetomidine, to inhibit baroreflex control of the circulation, resulting in increased blood pressure and heart rate 5.
- The pharmacology and toxicology of glycopyrrolate have been extensively studied, and it has been found to have a favorable safety profile for chronic use indications 6.
- While glycopyrrolate can cause tachycardia, beta-blockers such as bisoprolol have been shown to be effective in treating arrhythmias, including supraventricular and ventricular arrhythmias 7.