What are the side effects of glycopyrrolate?

Glycopyrrolate Side Effects

Glycopyrrolate commonly causes anticholinergic side effects including blurring of vision, dry mouth, dilated pupils, urinary retention, and sedation. 1

Common Side Effects

• Dry mouth (most common side effect, occurring in 9-41% of patients) 2
• Constipation (9-39% of patients) 2
• Behavioral changes (18-36% of patients) 2
• Vomiting 1
• Flushing of the face or skin 1, 3
• Nasal congestion 1
• Headache 1
• Swollen sinuses (sinusitis) 1
• Problems urinating or difficulty starting urination 1, 3

Serious Side Effects

• Overheating and heat stroke risk: Glycopyrrolate reduces sweating, which can lead to overheating in hot environments 3
• Constipation that may progress to intestinal blockage (particularly concerning in patients with colostomy or ileostomy) 3
• Urinary retention requiring discontinuation of the medication 3
• Significant toxicity and withdrawal effects when used for more than several days 1
• Hypersensitivity reactions including skin rash and hives 3

Special Populations and Considerations

Patients with Neurological Conditions

• In children with cerebral palsy and other neurodevelopmental disabilities, side effects led to discontinuation of therapy in 28% of patients despite effectiveness 4
• Side effects may be difficult to detect in patients with neurologic problems who cannot adequately communicate 3

Elderly Patients

• Extra caution is needed in elderly patients due to increased sensitivity to anticholinergic effects 3

Patients with Medical Conditions

• Contraindicated in patients with:

  • Problems urinating 3
  • Paralytic ileus 3
  • Lack of normal bowel tone or tension 3
  • Severe ulcerative colitis 3
  • Myasthenia gravis 3

• Use with caution in patients with:

  • Thyroid problems 3
  • High blood pressure 3
  • Heart problems or abnormal heart beats 3
  • Hiatal hernia with GERD 3
  • Eye problems 3

Monitoring and Management

• Monitor for signs of constipation, which is the most common side effect requiring discontinuation 3
• Watch for signs of urinary retention (inability to urinate, dry diapers/undergarments, irritability) 3
• Avoid hot environments to prevent overheating 3
• When used for end-of-life secretion management, monitor for reduction in respiratory secretions and improved comfort 5

Dosing Considerations to Minimize Side Effects

• Glycopyrrolate should be administered 1 hour before or 2 hours after meals to avoid reduced absorption with high-fat meals 3
• Start with low doses and gradually titrate based on therapeutic response and adverse reactions 3
• The effective dose range can be surprisingly broad (0.01 to 0.82 mg/kg per day in one study), requiring individualized dosing 4
• For respiratory secretion management at end-of-life, typical dosing is 0.2-0.4 mg IV or subcutaneously every 4 hours as needed 5

Advantages Over Other Anticholinergics

• Glycopyrrolate has a quaternary ammonium structure that limits its ability to cross the blood-brain barrier, resulting in fewer central nervous system side effects compared to other anticholinergics 6
• This makes it particularly valuable in patients who already have cognitive deficits 6
• When used for end-of-life congestion management, glycopyrrolate is less likely to cause delirium compared to other anticholinergics like scopolamine 5