Recommended Intravenous (IV) Dose of Glycopyrrolate for Pediatric Patients
The recommended intravenous (IV) dose of glycopyrrolate for pediatric patients is 0.004 mg/kg for premedication and intraoperative use, with a maximum single dose of 0.1 mg. 1
Dosing Guidelines by Clinical Indication
Preanesthetic Medication
- IV glycopyrrolate should be administered at 0.004 mg/kg when used as preanesthetic medication 1
- For infants (1 month to 2 years of age), higher doses up to 0.009 mg/kg may be required 1
- Should be administered 30-60 minutes prior to anticipated induction of anesthesia or at the time when preanesthetic narcotics/sedatives are given 1
Intraoperative Medication
- When used intraoperatively to counteract drug-induced or vagal reflexes and associated arrhythmias, the pediatric dose is 0.004 mg/kg IV 1
- Single doses should not exceed 0.1 mg 1
- May be repeated as needed at intervals of 2-3 minutes 1
- The etiology of arrhythmia should be determined, and appropriate surgical or anesthetic manipulations should be performed to correct parasympathetic imbalance 1
Reversal of Neuromuscular Blockade
- For reversal of neuromuscular blockade, the recommended dose is 0.2 mg of glycopyrrolate for each 1.0 mg of neostigmine or 5.0 mg of pyridostigmine 1
- Drugs may be administered simultaneously by IV injection and can be mixed in the same syringe to minimize cardiac side effects 1, 2
Special Considerations and Precautions
When Used with Ketamine
- Glycopyrrolate at 0.005 mg/kg IM has been used successfully with ketamine for pediatric sedation to prevent increased salivation 3
- When ketamine is used for sedation/analgesia, glycopyrrolate may be administered to prevent the increased salivation that commonly occurs with ketamine 4
Safety Considerations
- Glycopyrrolate has a favorable cardiovascular profile compared to other anticholinergics like atropine, with fewer dysrhythmias, particularly ventricular ectopic beats 5
- Common adverse effects include dry mouth, constipation, and behavioral changes 6, 7
- Extravascular administration can result in severe skin injury 4
- Monitor for signs of anticholinergic toxicity, especially when using higher doses 1
Contraindications and Monitoring
- Not recommended for treatment of peptic ulcer in pediatric patients 1
- Vital signs should be monitored during administration, particularly heart rate 1
- Compatible with dextrose 5% and 10% in water, saline, dextrose 5% in sodium chloride 0.45%, sodium chloride 0.9%, and Ringer's Injection 1
- Incompatible with Lactated Ringer's solution 1
Overdose Management
- For overdose, neostigmine methylsulfate may be given intravenously in proportionately smaller doses than adults to reverse peripheral anticholinergic effects 1
- Physostigmine may be used if CNS symptoms (excitement, restlessness, convulsions) occur 1
- Supportive care including IV fluids and/or pressor agents should be administered to combat hypotension 1
Glycopyrrolate's pharmacokinetics in children show variable oral bioavailability (median 3.3%), with clearance ranging from 0.6 to 1.43 L/kg/h and half-life between 19 to 99 minutes in children 6. These factors should be considered when determining appropriate dosing intervals.