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 ... cardiac arrhythmias (including ... ventricular tachycardia, ventricular fibrillation); PRECAUTIONS General Investigate any tachycardia before giving glycopyrrolate injection since an increase in the heart rate may occur.
Paroxysmal Supraventricular Tachycardia (PSVT) is a type of cardiac arrhythmia. Although the label does not directly mention PSVT, it does mention that glycopyrrolate can cause cardiac arrhythmias and an increase in heart rate.
- The FDA drug label does mention tachycardia and cardiac arrhythmias as potential adverse effects of glycopyrrolate.
- However, it does not specifically mention PSVT. Given the information available, it is not possible to draw a direct conclusion about the relationship between glycopyrrolate and PSVT. 1 1 1
From the Research
Glycopyrrolate can potentially cause paroxysmal supraventricular tachycardia (PSVT) as a side effect, particularly at higher doses or in patients with pre-existing cardiovascular conditions. Glycopyrrolate is an anticholinergic medication that blocks the action of acetylcholine, which normally helps regulate heart rate [ 2 ]. When this regulation is disrupted, some patients may experience episodes of sudden rapid heartbeat (paroxysmal tachycardia).
Mechanism and Risk Factors
The mechanism behind this side effect relates to the medication's ability to block parasympathetic nervous system effects on the heart, potentially allowing sympathetic (stimulatory) effects to predominate, resulting in increased heart rate [ 2 ]. Patients with a history of heart rhythm disorders, coronary artery disease, or congestive heart failure should use glycopyrrolate with caution and under close medical supervision.
Diagnosis and Management
If a patient experiences tachycardia while taking glycopyrrolate, they should contact their healthcare provider immediately, as dose adjustment or medication change may be necessary [ 3 ]. The diagnosis and management of PSVT involve vagal maneuvers, intravenous adenosine, diltiazem, or verapamil for hemodynamically stable patients, and cardioversion for hemodynamically unstable patients [ 3 ].
Key Considerations
- Higher doses and pre-existing cardiovascular conditions increase the risk of glycopyrrolate-induced PSVT.
- Close medical supervision is crucial for patients with a history of heart rhythm disorders, coronary artery disease, or congestive heart failure.
- Immediate medical attention is necessary if tachycardia occurs while taking glycopyrrolate.