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.
Glycopyrrolate and Paroxysmal Atrial Tachycardia:
- The FDA drug label mentions that glycopyrrolate can cause cardiac arrhythmias, including ventricular tachycardia and ventricular fibrillation.
- It also mentions that an increase in heart rate may occur, and to investigate any tachycardia before giving glycopyrrolate injection.
- However, it does not directly mention paroxysmal atrial tachycardia (supraventricular tachycardia) as a potential side effect.
- Based on the available information, it can be inferred that glycopyrrolate may potentially contribute to the development of cardiac arrhythmias, including supraventricular tachycardia, due to its effects on the heart rate.
- Therefore, caution should be exercised when administering glycopyrrolate to patients with pre-existing cardiac conditions or those who are prone to arrhythmias. 1 1 1
From the Research
Glycopyrrolate is unlikely to cause paroxysmal atrial tachycardia (PAT) and may even be used to manage certain tachyarrhythmias. Glycopyrrolate is an anticholinergic medication that blocks the action of acetylcholine at muscarinic receptors, which generally results in an increased heart rate rather than causing specific tachyarrhythmias like PAT 2. The most recent and highest quality study available, a 2021 randomized open, parallel-controlled multicenter clinical trial, found that glycopyrrolate is safe and effective in preventing bradycardia induced by neostigmine injection after general anesthesia surgery, with no significant difference in the incidence of adverse reactions compared to atropine 3.
Key Points
- Glycopyrrolate is not typically associated with causing PAT, but rather may be used to manage certain tachyarrhythmias
- The medication works by blocking the action of acetylcholine at muscarinic receptors, resulting in an increased heart rate
- Typical dosing of glycopyrrolate varies by indication, including preoperative use, reversal of neuromuscular blockade, and chronic conditions like COPD
- If a patient develops tachycardia while taking glycopyrrolate, the medication should be evaluated as a potential contributor, especially in patients with risk factors for arrhythmias such as electrolyte abnormalities, structural heart disease, or concomitant use of other medications that affect cardiac conduction 4, 2
Considerations
- Patients with pre-existing cardiac conditions may be at higher risk for arrhythmias when taking glycopyrrolate
- The medication's safety profile is well-established, with minimal penetration of the blood-brain barrier and lack of phototoxicity, genotoxicity, and carcinogenicity 2
- Glycopyrrolate may be a suitable alternative to atropine in certain situations, such as preventing bradycardia induced by neostigmine injection after general anesthesia surgery 3