What are the contraindications for glycopyrrolate?

Contraindications for Glycopyrrolate

Glycopyrrolate is absolutely contraindicated in patients with known hypersensitivity to the drug or its inactive ingredients, and when used for longer-term peptic ulcer management, it is contraindicated in patients with glaucoma, obstructive uropathy, obstructive gastrointestinal disease, paralytic ileus, unstable cardiovascular status in acute hemorrhage, severe ulcerative colitis, toxic megacolon, and myasthenia gravis. 1

Absolute Contraindications

Universal Contraindication

• Known hypersensitivity to glycopyrrolate or any inactive ingredients 1

Additional Contraindications for Peptic Ulcer Management

When glycopyrrolate is used for longer duration therapy (as in peptic ulcer treatment), the following conditions are contraindicated 1:

• Glaucoma - The drug should be used with great caution, if at all, in patients with glaucoma 1
• Obstructive uropathy (e.g., bladder neck obstruction due to prostatic hypertrophy) 1
• Obstructive gastrointestinal disease including:
  • Achalasia 1
  • Pyloroduodenal stenosis 1
  • Other GI tract obstructions 1
• Paralytic ileus 1
• Intestinal atony in elderly or debilitated patients 1
• Unstable cardiovascular status in acute hemorrhage 1
• Severe ulcerative colitis 1
• Toxic megacolon complicating ulcerative colitis 1
• Myasthenia gravis 1

Context-Specific Contraindications

Bowel Obstruction Settings

• Complete mechanical bowel obstruction - Glycopyrrolate should not be used when mechanical bowel obstruction is present 2
• Diarrhea as early symptom of incomplete intestinal obstruction - Treatment would be inappropriate and possibly harmful, especially in patients with ileostomy or colostomy 1

Cardiac Considerations

• Uncontrolled tachycardia - Any tachycardia should be investigated before administration since glycopyrrolate may increase heart rate 1
• Contraindicated with oral antimuscarinic medication in cardiac insufficiency - As demonstrated in a case where conventional oral antimuscarinic medication was contraindicated due to cardiac insufficiency 3

Important Clinical Caveats

Distinction Between Short-Term and Long-Term Use

The FDA label specifically notes that the extensive list of contraindications applies primarily to longer duration therapy (such as peptic ulcer management), not necessarily to single-dose perioperative use 1. For anesthetic applications, the primary contraindication remains hypersensitivity.

Pediatric Benzyl Alcohol Concern

• Formulations containing benzyl alcohol require special consideration in neonates and preterm infants due to risk of toxicity (hypotension, metabolic acidosis) and kernicterus 1

Avoid Confusing Contraindications with Precautions

While not absolute contraindications, glycopyrrolate should be used with extreme caution in patients with coronary artery disease, congestive heart failure, cardiac arrhythmias, hypertension, hyperthyroidism, renal disease, autonomic neuropathy, hepatic disease, and hiatal hernia 1. These represent high-risk situations requiring careful monitoring rather than absolute prohibition.