Glycopyrrolate 4 mg/20mL Injection
Other active recalls for Glycopyrrolate (different manufacturers) — 4 · tap to view
🆔 Identity & classification
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🏷️ RxNorm drug class
This medicine belongs to the Anticholinergic class.
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🏭 Manufacturer & labeler
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🩺 Clinical
Patient education
Supplement & herbal interactions
Some supplements/herbs that may interact with Glycopyrrolate — tap one for details:
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Ask a licensed pharmacist directly — free, answered by our team.
🧪 Inactive Ingredients / Excipients
Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.
💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.
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UNII LKG8494WBH
Benzyl alcohol is a clear liquid used as a preservative and solvent in medicines. It helps prevent bacterial and fungal growth and dissolves other ingredients to create uniform liquid formulations.
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UNII QTT17582CB
A strong acid used to adjust and maintain the proper pH level in liquid medicines, ensuring stability and preventing breakdown of active ingredients.
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UNII 55X04QC32I
A strong alkaline chemical used to adjust and maintain the pH balance of liquid medicines. It helps keep the medicine stable and ensures it stays effective during storage.
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UNII 059QF0KO0R
Water is a liquid solvent that dissolves and mixes ingredients together in liquid medicines, syrups, and injections. It helps distribute the active drug evenly throughout the product.
4 inactive ingredients listed in the exact product block matched to this NDC.
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ingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.Inactive ingredient FAQ
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💲 Pricing
A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.
| Price system | Per each | Per package |
|---|---|---|
| Retail pharmacies payNADAC · weekly | Not in the retail survey — common for institutional, discontinued, or low-volume packs. | |
| Medicaid paysCMS SDUD · 12 mo | No recent Medicaid claims on file for this NDC — rare and low-volume NDCs are suppressed in the public data. | |
| Medicare drug plans payPart D · quarterly | No Part D plan price is available for this NDC in our data. | |
| Medicare Part B allowsASP · J1596 | $0.365 / J1596 unit | — |
Where does this data come from?
🧾 Billing & reimbursement
Where does this data come from?
🔁 Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Glycopyrrolate .2 mg/mL 25021-0796-01 | Sagent | 10 vials | $1.481 | AP | Availability likely | — |
| Glycopyrrolate .2 mg/mL 63323-0578-01 | Fresenius | 25 vials | $1.481 | AP | Availability likely | — |
| Glycopyrrolate .2 mg/mL 00143-9584-10 | Hikma | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 00143-9585-25 | Hikma | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 00143-9679-10 | Hikma | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 00143-9680-25 | Hikma | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 00404-9776-05 | Henry | 1 vial | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 00404-9777-20 | Henry | 1 vial | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 00517-4605-25 | American | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 00517-4620-25 | American | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate 1 mg/5mL 00781-3829-96 | Sandoz | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate 4 mg/20mLthis 00781-3831-95 | Sandoz | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 16729-0473-03 | Accord | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 16729-0474-03 | Accord | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate 1 mg/5mL 51662-1431-01 | HF | 5 ml | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 51662-1484-01 | HF | 20 ml | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 51662-1601-01 | HF | 5 ml | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 55150-0294-05 | AuroMedics | 25 vials | — | — | FDA listed | — |
| Glycopyrrolate .2 mg/mL 55150-0295-20 | AuroMedics | 25 vials | — | — | FDA listed | — |
| Glycopyrrolate .2 mg/mL 62332-0628-25 | Alembic | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 62332-0629-10 | Alembic | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate 1 mg/5mL 65145-0104-25 | Caplin | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate 4 mg/20mL 65145-0105-10 | Caplin | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 66794-0204-42 | Piramal | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 66794-0205-41 | Piramal | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 68083-0378-25 | Gland | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 68083-0379-10 | Gland | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 70069-0013-25 | Somerset | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 70069-0014-10 | Somerset | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 70069-0616-10 | Somerset | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 70069-0619-25 | Somerset | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate 1 mg/5mL 70121-1396-05 | Amneal | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate 4 mg/20mL 70121-1397-07 | Amneal | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 70700-0167-25 | Xiromed | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 70700-0168-23 | Xiromed | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 70700-0902-25 | Xiromed, | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 70700-0903-23 | Xiromed, | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 70756-0633-25 | Lifestar | 25 vials | — | — | FDA listed | — |
| Glycopyrrolate .2 mg/mL 70756-0634-10 | Lifestar | 10 vials | — | — | FDA listed | — |
| Glycopyrrolate .2 mg/mL 71288-0415-06 | Meitheal | 25 vials | — | AP | FDA listed | — |
| glycopyrrolate 1 mg/5mL 71839-0125-25 | BE | 25 vials | — | AP | FDA listed | — |
| glycopyrrolate 4 mg/20mL 71839-0126-25 | BE | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 71872-7012-01 | Medical | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 71872-7013-01 | Medical | 1 vial | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 71872-7094-01 | Medical | 1 vial | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 71872-7175-01 | Medical | 1 vial | — | AP | FDA listed | — |
| Glycopyrrolate 4 mg/20mL 71872-7179-01 | Medical | 1 vial | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 71872-7196-01 | Medical | 1 vial | — | AP | FDA listed | — |
| Glycopyrrolate 4 mg/20mL 71872-7289-01 | Medical | 1 vial | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 71872-7292-01 | Medical | 1 vial | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 71872-7307-01 | Medical | 1 vial | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 75834-0195-25 | Nivagen | 25 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 75834-0196-10 | Nivagen | 10 vials | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 84549-0204-42 | ProPharma | 5 ml | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 84549-0205-41 | ProPharma | 20 ml | — | AP | FDA listed | — |
| Glycopyrrolate .2 mg/mL 86211-0113-10 | Jvet | 10 vials | — | AP | FDA listed | — |
Where does this data come from?
⏳ Availability & generic status
This product is an FDA-approved generic. Other versions of the same drug are listed under Therapeutic equivalents, least expensive first.
Where does this data come from?
📊 Medicare Part D spend CMS · PART D · 2026 (Q1)
🔬 Reported adverse events (FAERS)
Top reported reactions
Age at onset
Reporter sex
Serious outcomes
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📦 Packaging — all sizes for this product
| Package NDC | Description | Marketing start | Status |
|---|---|---|---|
| 00781-3831-95 You're viewing this | 10 VIAL in 1 CARTON (0781-3831-95) / 20 mL in 1 VIAL (0781-3831-80) | 2019-07-22 | Active |
🧭 About this NDC listing & data coverage
What data is (and isn’t) available for this NDC — tap to expand
| NDC identity (package / product / labeler codes) | ✓ Available |
| Labeler | ✓ Available |
| Product & package description | ✓ Available |
| Marketing category & status | ✓ Available |
| Active ingredient / dosage form / route | ✓ Available |
| FDA label (SPL via DailyMed) | ✓ Available |
| Package photos | ✓ Available |
| Inactive ingredients (structured) | ✓ Available |
| NADAC pharmacy acquisition price (CMS) | — Not published for this NDC CMS publishes NADAC only for NDCs reported in its retail-pharmacy survey. |
| Orange Book / therapeutic-equivalence data | ✓ Available |
| HCPCS J-code billing crosswalk | ✓ Available |
| Medicaid utilization (CMS SDUD) | — Not published for this NDC CMS reports utilization only for NDCs with Medicaid claims above its privacy threshold. |
Questions about this listing
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📄 Full prescribing information FDA SPL
🎯 Indications and Usage ▾
1 INDICATIONS AND USAGE Glycopyrrolate injection is an anticholinergic indicated: in anesthesia (adult and pediatric patients) • for reduction of salivary, tracheobronchial, and pharyngeal secretions, reduction of volume and acidity of gastric secretions, and blockade of cardiac inhibitory reflexes during induction of anesthesia and intubation. • intraoperatively to counteract surgically or drug-induced or vagal reflex-associated arrhythmias. • for protection against peripheral muscarinic effects of cholinergic agents.
( 1 ) in peptic ulcer (adults) • To reduce symptoms of a peptic ulcer as an adjunct to treatment of peptic ulcer when rapid anticholinergic effect is desired or oral medication is not tolerated. Limitations of Use Glycopyrrolate injection is not indicated as monotherapy for the treatment of peptic ulcer because effectiveness in peptic ulcer healing has not been established. ( 1 )
1.1Preanesthetic Glycopyrrolate injection is indicated in adults and pediatric patients for reduction of salivary, tracheobronchial, and pharyngeal secretions, reduction of volume and acidity of gastric secretions, and blockade of cardiac inhibitory reflexes during induction of anesthesia and intubation.
1.2Intraoperative Glycopyrrolate injection is indicated in adults and pediatric patients to counteract surgically or drug-induced or vagal reflex-associated arrhythmias.
1.3Reversal of Neuromuscular Blockade Glycopyrrolate injection is indicated in adults and pediatric patients for protection against peripheral muscarinic effects of cholinergic agents such as neostigmine and pyridostigmine given to reverse the neuromuscular blockade due to non-depolarizing agents.
1.4Peptic Ulcer Glycopyrrolate injection is indicated in adults to reduce symptoms of a peptic ulcer as an adjunct to treatment of peptic ulcer when rapid anticholinergic effect is desired or when oral medication is not tolerated. • Limitations of Use Glycopyrrolate injection is not indicated as monotherapy for the treatment of peptic ulcer because effectiveness in peptic ulcer healing has not been established.
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION Glycopyrrolate Injection may be administered intramuscularly (IM), or intravenously (IV) without dilution, in the following indications. ( 2.1 ): Adults ( 2.2 , 2.3 , 2.4 , 2.5 ) Preanesthetic Medication: 0.004 mg/kg IM, given 30 to 60 minutes prior to the anticipated time of induction of anesthesia Intraoperative Medication: single doses of 0.1 mg IV and repeated, as needed, at intervals of 2 to 3 minutes Reversal of Neuromuscular Blockade: 0.2 mg for each 1 mg of neostigmine or 5 mg of pyridostigmine Peptic Ulcer: 0.1 mg IV or IM at 4-hour intervals, 3 or 4 times daily Pediatric patients ( 2.2 , 2.3 , 2.4 ) Preanesthetic Medication: 0.004 mg/kg IM, given 30 to 60 minutes prior to the anticipated time of induction of anesthesia.
Patients under 2 years of age may require up to 0.009 mg/kg Intraoperative Medication: 0.004 mg/kg IV, not to exceed 0.1 mg in a single dose and repeated, as needed, at intervals of 2 to 3 minutes Reversal of Neuromuscular Blockade: 0.2 mg IV for each 1 mg of neostigmine or 5 mg of pyridostigmine Peptic Ulcer: Glycopyrrolate Injection is not indicated for the treatment of peptic ulcer in pediatric patients Do not use this prefilled syringe to administer a dose of less than 0.1 mg (0.5 mL). ( 2.2 , 2.3 , 2.4 )
2.1Important Dosage and Administration Instructions • Dosing of this glycopyrrolate injection product is not possible in patients who require doses less than 0.1 mg because the recommended dose cannot be achieved with the supplied pre-filled syringe. For patients who require doses less than 0.1 mg, use another glycopyrrolate injection product that allows dosing of less than 0.1 mg. • Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. • Glycopyrrolate injection may be administered intramuscularly or intravenously, without dilution. • Do not introduce any other fluid into the syringe at any time. • Do not dilute for IV push. • Do not re-sterilize the syringe. • Do not use this product on a sterile field. • This product is for single dose only.
2.2Recommended Dosage of Preanesthetic Medication in Adults and Pediatric Patients The recommended dose of glycopyrrolate injection is 0.004 mg/kg by intramuscular injection, given 30 to 60 minutes prior to the anticipated time of induction of anesthesia or at the time the preanesthetic narcotic and/or sedative are administered. Patients less than 2 years of age may require up to 0.009 mg/kg. Do not use this prefilled syringe to administer a dose of less than 0.1 mg (0.5 mL).
2.3Recommended Dosage as Intraoperative Medication to Counteract Drug-induced or Vagal Reflexes and Their Associated Arrhythmias (e.g., bradycardia) in Adults and Pediatric Patients The recommended adult dose of glycopyrrolate injection is 0.1 mg intravenously. Repeat this dose, as needed, at intervals of 2 to 3 minutes. The recommended pediatric dosage is 0.004 mg/kg intravenously, not to exceed 0.1 mg in a single dose, repeated every 2 to 3 minutes.
Attempt to determine the etiology of the arrhythmia, and perform the surgical or anesthetic manipulations necessary to correct parasympathetic imbalance. Because of the long duration of action of glycopyrrolate injection if used as preanesthetic medication, additional glycopyrrolate injection for anticholinergic effect intraoperatively is rarely needed. Do not use this prefilled syringe to administer a dose of less than 0.1 mg (0.5 mL).
2.4Recommended Dosage for Reversal of Neuromuscular Blockade in Adults and Pediatric Patients The recommended dose of glycopyrrolate injection is 0.2 mg IV for each 1 mg of neostigmine or 5 mg of pyridostigmine. In order to minimize the appearance of cardiac side effects, the drugs may be administered simultaneously by intravenous injection. Do not use this prefilled syringe to administer a dose of less than 0.1 mg (0.5 mL).
2.5 Recommended Dosage for Peptic Ulcer in Adu…
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS Injection: 0.2 mg/mL glycopyrrolate in presentation of 0.2 mg/1 mL, 0.4 mg/2 mL, 1 mg/5 mL, and 4 mg/20 mL Injection: 0.2 mg/mL glycopyrrolate in presentation of 0.2 mg/1 mL, 0.4 mg/2 mL, 1 mg/5 mL, and 4 mg/20 mL
⛔ Contraindications ▾
4 CONTRAINDICATIONS Glycopyrrolate injection is contraindicated in: • patients with known hypersensitivity to glycopyrrolate injection or any of its inactive ingredients. • peptic ulcer patients with the following concurrent conditions: glaucoma; obstructive uropathy (for example, bladder neck obstruction due to prostatic hypertrophy); obstructive disease of the gastrointestinal tract (as in achalasia, pyloroduodenal stenosis, etc.); paralytic ileus, intestinal atony of the elderly or debilitated patient; unstable cardiovascular status in acute hemorrhage; severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; myasthenia gravis. • Known hypersensitivity to glycopyrrolate or any of its inactive ingredients.
( 4 ) • Peptic ulcer patients with glaucoma; obstructive uropathy; obstructive disease of the gastrointestinal tract; paralytic ileus, intestinal atony of the elderly, or debilitated patient; unstable cardiovascular status in acute hemorrhage; severe ulcerative colitis; toxic megacolon; complicating ulcerative colitis; myasthenia gravis. ( 4 )
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS • Precipitation of Acute Glaucoma: May cause mydriasis and increase intraocular pressure in patients with glaucoma. Advise patients with glaucoma to promptly seek medical care if they experience symptoms of acute angle closure glaucoma. ( 5.1 ) • Drowsiness or Blurred Vision: May cause drowsiness or blurred vision.
Advise patients not to drive or perform hazardous work until resolved. ( 5.2 ) • Heat Prostration: Advise patients to avoid exertion and high environmental temperatures after receiving Glycopyrrolate Injection. ( 5.3 ) • Intestinal Obstruction: Diarrhea may be an early symptom of incomplete intestinal obstruction.
Avoid use in patients with diarrhea and ileostomy or colostomy. ( 5.4 ) • Tachycardia: Increase in heart rate may occur. Use with caution in patients with coronary artery disease, congestive heart failure, cardiac arrhythmias, hypertension, or hyperthyroidism.
( 5.5 )
5.1Precipitation of Acute Glaucoma Glycopyrrolate injection may cause mydriasis and increase intraocular pressure in patients with glaucoma. Advise patients with glaucoma to promptly seek medical care in the event that they experience symptoms of acute angle closure glaucoma (pain and reddening of the eyes, accompanied by dilated pupils).
5.2Drowsiness or Blurred Vision Glycopyrrolate injection may cause drowsiness or blurred vision. Warn patients not to participate in activities requiring mental alertness, such as operating a motor vehicle or other machinery or performing hazardous work, until these issues resolve.
5.3Heat Prostration In the presence of fever, high environmental temperature, and/or during physical exercise, heat prostration can occur with use of anticholinergic agents including glycopyrrolate injection (due to decreased sweating), particularly in children and the elderly. Advise patients to avoid exertion and high environmental temperature after receiving glycopyrrolate injection.
5.4Intestinal Obstruction Diarrhea may be an early symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. In this instance treatment with glycopyrrolate injection is inappropriate and possibly harmful. Glycopyrrolate is contraindicated in patients with these conditions.
5.5Tachycardia Investigate any tachycardia before giving glycopyrrolate injection because an increase in the heart rate may occur. Use with caution in patients with coronary artery disease, congestive heart failure, cardiac arrhythmias, hypertension, or hyperthyroidism.
5.6Risk of Use in Patients with Renal Impairment Renal elimination of glycopyrrolate may be significantly reduced in patients with renal failure. Dosage adjustments may be necessary in this population [see Clinical Pharmacology ( 12.3 )].
5.7Autonomic Neuropathy, Hepatic Disease, Ulcerative Colitis, Prostatic Hypertrophy, or Hiatal Hernia Use glycopyrrolate injection with caution in the elderly and in all patients with autonomic neuropathy, hepatic disease, ulcerative colitis, prostatic hypertrophy, or hiatal hernia, because anticholinergic drugs may aggravate these conditions. Consider dose reduction and closely monitor the elderly and patients with autonomic neuropathy, hepatic disease, ulcerative colitis, prostatic hypertrophy, or hiatal hernia.
5.8Delayed Gastric Emptying/Gastric Stasis The use of anticholinergic drugs, including glycopyrrolate injection, in the treatment of peptic ulcer may produce a delay in gastric emptying due to antral stasis. Monitor patients for symptoms such as vomiting, dyspepsia, early satiety, abdominal distention, and increased abdominal pain. Discontinue glycopyrrolate injection treatment if these symptoms develop or worsen on treatment.
5.9Light Sensitivity Patients may experience sensitivity of the eyes to light. Advise patients to protect their eyes from light after receiving glycopyrrolate injection.
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS The following adverse reactions were identified in clinical studies or postmarketing reports. Because some of these reactions were reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Adverse reactions to anticholinergics include xerostomia (dry mouth); urinary hesitancy and retention; blurred vision and photophobia due to mydriasis (dilation of the pupil); cycloplegia; increased ocular tension; tachycardia; palpitation; decreased sweating; loss of taste; headache; nervousness; drowsiness; weakness; dizziness; insomnia; nausea; vomiting; impotence; suppression of lactation; constipation; bloated feeling; severe allergic reactions including anaphylactic/anaphylactoid reactions; hypersensitivity; urticaria, pruritus, dry skin, and other dermal manifestations; some degree of mental confusion and/or excitement, especially in elderly persons.
The following adverse events have been reported from post-marketing experience with glycopyrrolate: malignant hyperthermia; cardiac arrhythmias (including bradycardia, ventricular tachycardia, ventricular fibrillation); cardiac arrest; hypertension; hypotension; seizures; and respiratory arrest. Post-marketing reports have included cases of heart block and QTc interval prolongation associated with the combined use of glycopyrrolate and an anticholinesterase. Injection site reactions including pruritus, edema, erythema, and pain have also been reported.
Most common adverse reactions are related to anticholinergic pharmacology and may include xerostomia (dry mouth); urinary hesitancy and retention; blurred vision and photophobia due to mydriasis (dilation of the pupil); cycloplegia; increased ocular tension; tachycardia; bradycardia; palpitation; and decreased sweating. ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Sandoz Inc. at 1-800-525-8747 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
🔄 Drug Interactions ▾
7 DRUG INTERACTIONS The concurrent use of glycopyrrolate injection with other anticholinergics or medications with anticholinergic activity, such as phenothiazines, antiparkinson drugs, or tricyclic antidepressants, may intensify the antimuscarinic effects and result in an increase in anticholinergic side effects. Concomitant administration of glycopyrrolate injection and potassium chloride in a wax matrix may increase the severity of potassium chloride-induced gastrointestinal lesions as a result of a slower gastrointestinal transit time.
Other anticholinergics or drugs with anticholinergic activity: May intensify the antimuscarinic effects and result in an increase in anticholinergic side effects. ( 7 ) Potassium Chloride in a Wax Matrix: May increase severity of potassium chloride-induced gastrointestinal lesions. ( 7 )
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS Pediatric Use: Infants, patients with Down’s Syndrome, and pediatric patients with spastic paralysis or brain damage may experience an increased response to anticholinergics, thus increasing the potential for side effects. Large doses may cause hyperexcitability. ( 8.4 )
8.1Pregnancy Risk Summary Limited available data over decades of use with glycopyrrolate in pregnant women have not identified a drug-associated risk of birth defects and miscarriage, however, most of the reported exposures occurred after the first trimester. Most of the available data are based on studies with exposures that occurred at the time of Cesarean section delivery, and these studies have not identified an adverse effect on maternal outcomes or infant Apgar scores (see Data) . In animal reproduction studies in pregnant rats and rabbits administered glycopyrrolate orally (rats) and intramuscularly (rabbits) during the period of organogenesis, no teratogenic effects were seen at 320-times and 5-times the maximum recommended human dose (MRHD) of 2 mg (on a mg/m 2 basis), respectively (see Data) .
The background risk for major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in the clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Data Human Data Published, randomized, controlled trials over several decades, which compared the use of glycopyrrolate to another antimuscarinic agent in pregnant women during Cesarean section, have not identified adverse maternal or infant outcomes. In normal doses (0.004 mg/kg), glycopyrrolate does not appear to affect fetal heart rate or fetal heart rate variability to a significant degree. Concentrations of glycopyrrolate in umbilical venous and arterial blood and in the amniotic fluid are low after intramuscular administration to parturients.
Therefore, glycopyrrolate does not appear to penetrate through the placental barrier in significant amounts. There are no studies on the safety of glycopyrrolate exposure during the period of organogenesis, and therefore, it is not possible to draw any conclusions on the risk of birth defects following exposure to glycopyrrolate during pregnancy. In addition, there are no data on the risk of miscarriage following fetal exposure to glycopyrrolate.
Animal Data Reproduction studies with glycopyrrolate were performed in rats at a dietary dose of approximately 65 mg/kg/day (exposure was approximately 320 times the maximum recommended daily human dose of 2 mg on a mg/m 2 basis) and rabbits at intramuscular doses of up to 0.5 mg/kg/day (exposure was approximately 5 times the maximum recommended daily human dose on a mg/m 2 basis). These studies produced no teratogenic effects to the fetus. A preclinical study on reproductive performance of rats given glycopyrrolate resulted in a decreased rate of conception and survival at weaning.
8.2Lactation Risk Summary There are no data on the presence of glycopyrrolate in either human milk or animal milk, the effects on the breastfed infant, or the effects on milk production. As with other anticholinergics, glycopyrrolate may cause suppression of lactation [see Adverse Reactions ( 6 )] . The developmental and health benefits of breast feeding should be considered along with the mother’s clinical need for glycopyrrolate injection and any potential adverse effects on the breastfed child from glycopyrrolate injection or from the underlying maternal condition.
8.4Pediatric Use Glycopyrrolate Injection is indicated in pediatric patients: • for reduction of salivary, tracheobronchial, and pharyngeal secretions, reduction of volume and acidity of gastric secretions, and blockade of cardiac inhibitory reflexes during induction of anesthesia and intubation • intraoperatively to counteract surgica…
🤰 Pregnancy ▾
8.1Pregnancy Risk Summary Limited available data over decades of use with glycopyrrolate in pregnant women have not identified a drug-associated risk of birth defects and miscarriage, however, most of the reported exposures occurred after the first trimester. Most of the available data are based on studies with exposures that occurred at the time of Cesarean section delivery, and these studies have not identified an adverse effect on maternal outcomes or infant Apgar scores (see Data) . In animal reproduction studies in pregnant rats and rabbits administered glycopyrrolate orally (rats) and intramuscularly (rabbits) during the period of organogenesis, no teratogenic effects were seen at 320-times and 5-times the maximum recommended human dose (MRHD) of 2 mg (on a mg/m 2 basis), respectively (see Data) .
The background risk for major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in the clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Data Human Data Published, randomized, controlled trials over several decades, which compared the use of glycopyrrolate to another antimuscarinic agent in pregnant women during Cesarean section, have not identified adverse maternal or infant outcomes. In normal doses (0.004 mg/kg), glycopyrrolate does not appear to affect fetal heart rate or fetal heart rate variability to a significant degree. Concentrations of glycopyrrolate in umbilical venous and arterial blood and in the amniotic fluid are low after intramuscular administration to parturients.
Therefore, glycopyrrolate does not appear to penetrate through the placental barrier in significant amounts. There are no studies on the safety of glycopyrrolate exposure during the period of organogenesis, and therefore, it is not possible to draw any conclusions on the risk of birth defects following exposure to glycopyrrolate during pregnancy. In addition, there are no data on the risk of miscarriage following fetal exposure to glycopyrrolate.
Animal Data Reproduction studies with glycopyrrolate were performed in rats at a dietary dose of approximately 65 mg/kg/day (exposure was approximately 320 times the maximum recommended daily human dose of 2 mg on a mg/m 2 basis) and rabbits at intramuscular doses of up to 0.5 mg/kg/day (exposure was approximately 5 times the maximum recommended daily human dose on a mg/m 2 basis). These studies produced no teratogenic effects to the fetus. A preclinical study on reproductive performance of rats given glycopyrrolate resulted in a decreased rate of conception and survival at weaning.
🧒 Pediatric Use ▾
8.4Pediatric Use Glycopyrrolate Injection is indicated in pediatric patients: • for reduction of salivary, tracheobronchial, and pharyngeal secretions, reduction of volume and acidity of gastric secretions, and blockade of cardiac inhibitory reflexes during induction of anesthesia and intubation • intraoperatively to counteract surgically or drug-induced or vagal reflex-associated arrhythmias • for protection against peripheral muscarinic effects of cholinergic agents such as neostigmine and pyridostigmine given to reverse the neuromuscular blockade due to nondepolarizing agents Heat prostration can occur in pediatric patients in the presence of fever, high environmental temperature, and/or during physical exercise with use of anticholinergic agents including glycopyrrolate injection [see Warnings and Precautions ( 5.3 )] .
Young pediatric patients (and especially those less than 1 month of age), patients with Down syndrome, and pediatric patients with spastic paralysis or brain damage may experience an increased response to anticholinergics, thus increasing the potential for side effects. A paradoxical reaction characterized by hyperexcitability may occur in pediatric patients receiving large doses of anticholinergics including glycopyrrolate injection. Dysrhythmias associated with the use of glycopyrrolate intravenously as a premedicant or during anesthesia have been observed in pediatric patients.
The safety and effectiveness of glycopyrrolate injection for treatment of peptic ulcer have not been established in pediatric patients.
🧓 Geriatric Use ▾
8.5Geriatric Use Clinical studies of glycopyrrolate injection did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other therapy.
🆘 Overdosage ▾
10 OVERDOSAGE To combat peripheral anticholinergic effects, a quaternary ammonium anticholinesterase such as neostigmine methylsulfate (which does not cross the blood-brain barrier) may be given intravenously in increments of 0.25 mg in adults. This dosage may be repeated every five to ten minutes until anticholinergic overactivity is reversed or up to a maximum of 2.5 mg. Proportionately smaller doses should be used in pediatric patients.
Indication for repetitive doses of neostigmine should be based on close monitoring of the decrease in heart rate and the return of bowel sounds. If CNS symptoms (e.g., excitement, restlessness, convulsions, psychotic behavior) occur, physostigmine (which does cross the blood–brain barrier) may be used. Physostigmine 0.5 to 2 mg should be slowly administered intravenously and repeated as necessary up to a total of 5 mg in adults.
Proportionately smaller doses should be used in pediatric patients. To combat hypotension, administer IV fluids and/or pressor agents along with supportive care. Fever should be treated symptomatically.
Following overdosage, a curare-like action may occur, i.e., neuromuscular blockade leading to muscular weakness and possible paralysis. In the event of a curare-like effect on respiratory muscles, artificial respiration should be instituted and maintained until effective respiratory action returns.
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action Glycopyrrolate, like other anticholinergic (antimuscarinic) agents, inhibits the action of acetylcholine on structures innervated by postganglionic cholinergic nerves and on smooth muscles that respond to acetylcholine but lack cholinergic innervation. These peripheral cholinergic receptors are present in the autonomic effector cells of smooth muscle, cardiac muscle, the sinoatrial node, the atrioventricular node, exocrine glands and, to a limited degree, in the autonomic ganglia. Thus, it diminishes the volume and free acidity of gastric secretions and controls excessive pharyngeal, tracheal, and bronchial secretions.
12.2Pharmacodynamics Glycopyrrolate antagonizes muscarinic symptoms (e.g., bronchorrhea, bronchospasm, bradycardia, and intestinal hypermotility) induced by cholinergic drugs such as the anticholinesterases. The highly polar quaternary ammonium group of glycopyrrolate limits its passage across lipid membranes, such as the blood-brain barrier, in contrast to atropine sulfate and scopolamine hydrobromide, which are highly non-polar tertiary amines which penetrate lipid barriers easily. For this reason, the occurrence of CNS-related side effects is lower, in comparison to their incidence following administration of anticholinergics which are chemically tertiary amines that can cross this barrier readily.
With intravenous injection, the onset of action is generally evident within one minute. Following intramuscular administration, the onset of action is noted in 15 to 30 minutes, with peak effects occurring within approximately 30 to 45 minutes. The vagal blocking effects persist for 2 to 3 hours and the antisialagogue effects persist up to 7 hours, periods longer than for atropine.
12.3Pharmacokinetics The following pharmacokinetic information and conclusions were obtained from published studies that used nonspecific assay methods. Distribution The mean volume of distribution of glycopyrrolate was estimated to be 0.42 ±
0.22L/kg. Elimination Metabolism The in vivo metabolism of glycopyrrolate in humans has not been studied. Excretion The mean clearance and mean t 1/2 values were reported to be 0.54 ±
0.14L/kg/hr and 0.83 ± 0.27 hr, respectively post IV administration. After IV administration of a 0.2 mg radiolabeled glycopyrrolate, 85% of dose recovered was recovered in urine 48 hours post dose and some of the radioactivity was also recovered in bile. After IM administration of glycopyrrolate to adults, the mean t 1/2 value is reported to be between 0.55 to 1.25 hrs.
Over 80% of IM dose administered was recovered in urine and the bile as unchanged drug and half the IM dose is excreted within 3 hrs. The following table summarizes the mean and standard deviation of pharmacokinetic parameters from a study. Group t 1/2 (hr) V ss (L/kg) CL (L/kg/hr) T max (min) C max (mcg/L) AUC (mcg/L•hr) (6 mcg/kg IV) 0.83±0.27 0.42±0.22 0.54±0.14 – – 8.64±1.49* (8 mcg/kg IM) – – – 27.48±6.12 3.47±1.48 6.64±2.33* * 0 to 8 hr Specific Populations Pediatric Patients Following IV administration (5 mcg/kg glycopyrrolate) to infants and children, the mean t 1/2 values were reported to be between 21.6 and 130.0 minutes and between 19.2 and 99.2 minutes, respectively.
Patients with Renal Impairment In one study glycopyrrolate was administered IV in uremic patients undergoing renal transplantation. The mean elimination half-life was significantly longer (46.8 minutes) than in healthy patients (18.6 minutes). The mean area-under-the-concentration-time curve (10.6 hrmcg/L), mean plasma clearance (0.43 L/hr/kg), and mean 3-hour urine excretion (0.7%) for glycopyrrolate were also significantly different than those of controls (3.73 hr-mcg/L,
1.14L/hr/kg, and 50%, respectively). These results suggest that the elimination of glycopyrrolate is significantly reduced in patients with renal failure.
🧬 Mechanism of Action ▾
12.1Mechanism of Action Glycopyrrolate, like other anticholinergic (antimuscarinic) agents, inhibits the action of acetylcholine on structures innervated by postganglionic cholinergic nerves and on smooth muscles that respond to acetylcholine but lack cholinergic innervation. These peripheral cholinergic receptors are present in the autonomic effector cells of smooth muscle, cardiac muscle, the sinoatrial node, the atrioventricular node, exocrine glands and, to a limited degree, in the autonomic ganglia. Thus, it diminishes the volume and free acidity of gastric secretions and controls excessive pharyngeal, tracheal, and bronchial secretions.
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED/STORAGE AND HANDLING Glycopyrrolate injection, USP 0.2 mg/mL, is a clear, colorless solution free from visible particles available in: Strength Vial NDC Carton NDC 0.2 mg in 1 mL, Single-Dose Vial 0781-3825-71 0781-3825-96, Carton of 25 Vials 0.4 mg in 2 mL, Single-Dose Vial 0781-3827-72 0781-3827-96, Carton of 25 Vials 1 mg in 5 mL, Multiple-Dose Vial 0781-3829-75 0781-3829-96, Carton of 25 Vials 4 mg in 20 mL, Multiple-Dose Vial 0781-3831-80 0781-3831-95, Carton of 10 Vials Store at controlled room temperature, between 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature].
📋 Description ▾
11 DESCRIPTION Glycopyrrolate is a synthetic anticholinergic agent. It is a quaternary ammonium salt with the following chemical name: 3[(cyclopentylhydroxyphenylacetyl)oxy]-1,1-dimethyl pyrrolidinium bromide. Its structural formula is as follows: Molecular Formula: C 19 H 28 BrNO 3 Molecular Weight: 398.33 Glycopyrrolate occurs as a white, odorless crystalline powder.
Freely soluble in water, soluble in ethanol (96%). Very slightly soluble in methylene chloride. Practically insoluble in chloroform and in ether.
Unlike atropine, glycopyrrolate is completely ionized at physiological pH values. Glycopyrrolate injection, USP is a clear, colorless, sterile liquid; pH 2.0 to 3.0. The partition coefficient of glycopyrrolate in a n-octanol/water system is 0.304 (log 10 P= -1.52) at ambient room temperature (24°C).
Glycopyrrolate injection, USP, is intended for intramuscular or intravenous administration. Each 1 mL contains glycopyrrolate 0.2 mg, water for injection, benzyl alcohol as preservative, and pH adjusted with hydrochloric acid and/or sodium hydroxide as needed. chemical-structure
💬 Information for Patients ▾
17 PATIENT COUNSELING INFORMATION Drowsiness or Blurred Vision Inform patients that glycopyrrolate injection may cause drowsiness or blurred vision. Warn patients not to operate a motor vehicle or other machinery or perform hazardous work until these issues resolve [see Warnings and Precautions ( 5.2 )] . Heat Prostration Inform patients that in the presence of fever, high environmental temperature and/or during physical exercise, heat prostration can occur with use of anticholinergic agents, including glycopyrrolate injection (due to decreased sweating), particularly in children and the elderly.
Advise patients to avoid exertion and high environmental temperature after receiving glycopyrrolate injection [see Warnings and Precautions ( 5.3 )] . Light Sensitivity Advise patients that glycopyrrolate injection may cause sensitivity of the eyes to light and to protect their eyes from light after receiving glycopyrrolate injection [see Warnings and Precautions ( 5.9 )] . Drug Interactions Inform patients that glycopyrrolate injection may interact with other drugs.
Advise patients to report to their healthcare provider the use of any other medication [see Drug Interactions ( 7 )] . Distributed by Sandoz Inc., Princeton, NJ 08540