Glycopyrrolate 200 micrograms / ml solution for injection – patient leaflet, side effects, dosage

1. What Glycopyrrolate Injection is and what it is used for

Glycopyrrolate belongs to a group of medicines called anticholinergic drugs. Glycopyrrolate Injection may be used

• to protect against some of the unwanted effects of drugs such as neostigmine or pyridostigmine, which are used to reverse the effects of certain types of muscle- relaxing drugs (called non-depolarising muscle relaxants)
• before an operation, to reduce saliva and other secretions and to make the stomach contents less acid
• before or during an operation, to reduce or prevent slowness of the heartbeat during surgery.

2. What you need to know before you are given Glycopyrrolate Injection

You must not be given Glycopyrrolate injection

• if you are allergic to glycopyrrolate or any of the other ingredients of this medicine (listed in section 6).
• if you have glaucoma (increased pressure in the eye).
• if you suffer from myasthenia gravis (a disorder that causes extreme muscle weakness and fatigue).
• if you have an enlarged prostate.

• if you have stomach or bowel problems such as obstruction of the stomach

  (pyloric stenosis) or bowel causing vomiting, abdominal pain and swelling (paralytic ileus).

• if you are taking Anticholinesterase-antimuscarinic combinations such as neostigmine plus glycopyrrolate should be avoided in patients with a prolonged QT interval (irregular heart rhythm).

Warnings and precautions

Talk to your doctor or nurse before you are given Glycopyrrolate Injection

• if you have Down’s Syndrome.
• if you are over 60 years of age.
• if you are a child.
• if you have history of heart disease, heart attack, coronary heart disease or irregular heart beats or high blood pressure.
• if you have a condition characterised by rapid heartbeat (including over-active thyroid, heart failure or heart surgery).
• if you have an overactive thyroid gland.
• if you have a high temperature (fever) (as the drug will inhibit sweating).
• if you have been administered inhalation anesthesia (to put you asleep before an operation) as it may cause a change in your normal heart rhythm.
• if you have gastric reflux (a condition in which the liquid stomach contents backs up (regurgitates) into the gullet.
• if you have diarrhea.
• if you have ulcerative colitis (an inflammation of the large intestine).
• if you have kidney disease you need to avoid repeated or large doses.
• if you are pregnant or are breast feeding (see section Pregnancy and breast-feeding below).

Other medicines and Glycopyrrolate Injection

Tell your doctor if you are taking, have recently taken, or might take any other medicines. A number of drugs can interact with Glycopyrrolate Injection which can significantly alter their effects.

These drugs include:

• Drugs for depression known as Tricyclic antidepressants (for example amitriptyline or imipramine) and Monoamine Oxidase Inhibitors (MAOIs) (for example phenelzine, tranylcypromine).
• Clozapine which is used to treat severe mental disorders.
• Phenothiazines used to treat severe mental problems or nausea, vomiting or vertigo (for example chlorpromazine, fluphenazine, prochlorperazine, trifluoperazine).
• Antihistamines used to treat allergies (for example promethazine).
• Strong pain relievers such as Nefopam.
• Pethidine (used to treat moderate to severe pain).
• Domperidone or metoclopramide (used to treat nausea and vomiting).
• Ketoconazole (used to treat fungal infections).
• Amantadine, levodopa which is used to treat Parkinson’s disease or viral infection.
• Memantine (used to treat Alzheimer’s disease).
• Parasympathomimetics (these are drugs that affect chemicals in the body which are involved in transmission of nerve impulses to a muscle) (for example carbachol, neostigmine, physostigmine).
• Ritodrine (used to prevent uncomplicated premature labour).
• Corticosteroids used to treat various conditions including asthma and inflammatory disease (for example prednisolone).
• Slow-dissolving digoxin tablets, disopyramide (used to treat heart problems).

Glyceryl trinitrate tablets (used to treat angina) may not dissolve under the tongue as well as usual owing to the dry mouth which glycopyrrolate causes.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before you are given this medicine.

Driving and using machines

Glycopyrrolate may cause your eyesight to become blurred and this could interfere with your ability to drive or operate machinery safely. If you notice any problems with your vision after you receive your injection, do not drive or operate machinery until these effects have fully cleared. If you are in any doubt, ask your doctor for advice.

Information on sodium content

This medicine contains less than 1 mmol sodium (23 mg) per 2ml, that is to say essentially ‘sodium- free’.

3. How Glycopyrrolate Injection is given to you

The recommended dose is

Dosage when used before an operation

Adults and elderly

200 to 400 micrograms (0.2 to 0.4mg) may be injected into a vein or into a muscle before the anaesthetic is given. Alternatively, a dose of 4 to 5 micrograms per kilogram of body weight (0.004 to 0.005mg per kg) may be used, up to a maximum dose of 400 micrograms (0.4mg).

Use in children and adolescents:

4 to 8 micrograms per kilogram of body weight (0.004 to 0.008mg per kg) up to a maximum of 200 micrograms (0.2mg) may be injected into a vein or into a muscle before the anaesthetic is given.

Dosage when used during an operation

Adults and elderly

A single dose of 200 to 400 micrograms (0.2 to 0.4mg) should be given by injection into a vein. Alternatively, a single dose of 4 to 5 micrograms per kilogram of body weight (0.004 to 0.005mg per kg) may be used, up to a maximum of 400 micrograms (0.4mg). This dose may be repeated if necessary.

Use in children and adolescents

A single dose of 200 micrograms (0.2mg) should be given by injection into a vein. Alternatively, a single dose of 4 to 8 micrograms per kilogram of body weight (0.004 to 0.008mg per kg) may be used, up to a maximum of 200 micrograms (0.2mg). This dose may be repeated if necessary.

Dosage when reversing the effects of non-depolarising muscle relaxants

Adults and elderly:

200 micrograms (0.2mg) per 1,000 micrograms (lmg) of neostigmine or the equivalent dose of pyridostigmine, by injection into a vein.

Alternatively, a dose of 10 to 15 micrograms per kilogram of body weight (0.01 to 0.015mg per kg) may be injected into a vein with 50 micrograms per kg (0.05mg per kg) of neostigmine or equivalent dose of pyridostigmine. Glycopyrrolate Injection may be administered at the same time and from the same syringe with the neostigmine or pyridostigmine.

Use in children and adolescents

10 micrograms per kg of body weight (0.0lmg per kg) may be injected into a vein with 50 micrograms per kg (0.05mg per kg) of neostigmine or the equivalent dose of pyridostigmine. Glycopyrrolate Injection may be administered at the same time and from the same syringe with the neostigmine or pyridostigmine.

Method of administration

Glycopyrrolate Injection is administered by injection into a muscle or into a vein.

If you are given more Glycopyrrolate Injection than you should. This is unlikely because the dose will be administered by a health professional. If you have any further questions on the use of this medicine, ask your doctor or nurse.

4. Possible side effects

Like all medicines, this medicine can sometimes cause side-effects, although not everybody gets them.

Consult a doctor straight away if you notice any of the following symptoms - you may need urgent medical treatment:

Swelling mainly of the face, lips or throat which makes it difficult to swallow or breathe, itching and rashes. This could be a sign of a severe allergic reaction or angioedema (frequency not known, cannot be estimated from the available data).

All medicines can cause allergic reactions although serious allergic reactions are very rare.

Other side effects have also been reported under the following frequency

Very rare (may affect up to 1 in 10,000 people)

• glaucoma (increased pressure in the eyes).

Not known: frequency cannot be estimated from the available data

• dry mouth
• difficulty in passing stools (constipation)
• absence of sweating
• slow heart rate followed by rapid heart rate, palpitations and irregular heart beat
• reduced secretions in the lungs
• difficulty in passing urine
• visual disturbances
• increased sensitivity towards light (photophobia)
• confusion
• nausea (feeling sick)
• vomiting
• dryness of the skin
• flushing
• giddiness
• urgent need to urinate
• unable to completely empty the bladder (urinary retention)

Reporting of side effects

If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme

Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Glycopyrrolate Injection

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the label, carton after EXP. The expiry date refers to the last day of that month.

Do not store above 25°C. Protect from light.

If only part of the contents of an ampoule is used, the remaining solution should be discarded.

Do not use this medicine if you notice the ampoule is damaged or if the contents are discoloured.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment

6. Contents of the pack and other information

What Glycopyrrolate Injection contains

• The active substance is glycopyrrolate.

Each 1ml of glass ampoule contains 200 micrograms (0.2mg) glycopyrrolate. Each 3ml glass ampoule contains 600 micrograms (0.6mg) glycopyrrolate.

• The other ingredients are sodium chloride, dilute hydrochloric acid and water for injections.

What Glycopyrrolate Injection looks like and contents of the pack

Glycopyrrolate Injection is a clear, colourless, sterile solution for injection. Glycopyrrolate Injection is available in clear glass ampoules containing 1ml or 3ml of solution. Each cardboard carton contains ten l ml ampoules or ten 3 ml ampoules. Not all pack sizes may be marketed.

Marketing Authorisation Holder

Mercury Pharmaceuticals Ltd,

Dashwood House, 69 Old Broad Street, London, EC2M 1QS, United Kingdom

Manufacturer

B. Braun Melsungen AG, Mistelweg 2, 12357 Berlin, Germany.

This leaflet was last revised in September 2023.