Glycovent Nebuliser Solution

Indications

Glycopyrronium is used in several forms:

• Injection: before and during surgery to reduce saliva and airway secretions, to stop the heart slowing too much during anaesthesia, and together with Neostigmine to reverse muscle relaxants at the end of surgery.
• Inhaler: long-term maintenance treatment of chronic obstructive pulmonary disease (COPD), alone or combined with other inhaled medicines. It is not for sudden attacks of breathlessness.
• Tablets or oral solution: to reduce severe drooling in people with nerve conditions such as cerebral palsy, and sometimes for other uses such as excessive sweating, as prescribed.

How It Works

Glycopyrronium is an anticholinergic (antimuscarinic) medicine. It blocks acetylcholine, a natural chemical messenger, at glands and smooth muscle. This reduces saliva, sweat and airway secretions, and relaxes the airways so breathing is easier in COPD. It does not easily enter the brain, so it causes less confusion than some similar medicines.

Dosage and Administration

• Injection: given by a doctor or nurse in hospital; the dose depends on the procedure and the patient's weight.
• Inhaler for COPD: usually one inhalation (about 50 micrograms) once a day at the same time each day, or as prescribed. Use it only with the device it comes with and follow the device instructions.
• Tablets or oral solution: as prescribed; the dose is started low and adjusted by the doctor. Take at least 1 hour before or 2 hours after food, because food reduces absorption.

Interactions

Its effects add up with other anticholinergic medicines, such as some antihistamines, tricyclic antidepressants (for example Amitriptyline), some antipsychotics and antispasmodics (for example Hyoscine), increasing dry mouth, constipation and difficulty passing urine. Do not use it with another inhaled long-acting anticholinergic such as Tiotropium. The oral form should not be taken with solid Potassium Chloride tablets, as these can irritate the gut. Tell the doctor about all medicines you take.

Contraindications

• Allergy to glycopyrronium or any ingredient of the product.
• Angle-closure glaucoma.
• Difficulty passing urine due to an enlarged prostate or bladder blockage.
• Blockage or paralysis of the bowel, severe ulcerative colitis or toxic megacolon.
• Myasthenia gravis (for tablets and oral solution).

Side Effects

Common: dry mouth, constipation, difficulty passing urine, blurred vision, flushing, reduced sweating and fast heartbeat. With the inhaler: dry mouth, cough, throat irritation and urinary infection.

Get urgent medical help for: eye pain or redness with blurred vision or halos around lights (possible glaucoma), being unable to pass urine, sudden wheezing or breathlessness just after using the inhaler, fast or irregular heartbeat, severe constipation or stomach pain, high temperature in hot weather, or signs of an allergic reaction (swelling of the face, lips or throat, difficulty breathing).

Pregnancy and Lactation

There is limited information on use in pregnancy, so it should be used only if the doctor judges it necessary. It is not known how much passes into breast milk; ask the doctor before using it while breastfeeding.

Precautions and Warnings

Use with care in heart disease, irregular heartbeat, high blood pressure, an overactive thyroid, kidney problems (a lower dose may be needed), enlarged prostate, acid reflux, and in older people. Because it reduces sweating, it can cause overheating and fever in hot weather; avoid heavy exertion in the heat. It may cause blurred vision or dizziness, so do not drive if affected. The COPD inhaler is not a rescue inhaler; keep a quick-relief inhaler for sudden symptoms.

Overdose

Too much can cause severe dry mouth, hot dry skin, fever, very fast heartbeat, blurred vision, inability to pass urine and restlessness or confusion. Seek emergency medical help. In hospital the effects can be reversed with medicines such as Neostigmine.

Therapeutic Class

Anticholinergic (antimuscarinic) agent; long-acting muscarinic antagonist (LAMA) when inhaled.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Keep inhaler capsules in the blister until just before use. Injections are stored and handled by hospital staff.