Side effects of glycopyrrolate

Glycopyrrolate

Glycopyrrolate is a medicine used to treat ulcers and reduce excessive drooling caused by certain medical conditions (especially cerebral palsy).

The medicine is sold under the brand names Robinul, Cuvposa, Robinul Forte, and Glycate.

Glycopyrrolate is also given before surgery to reduce secretions in the mouth, throat, airways, and stomach — and it’s given both before and during surgery to block certain reflexes and protect against side effects of some medications.

Glycopyrrolate belongs to a class of drugs called anticholinergics. It works by blocking the activity of acetylcholine, a neurotransmitter.

The Food and Drug Administration (FDA) first approved glycopyrrolate in 1961. It’s manufactured by several different pharmaceutical companies.

Glycopyrrolate Warnings

Before taking glycopyrrolate, tell your doctor if you have, or have ever had:

  • Glaucoma
  • An enlarged prostate
  • Ulcerative colitis
  • Paralytic ileus (a bowel condition)
  • Gastrointestinal disease
  • Myasthenia gravis (a chronic neuromuscular disease)
  • Overactive thyroid
  • High blood pressure
  • Irregular or rapid heartbeat
  • Heart failure or coronary artery disease
  • Hiatal hernia (a condition in which part of the stomach pushes up into the chest) with reflux
  • Kidney or liver disease
  • Disorders of the nervous system
  • Spastic paralysis (a disorder characterized by weakness and stiffness of muscles) or brain damage
  • Allergies to medicines

Tell your doctor you take glycopyrrolate before having any type of surgery, including a dental procedure.

Glycopyrrolate may reduce your body’s ability to cool down by sweating. It can cause fever or heat stroke in very high temperatures.

Be sure to drink plenty of water and avoid excessive heat while taking this medicine.

Glycopyrrolate can also make your eyes more sensitive to sunlight, so it may be helpful to wear sunglasses while taking the medication.

Elderly people and children may be more sensitive to certain side effects of glycopyrrolate. Talk to your doctor if this is a concern.

Newborns and infants should not take glycopyrrolate unless a doctor tells you otherwise.

Some formulations of the drug contain benzyl alcohol, which can cause serious and sometimes fatal side effects in babies.

Pregnancy and Glycopyrrolate

Talk to your doctor if you’re pregnant or become pregnant while taking glycopyrrolate.

You’ll have to discuss the risks and benefits of using this medicine during pregnancy.

It’s not known whether glycopyrrolate passes into breast milk. Check with your doctor before breastfeeding while taking this drug.

Before taking glycopyrrolate,

  • tell your doctor and pharmacist if you are allergic to glycopyrrolate, any other medications, or any of the ingredients in glycopyrrolate tablets or solution. Ask your pharmacist for a list of the ingredients..
  • tell your doctor if you are taking extended-release (long-acting) potassium chloride tablets or capsules. Your doctor may tell you not to take glycopyrrolate if you are taking this medication.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amantadine (Symmetrel); atenolol (Tenormin, in Tenoretic); digoxin (Lanoxin); levodopa (in Rytary, in Sinemet, in Stavelo); ipratropium (Atrovent); mediations for anxiety, irritable bowel disease, mental illness, motion sickness, Parkinson’s disease, seizures, ulcers, or urinary problems; sedatives; tranquilizers; and tricyclic antidepressants such as amitriptyline, amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with glycopyrrolate, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
  • tell your doctor if you have or have ever had glaucoma; difficulty urinating; a blockage or narrowing of your stomach or intestines, paralytic ileus (condition in which digested food does not move through the intestines) toxic megacolon (a serious or life-threatening widening of the intestine), or myasthenia gravis (a disorder of the nervous system that causes muscle weakness). Your doctor may tell you not to take glycopyrrolate.
  • tell your doctor if you have or have ever had enlargement of the prostate, ulcerative colitis (a condition which causes swelling and sores in the lining of the colon and rectum), overactive thyroid, high blood pressure, heart failure, irregular or rapid heartbeats, coronary artery disease, hiatal hernia with reflux, disorders of the nervous system, or kidney or liver disease.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking glycopyrrolate, call your doctor.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking glycopyrrolate.
  • you should know that glycopyrrolate may make you drowsy or cause blurred vision. Do not drive a car or operate machinery until you know how this medication affects you.
  • you should know that glycopyrrolate reduces the body’s ability to cool off by sweating. Avoid being in hot or very warm temperatures. If you experience any of the following symptoms, call your doctor immediately: lack of sweating in hot weather; hot, red skin; decreased alertness; loss of consciousness; fast, weak pulse; fast, shallow breathing; or fever.

glycopyrrolate (oral) (Cuvposa, Robinul, Robinul Forte)

Brand Names: Cuvposa, Robinul, Robinul Forte

Generic Name: glycopyrrolate (oral)

  • What is glycopyrrolate (Cuvposa, Robinul, Robinul Forte)?
  • What are the possible side effects of glycopyrrolate (Cuvposa, Robinul, Robinul Forte)?
  • What is the most important information I should know about glycopyrrolate (Cuvposa, Robinul, Robinul Forte)?
  • What should I discuss with my healthcare provider before taking glycopyrrolate (Cuvposa, Robinul, Robinul Forte)?
  • How should I take glycopyrrolate (Cuvposa, Robinul, Robinul Forte)?
  • What happens if I miss a dose (Cuvposa, Robinul, Robinul Forte)?
  • What happens if I overdose (Cuvposa, Robinul, Robinul Forte)?
  • What should I avoid while taking glycopyrrolate (Cuvposa, Robinul, Robinul Forte)?
  • What other drugs will affect glycopyrrolate (Cuvposa, Robinul, Robinul Forte)?
  • Where can I get more information (Cuvposa, Robinul, Robinul Forte)?

What is glycopyrrolate (Cuvposa, Robinul, Robinul Forte)?

Glycopyrrolate helps to control conditions such as peptic ulcers that involve excessive stomach acid production.

Glycopyrrolate is also used to reduce drooling in children ages 3 to 16 who have certain medical conditions, such as cerebral palsy.

Glycopyrrolate injection is also used during surgery to reduce secretions in your stomach or airway, and to help protect your heart and nervous system while you are under general anesthesia.

Glycopyrrolate may also be used for purposes not listed in this medication guide.

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What are the possible side effects of glycopyrrolate (Cuvposa, Robinul, Robinul Forte)?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using glycopyrrolate and call your doctor at once if you have:

  • severe constipation, severe stomach pain and bloating;
  • diarrhea (especially if you have a colostomy or ileostomy);
  • painful or difficult urination;
  • fast or pounding heartbeats, fluttering in your chest;
  • confusion, severe drowsiness;
  • eye pain, seeing halos around lights;
  • fever, shallow breathing, weak pulse, hot and red skin; or
  • (in a child taking glycopyrrolate) dry diapers, fussiness, or excessive crying.

Common side effects may include:

  • constipation, nausea, vomiting, bloating;
  • drowsiness, dizziness, weakness, feeling nervous;
  • slow heartbeats;
  • sleep problems (insomnia);
  • blurred vision, sensitivity to light;
  • dry mouth, decreased sense of taste;
  • decreased sweating, decreased urination;
  • impotence, sexual problems;
  • headache; or
  • rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about glycopyrrolate (Cuvposa, Robinul, Robinul Forte)?

You should not use glycopyrrolate if you have urination problems, a blockage in your stomach or intestines, severe constipation, severe ulcerative colitis or toxic megacolon, glaucoma, myasthenia gravis, or active bleeding with heart and blood circulation problems.

Glycopyrrolate Side Effects

Medically reviewed by Drugs.com. Last updated on Jan 25, 2019.

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For the Consumer

Applies to glycopyrrolate: oral solution, oral tablet

Other dosage forms:

  • inhalation capsule, inhalation solution
  • solution

Along with its needed effects, glycopyrrolate may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking glycopyrrolate:

More common

  • Body aches or pain
  • chills
  • constipation
  • cough
  • decrease in the frequency of urination
  • decrease in urine volume
  • difficulty in passing urine (dribbling)
  • difficulty with breathing
  • ear congestion
  • feeling of warmth
  • fever
  • headache
  • loss of voice
  • nasal congestion
  • painful urination
  • redness of the face, neck, arms, and occasionally, upper chest
  • runny nose
  • sneezing
  • sore throat
  • unusual tiredness or weakness

Less common

  • Abdominal or stomach discomfort or pain
  • abdominal or stomach distension
  • chest pain
  • confusion
  • convulsions
  • dizziness
  • dry heaves
  • dry mouth
  • fainting
  • increase in heart rate
  • lightheadedness
  • pain or tenderness around the eyes and cheekbones
  • rapid breathing
  • shortness of breath or troubled breathing
  • stuffy nose
  • sunken eyes
  • thirst
  • tightness in the chest
  • vomiting
  • wheezing
  • wrinkled skin

Get emergency help immediately if any of the following symptoms of overdose occur while taking glycopyrrolate:

  • low blood pressure
  • muscle weakness
  • trouble breathing

Some side effects of glycopyrrolate may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

  • Altered mood
  • anxiety
  • attack, assault, or force
  • bloated
  • change in taste
  • chapped lips
  • crying
  • dry skin
  • dry tongue
  • excess air or gas in the stomach or intestines
  • full feeling
  • hyperventilation
  • irregular heartbeats
  • irritability
  • loss of taste
  • moaning
  • nervousness
  • pain
  • paleness of the skin
  • passing gas
  • rash
  • restlessness
  • shaking
  • trouble with sleeping
  • uncontrolled eye movements

For Healthcare Professionals

Applies to glycopyrrolate: compounding powder, inhalation capsule, inhalation solution, injectable solution, oral solution, oral tablet

Gastrointestinal

Very common (10% or more): Dry mouth (40%), vomiting (40%), constipation (35%)

Frequency not reported: Abdominal distension, abdominal pain, stomach discomfort, chapped lips, flatulence, retching, dry tongue

Cardiovascular

Very common (10% or more): Flushing (30%)

Frequency not reported: Heart rate increase, pallor

Nervous system

Very common (10% or more): Headache (15%)

Frequency not reported: Convulsion, dysgeusia, nystagmus

Postmarketing reports: Loss of taste

Genitourinary

Very common (10% or more): Urinary retention (15%)

Postmarketing reports: Suppression of lactation

Immunologic

Very common (10% or more): Sinusitis (15%), upper respiratory tract infection (15%)

Frequency not reported: Pneumonia, tracheostomy infection, urinary tract infection

Respiratory

Very common (10% or more): Nasal congestion (30%)

Frequency not reported: Increased viscosity of bronchial secretion, nasal dryness

Psychiatric

Frequency not reported: Irritability, agitation, restlessness, abnormal behavior, aggression, crying, impulse control disorder, moaning, mood altered

Dermatologic

Frequency not reported: Dry skin, pruritus, rash

Metabolic

Frequency not reported: Dehydration

Other

Frequency not reported: Pain

1. “Product Information. Cuvposa (glycopyrrolate).” Shionogi USA Inc, Florham Park, NJ.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

Medical Disclaimer

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Oral Medications

Oral hyperhidrosis medications are best suited for patients with certain types of excessive sweating such as excessive facial sweating (cranio-facial hyperhidrosis), generalized hyperhidrosis, and those who have not had success using other therapies like clinical strength antiperspirants, iontophoresis, Botox, or a customized combination of these. People who have compensatory sweating from ETS surgery, sweat over a large body area (such as the back or chest), need temporary relief from sweating every once in a while for a special event (such as a performance or presentation), or have excessive sweating secondary to a medication or medical condition may also find success with oral medications.

Anticholinergics

The most commonly used medications for managing excessive sweating are anticholinergics. These include medicines such as: glycopyrrolate, oxybutynin, benztropine, propantheline, and others.

Many hyperhidrosis patients experience success with anticholinergic therapy. Anticholinergics have not, however, been studied in controlled clinical trials specifically for hyperhidrosis. Their FDA approval is, on the other hand, based on studies involving other medical conditions. Their use for hyperhidrosis is thus “off-label”. Of course, it is common for medications to be used “off-label” and a substantial safe history of off-label use of these meds has helped many doctors to feel confident about them. Some anticholinergics, such as glycopyrrolate and oxybutynin, have even been found to be safe in young children.

It should be noted, however, that more recent studies(in JAMA Neurology 2016 and JAMA Internal Medicine 2015) have reported a potential link between the development of dementia and/or brain atrophy and long-term, high-level anticholinergic use by older people. Patients over (or near) the age of 65 may want to discuss these studies (JAMA Neurology 2016 and JAMA Internal Medicine 2015) with their physicians before embarking on or continuing anticholinergic therapy for excessive sweating.

Besides possibly in this older age group (and more studies are needed on this), anticholinergics do not, in general, affect the central nervous system (the brain and spinal cord). They work, instead, more peripherally by blocking the chemical messenger acetylcholine as it attempts to travel to receptors on the sweat glands that are responsible for triggering sweating. Similar receptors are, however, located in multiple areas of the body, so there can be a range of side effects from anticholingeric therapy such as: dry mouth, constipation, impaired taste, blurred vision, urinary retention, and heart palpitations. These side effects can usually be managed by adjusting the individual’s dose. Of possible future use, a new medication that combines oxybutynin and pilocarpine (to combat dry mouth and other side effects) is being studied. David M. Pariser, MD, International Hyperhidrosis Society founding board member, and an expert in treating hyperhidrosis patients, characterizes the side effects of anticholinergic treatments as “predictable, manageable and usually mild.”

That said, there are some hyperhidrosis patients who need to be cautious when using anticholinergics.

As mentioned above, patients age 65 or older may want to discuss their anticholinergic use and potential dementia risks with their physicians, but other patients need to be careful and informed, too.

Because anticholinergic medications work systemically and cannot target any one body area in particular, they decrease sweating over the entire body, even those locations where sweating is not a problem. This overall decrease in sweating can put the patient at risk for overheating. Dee Anna Glaser, MD, president and founding board member of the International Hyperhidrosis Society, treats hundreds of hyperhidrosis patients a year and is well versed in anticholinergic use. She cautions her patients saying, “When taking anticholingerics, the body may have more difficulty keeping itself cool with the sweat mechanism ‘turned off.’ Therefore, athletes, people who participate in sports, people who work outdoors and anyone who may potentially cause themselves injury by becoming overheated must use extra care when considering these treatments.” Patients or parents of children taking the medication must remain aware of temperature, water intake, exertion, and any symptoms of overheating such as pale skin, dizziness, muscle cramping, weakness, headache, and nausea.

Further, patients with glaucoma (especially narrow-angle glaucoma) and those who have impaired gastric emptying or a history or symptoms of urinary retention should not use anticholingeric therapy.

Two commonly prescribed anticholinergic medications are now available in liquid formulations, which is important and helpful for children who suffer from hyperhidrosis. Specifically, the FDA has approved a liquid form of the anticholinergic glycopyrrolate (brand name, Cuvposa) to reduce drooling in pediatric cerebral palsy patients. This new formulation of a commonly used anticholinergic medication offers an alternative for children who are unable or unwilling to swallow the pills. Oxybutynin is also available in a liquid formulation, and is approved for use in pediatric patients with certain bladder and urinary conditions. Dr. Pariser says the benefits of oral anticholinergics in liquid form have been immediate. “I had an 8-year-old child who couldn’t swallow the tablets, no matter how crushed or mixed with food. Here’s a great solution. And because this medicine is approved for children, it gives reassurance to patients of all ages who have safety concerns with this therapy.”

Beta Blockers and Benzodiazepines

There are other oral medications besides anticholinergics that are successful in treating patients with specific types of hyperhidrosis, as well. Beta blockers (propranolol) and benzodiazepines work by “blocking” the physical manifestations of anxiety. These meds act on the central nervous system and are best for patients who experience episodic or event-driven hyperhidrosis (such as excessive sweating brought on by job interviews or presentations). Side effects limit their long-term use. For instance, benzodiazepines can be habit-forming, and many patients cannot tolerate the sedative effects caused by both of these drug therapies.

There have also been single-case or small samples of patients with specific types of hyperhidrosis who responded to a variety of other oral medications. Agents such as Clonidine, indomethacin, gabapentin, and multiple others have shown effectiveness in very specific cases of hyperhidrosis.

Some physicians and their patients have had great success treating sweaty palms and sweaty feet by adding a crushed anticholinergic tablet to the water used during iontophoresis. Learn more about iontophoresis and how anticholinergics can make the process even more effective.

If you are interested in learning more about using oral medications to treat excessive sweating, find a healthcare provider who is well-versed in hyperhidrosis care and oral medications in the IHHS’s Physician Finder database.

What if a systemic oral medication isn’t right for you now? Maybe one will be in the future! Who knows what may become available! There are innovative developments on the horizon in hyperhidrosis care. But keep in mind, also, that there are great treatments available right now.

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