Glycopyrrolate Use in Children

Marcia L. Buck, Pharm.D., FCCP, FPPAG


Pediatr Pharm. 2010;6(12) 

In This Article

Abstract and Introduction


Glycopyrrolate, a synthetic anti-cholinergic, was approved for use by the Food and Drug Administration (FDA) in 1961.[1,2] It is used primarily in the preoperative setting or during procedural sedation to reduce salivary, pharyngeal, and bronchial secretions, reduce the volume and acidity of gastric secretions, and block cardiac vagal inhibitory reflexes during induction and intubation. Glycopyrrolate is also used to antagonize the peripheral muscarinic effects (bronchospasm, bradycardia, and increased gastrointestinal motility) produced by acetylcholinesterases such as neostigmine when they are given postoperatively to reverse non-depolarizing neuromuscular blocking agents.

For many years, glycopyrrolate has been used off-label for the management of sialorrhea in children with cerebral palsy or other neurologic conditions and to reduce tracheobronchial secretions in children with tracheostomies.[3] On July 29, 2010, a new glycopyrrolate oral solution was approved by the FDA for the treatment of chronic severe sialorrhea caused by neurologic conditions in pediatric patients between 3 and 16 years of age.[4] This issue of Pediatric Pharmacotherapy will provide a brief review of the pharmacology of glycopyrrolate and an overview of recent case reports and studies related to its use in children.


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