Section 08 · Monograph
Glycopyrrolate
Reviewed Nov 2026FDA label
Robinul / CuvposaAnticholinergic
- Forms
- Tab: 1, 2mg | Sol: 1mg/5mL
- Dose
- Sialorrhea (off-label in ALS): 1-2mg TID
- MOA
- Muscarinic receptor blockade, ↓salivation
Indications
- Adjunct in peptic ulcer disease (tablets)FDA-labeled
- Chronic severe drooling in pediatric patients with neurologic conditions (oral solution)FDA-labeled
- Reduction of salivary secretions before anesthesia (injection)FDA-labeled
Off-Label Uses
- Sialorrhea in ALS and Parkinson's diseaseOff-label
Mechanism of Action
- Quaternary ammonium muscarinic antagonist that does not readily cross the blood-brain barrier, reducing salivary and other secretions
Full Dosing
Adult / usual
- Sialorrhea (off-label adults): 1-2mg three times daily
- Take 1 hour before or 2 hours after meals; titrate to effect
Pediatric
- Pediatric chronic drooling (oral solution): 0.02mg/kg three times daily, titrated
Contraindications
- Glaucoma
- Obstructive uropathy, obstructive GI disease or paralytic ileus
- Severe ulcerative colitis or toxic megacolon
- Myasthenia gravis (tablets), hypersensitivity
Drug Interactions
- Other anticholinergic drugs: additive effects
- Cholinesterase inhibitors antagonize effect
- Amantadine and tricyclics: additive anticholinergic effects
Adverse Effects
- Dry mouth, constipation, urinary retention
- Blurred vision, tachycardia
- Decreased sweating and heat intolerance
- Thickened bronchial secretions — monitor airway in patients with ALS
Monitoring Parameters
- Salivation response and airway secretions
- Urinary retention and bowel function
- Heat exposure
Pregnancy & Lactation
- Limited data; use only if benefit justifies risk
- May suppress lactation