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Library / Pharmacology / Autonomics / Anticholinergics / Glycopyrrolate

Glycopyrrolate

Key Board Facts Grid

Target Receptors

Peripheral M1, M2, M3 muscarinic antagonist

BBB Penetration

Quaternary ammonium; does NOT cross the BBB

Primary Indication

Preoperative reduction of airway and gastric secretions, peptic ulcer, drooling

First-Line Antidote

Physostigmine for muscarinic toxicity if systemic absorption occurs

Mechanism of Action

  • Competitive muscarinic antagonism in salivary and gastric glands.
  • Decreases oral secretions, gastric acid, and GI motility.
  • Quaternary structure prevents CNS entry, minimizing delirium and sedation.

Adverse Effects & Toxicities

  • Dry mouth, constipation, urinary retention, blurred vision, tachycardia.
  • Much less CNS delirium than atropine or scopolamine.
  • Contraindications: narrow-angle glaucoma, severe BPH/urinary retention, GI obstruction.

DO / OMM Board Pearl

Peripheral autonomic salivary/gastric splanchnic block. Useful when anticholinergic effects are desired without CNS penetration, such as with pyridostigmine in myasthenia gravis.