Table 12

Glycopyrronium sublingual

Glycopyrronium sublingual
What is it?Antichloinergic
Mechanism of actionAntimuscarinic
Starting dose200mcg eight hourly prn sublingual
Time to onset of effect30–40 min17
FormulationOral solution
Noisy rattling breathing
Medical management of malignant bowel obstruction
Paraneoplastic fevers and sweating
Common adverse effectsConstipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting16
ContraindicationsTachycardia >100
Cardiac conduction disorders16
Renal impairment—may need to reduce dose
LicenceOral solution ‘off label’ use in adults and ‘off label’ route (however licensed for oral administration in children>3 years to adolescents with neurological disorders)
Injection is a licensed product but ‘off label’ route
BenefitsSmall volume
RisksRisk of glass ampoule when administering
Cost£91 for 150 mL × 200 μg/mL oral solution
£76.80 for 60 mL × 400 mcg/mL oral solution
£9.95 for 10 × 200 μg/mL ampoules for injection