glycopyrronium + neostigmine metilsulfate at a glance
Medicine class
Anticholinesterase plus antimuscarinic reversal agent
Usual role
Reverses residual non-depolarising neuromuscular block after anaesthesia
Administration
Given into a vein by a healthcare professional in a monitored setting
What is glycopyrronium + neostigmine metilsulfate used for?
This combination is licensed for:
Reversal of residual non-depolarising, competitive neuromuscular block after anaesthesia.
How does glycopyrronium + neostigmine metilsulfate work?
Neostigmine increases acetylcholine at the neuromuscular junction, allowing nerve signals to activate skeletal muscle again. Glycopyrronium blocks many unwanted peripheral effects of increased acetylcholine, including a slow heart rate and excessive secretions.
glycopyrronium + neostigmine metilsulfate preparations and strengths
Injection
Route: Parenteral
Strengths: 0.5 mg + 2.5 mg/mL
How to take glycopyrronium + neostigmine metilsulfate
The anaesthetic team gives this injection into a vein; it is not self-administered. Follow the hospital’s instructions about fasting and usual medicines before anaesthesia.
It is a clear, colourless solution in a glass ampoule.
It should not be mixed with medicines where compatibility has not been established.
Any solution remaining after opening must be discarded.
glycopyrronium + neostigmine metilsulfate side effects
Common or expected effects
- Dry mouth, constipation, nausea, vomiting, diarrhoea, increased saliva or throat secretions, dizziness, blurred or disturbed vision, flushing, dry skin, reduced sweating and difficulty passing urine have been reported, but their frequency cannot be estimated.
- A slow, fast, pounding or irregular heartbeat may occur.
Get urgent medical advice
- Severe allergic reaction, anaphylaxis or angioedema.
- Bronchospasm or breathing difficulty.
- Clinically important slow heartbeat, conduction disturbance or another abnormal heart rhythm.
- Severe eye pain with impaired vision, which may indicate acute angle-closure glaucoma.
- Severe weakness, muscle twitching or paralysis, particularly with excessive anticholinesterase effects.
glycopyrronium + neostigmine metilsulfate in pregnancy
Use in human pregnancy has not been systematically evaluated, although glycopyrronium crosses the placenta poorly. Tell the anaesthetist about pregnancy or possible pregnancy so the specialist team can assess whether it is needed.
glycopyrronium + neostigmine metilsulfate while breastfeeding
The active substances may reach breast milk, but the selected product information states that amounts are probably too small to be harmful. Tell the anaesthetic team that you are breastfeeding so advice can consider the baby and all medicines used during the procedure.
glycopyrronium + neostigmine metilsulfate interactions
The anaesthetic team should review all current medicines because several can alter neuromuscular transmission or increase antimuscarinic effects.
Suxamethonium
Must not be given with this combination because neostigmine can prolong or intensify its neuromuscular block.
Other antimuscarinic medicines
May increase dry mouth, constipation, urinary retention and, particularly in older people, confusion.
Tricyclic antidepressants, monoamine oxidase inhibitors, clozapine, amantadine or nefopam
May increase antimuscarinic adverse effects.
Common questions about glycopyrronium + neostigmine metilsulfate
Answers are fully visible for fast scanning and source review.
What is it used for?
It reverses residual muscle relaxation caused by non-depolarising neuromuscular blockers after anaesthesia.
Why are the two ingredients given together?
Neostigmine restores neuromuscular signalling, while glycopyrronium reduces unwanted effects such as a slow heart rate and excessive saliva.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.