Peptic Ulcer Disease
Glycopyrrolate is used as an adjunct in the treatment of peptic ulcer disease. Glycopyrrolate injection is used in patients with peptic ulcer disease when rapid antimuscarinic effect is desired or oral therapy is not tolerated. As with other antimuscarinics, there are no conclusive data from well-controlled studies which indicate that, in usually recommended dosage, glycopyrrolate aids in the healing, decreases the rate of recurrence, or prevents complications of peptic ulcers. In addition, in patients with gastric ulcer, antimuscarinics may delay gastric emptying and result in antral stasis. With the advent of more effective therapies for the treatment of peptic ulcer disease, antimuscarinics have only limited usefulness in this condition. Current epidemiologic and clinical evidence supports a strong association between gastric infection with Helicobacter pylori and the pathogenesis of duodenal and gastric ulcers, and the American College of Gastroenterology (ACG), the National Institutes of Health (NIH), and most clinicians currently recommend that all patients with initial or recurrent duodenal or gastric ulcer and documented H. pylori infection receive anti-infective therapy for treatment of the infection. For a more complete discussion of H. pylori infection, including details about the efficacy of various regimens and rationale for drug selection,
Glycopyrrolate injection has been used as a preoperative medication to inhibit salivation and excessive secretions of the respiratory tract; however, the current practice of using thiopental (no longer commercially available in the US), halothane, or similar general anesthetics that do not stimulate the production of salivary or tracheobronchial secretions has reduced the need to control excessive respiratory secretions during surgery. Although glycopyrrolate injection has been used prophylactically to prevent acid-aspiration pneumonitis during surgery, antimuscarinics, including glycopyrrolate, have not been shown to be effective for this use. Glycopyrrolate injection may be used to prevent cholinergic effects during surgery, such as cardiac arrhythmias, hypotension, and bradycardia, which may result from traction on viscera (with resultant vagal stimulation), stimulation of the carotid sinus, or administration of drugs (e.g., succinylcholine). Glycopyrrolate injection is administered concurrently with anticholinesterase agents (e.g., neostigmine, pyridostigmine) to block the adverse muscarinic effects of these latter agents when they are used after surgery to terminate curarization. Unlike atropine or hyoscyamine (tertiary amine antimuscarinics), glycopyrrolate (quaternary ammonium antimuscarinic) does not readily penetrate the CNS and therefore will not reverse the central effects of physostigmine. Because glycopyrrolate does not have appreciable CNS effects, it may be preferred in some patients. For further discussion on the use of glycopyrrolate injection in surgery, .