Glycopyrrolate

  • 1-2 mg qday-TID
  • Can be titrated upwards for better control if anticholinergic effects are well-tolerated

  • Anticholinergic Competitive antagonist of acetylcholine on postganglionic muscarinic receptors in sweat glands reduces perspiration

  • Avoid in elderly and in patients with
    • Uncontrolled narrow-angle glaucoma
    • Obstructive uropathy
    • Severe colitis
    • Diseases with decreased GI motility
    • Postural hypotension
    • Unstable cardiac disease
    • Cognitive impairment
    • Myasthenia gravis

  • Xerostomia
  • Dry eyes
  • Blurred vision
  • Constipation
  • Urinary retention 
  • Dizziness
  • Postural hypotension
  • Cognitive impairment (confusion)
  • Insomnia
  • Heart rhythm disturbance
  • Glaucoma (rare)
  • Hyperthermia (rare)
  • Seizures (rare)

Increased risk of anticholinergic side effects if taken with

  • Antidepressants (TCAs, SSRIs, MAOIs)
  • Olanzapine
  • Other anticholinergic medications

Increase pharmacologic effect of

  • Atenolol
  • Digoxin

Decrease pharmacologic effect of

  • Phenothiazines

  • Individual sensitivity and absorption to medication variable
  • Good for treatment of palmoplantar, axillary and craniofacial hyperhidrosis. 
  • Onset usually within days 
  • Although sometimes poorly tolerated, many patients’ symptoms are well controlled at low doses without many adverse effects
  • Pregnancy category B