Glycopyrrolate Risks, Warnings, and Complications

ACUTE ANGLE-CLOSURE GLAUCOMA: Glycopyrrolate can lead to increased intraocular pressure and cause acute angle-closure glaucoma. It can also make anti-glaucoma medications less effective and may be contraindicated in people with glaucoma. Seek immediate medical care if you develop symptoms of acute angle-closure glaucoma, such as eye pain, redness, and dilated pupils.

INTESTINAL OBSTRUCTION: Glycopyrrolate can cause partial or complete mechanical obstruction in the intestines (bowel blockage). This medication is contraindicated in people with gastrointestinal conditions in which there is a mechanical blockage in the GI tract, for example, pyloroduodenal stenosis or strictures. An early symptom of incomplete obstruction can be diarrhea, especially in people who have an ileostomy or colostomy. 

GASTROINTESTINAL ADVERSE REACTIONS: Glycopyrrolate medication affects gastrointestinal motility (decreases peristalsis or the wave-like muscle contractions that move food and waste forward in the gastrointestinal tract). This can lead to severe constipation, delayed gastric emptying, and intestinal pseudo-obstruction. It can also cause or worsen bowel problems such as paralytic ileus and toxic megacolon. Glycopyrrolate is contraindicated in people with gastrointestinal motility disorders such as achalasia, intestinal atony, and paralytic ileus. Risk factors for decreased gastrointestinal motility include the use of other anticholinergic drugs or other medications that also decrease peristalsis. Seek immediate medical care for stomach problems such as distention (bloating), abdominal pain, nausea, or vomiting.

VISUAL AND COGNITIVE ADVERSE EFFECTS: Glycopyrrolate can cause drowsiness, dizziness, blurred vision, and impaired mental or physical abilities. Be cautious while performing potentially hazardous tasks such as driving a motor vehicle or operating heavy machinery until you know how this medicine affects you. Concomitant use of other medications that also have anticholinergic effects can make these side effects worse. 

HEAT STROKE: People taking glycopyrrolate can develop heat prostration (heat stroke and raised body temperature) in hot weather due to decreased sweating. This risk is higher in older adults. Avoid exposure to hot weather while on glycopyrrolate. 

CONDITIONS WORSENED BY ANTICHOLINERGIC DRUG EFFECTS: Glycopyrrolate is not recommended in people who have medical conditions that can be worsened by anticholinergic effects, for example, autonomic neuropathy, kidney disease, ulcerative colitis, hyperthyroidism (overactive thyroid), heart disease, heart failure, arrhythmias (irregular heartbeat), high blood pressure, or hiatal hernia associated with gastroesophageal reflux disease and esophagitis, and in people taking other anticholinergic medications.

INCREASED RISK IN GERIATRIC PATIENTS: Older adults (age 65 years and above) are at an increased risk of anticholinergic effects of glycopyrrolate, including bowel obstruction, urinary retention, heat stroke, arrhythmias, falls, and delirium (confusion). Glycopyrrolate may be contraindicated in some older adults with underlying medical conditions.