glycopyrronium

General

Pronunciation:
glye-koe-pir-oh-nee-um

Trade Name(s)

• Qbrexza

Ther. Class.

none assigned

Pharm. Class.

anticholinergics

Indications

Primary axillary hyperhidrosis.

Action

Inhibits the action of acetylcholine at receptors on certain peripheral tissues, including sweat glands, which reduces sweating.

Therapeutic Effect(s):

Reduced sweating.

Pharmacokinetics

Absorption: Not systemically absorbed after topical administration.

Distribution: Minimal to no distribution to tissues.

Metabolism and Excretion: Unknown.

Half-life: Unknown.

TIME/ACTION PROFILE (plasma concentrations)

Contraindication/Precautions

Contraindicated in:

• Glaucoma;
• Acute hemorrhage;
• Severe ulcerative colitis;
• Toxic megacolon;
• Myasthenia gravis;
• Sjogren's syndrome;
• Paralytic ileus

Use Cautiously in:

• Urinary retention
• Renal impairment
• OB:   Safety not established in pregnancy;
• Lactation:  Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
• Pedi:   Children <9 yr (safety and effectiveness not established).

Adverse Reactions/Side Effects

Derm: dry skin

EENT: blurred vision, dry eye, mydriasis, nasal dryness, oropharyngeal pain

GI: dry mouth, constipation

GU: urinary hesitation

Local: burning, erythema, pruritus

Neuro: headache

Misc: heat stroke, hyperpyrexia

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Additive anticholinergic effects with other  anticholinergics, including  antihistamines,  phenothiazines,  meperidine,  amantadine,  tricyclic antidepressants,  quinidine, and  disopyramide ; avoid concurrent use.

Route/Dosage

Topical (Adults and Children ≥9 yr): Using a single cloth, apply to each underarm not more frequently than once every 24 hr.

Availability

Topical cloths: 2.4%

Assessment

• Monitor for signs and symptoms of urinary retention (difficulty passing urine, distended bladder) during therapy, especially in patients with prostatic hypertrophy or bladder-neck obstruction.

Potential Diagnoses

• Deficient knowledge, related to medication regimen (Patient/Family/Teaching) 

Implementation

• Topical Cloths are individually packaged. Unfold cloth and wipe across one entire underarm once. Using same cloth, wipe other underarm once. Discard cloth. A single cloth should be used to apply glycopyrronium to both underarms. Wash hands with soap immediately after use. Use only on underarms; do not apply to broken skin or apply occlusive dressing. May cause temporary pupil dilation and blurred vision if in contact with eyes.

Patient/Family Teaching

• Instruct patient in correct technique for applications. Do not apply to areas other than the underarm. Advise patient to read  Patient Information  before starting therapy and with each Rx refill in case of changes.
• May cause transient blurred vision. Caution patient to avoid driving and other activities requiring clear vision until response to medication is known.
• Advise patients to watch for generalized lack of sweating when in hot or very warm temperatures and to avoid use if not sweating under these conditions. If signs and symptoms of heat illness (hot, red skin; decreased alertness or passing out; fast, weak pulse; fast, shallow breathing; fever) occur notify health care professional promptly.
• Advise patient to notify health care professional immediately if signs and symptoms of urinary retention (difficulty urinating, urinating frequently, urination in a weak stream or drips, full bladder, difficulty emptying bladder) occur.
• Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Decreased underarm sweating.