Atropine sulfate 1 mg per 1 mlAtropine 1 mg/ 1 ml solution for
injection ampoules| 10 ampouleP£ 83. 61 DT = £ 83. 61eiiiiF 489Glycopyrronium bromide 13-Sep-2017
(Glycopyrrolate)
lINDICATIONS AND DOSE
Premedication at induction
▶BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INJECTION
▶Neonate: 5 micrograms/kg.▶Child 1 month–11 years: 4 – 8 micrograms/kg (max. per
dose 200 micrograms)
▶Child 12–17 years: 200 – 400 micrograms, alternatively
4 – 5 micrograms/kg (max. per dose 400 micrograms)
Intra-operative bradycardia
▶BY INTRAVENOUS INJECTION
▶Neonate: 10 micrograms/kg, repeated if necessary.▶Child: 4 – 8 micrograms/kg (max. per dose
200 micrograms), repeated if necessary
Control of muscarinic side-effects of neostigmine in
reversal of non-depolarising neuromuscular block
▶BY INTRAVENOUS INJECTION
▶Neonate: 10 micrograms/kg.▶Child 1 month–11 years: 10 micrograms/kg (max. per dose
500 micrograms)
▶Child 12–17 years: 10 – 15 micrograms/kg, alternatively,
200 micrograms per 1 mg of neostigmine to be
administered
Control of upper airways secretion|Hypersalivation
▶BY MOUTH
▶Child: 40 – 100 micrograms/kg 3 – 4 times a day (max. per
dose 2 mg), adjusted according to response, dose to be
administered using tablets or injection solution, see
Directions for administration
▶BY SUBCUTANEOUS INFUSION
▶Child 1 month–11 years: 12 – 40 micrograms/kg (max. per
dose 1. 2 mg) over 24 hours
▶Child 12–17 years: 0. 6 – 1. 2 mg/ 24 hours
▶BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR
INJECTION, OR BY INTRAVENOUS INJECTION
▶Child 1 month–11 years: 4 – 10 micrograms/kg 4 times a
day (max. per dose 200 micrograms) as required
▶Child 12–17 years: 200 micrograms every 4 hours as
required
SIALANAR®ORAL SOLUTION
Severe sialorrhoea (chronic pathological drooling)
▶BY MOUTH
▶Child 3–17 years:(consult product literature)lUNLICENSED USENot licensed for use in control of upper
airways secretion and hypersalivation.
IMPORTANT SAFETY INFORMATION
Antimuscarinic drugs used for premedication to general
anaesthesia should only be administered by, or under
the direct supervision of, personnel experienced in their
use.lCAUTIONS
SIALANAR®ORAL SOLUTIONCompromised blood-brain
barrier—monitor for behavioural changeslINTERACTIONS→Appendix 1 : glycopyrronium
lSIDE-EFFECTS
▶With oral useAngle closure glaucoma.anhidrosis.
arrhythmias.bronchial secretion decreased.dysphagia.
gastrointestinal hypomotility.mydriasis.photophobia.
speech disorder.thirst.urinary urgency
▶With parenteral useAngle closure glaucoma.anhidrosis.
bradycardia.bronchial secretion decreased.mydriasis.
photophobia.urinary urgency
lPREGNANCY
SIALANAR®ORAL SOLUTIONManufacturer advises avoid—
no information available.
lBREAST FEEDING
SIALANAR®ORAL SOLUTIONManufacturer advises avoid—
no information available.
lRENAL IMPAIRMENT
SIALANAR®ORAL SOLUTIONManufacturer advises avoid if
estimated glomerularfiltration rate is less than
30 mL/minute/ 1. 73 m^2.
Dose adjustmentsManufacturer advises reduce dose by
30 % if estimated glomerularfiltration rate is
30 – 89 mL/minute/ 1. 73 m^2 —consult product literature.
lDIRECTIONS FOR ADMINISTRATION
▶With oral use for Control of upper airways secretion or
HypersalivationFor administrationby mouth, injection
solution may be given or crushed tablets suspended in
water.
SIALANAR®ORAL SOLUTIONDoses should be given at
least 1 hour before or 2 hours after food, or at consistent
times with respect to food if co-administration with food is
required—high-fat food should be avoided; for
administration by a nasogastric or feeding tube,flush with
10 mL of water immediately after dosing.
lPRESCRIBING AND DISPENSING INFORMATIONTablets may
be available on a named-patient basis from specialist
importing companies.
lPATIENT AND CARER ADVICE
SIALANAR®ORAL SOLUTIONManufacturer advises
patients and their carers should be informed to stop
treatment and seek medical advice if constipation, urinary
retention, pneumonia, allergic reaction, pyrexia, or
changes in behaviour occur; treatment should also be
stopped and medical advice sought in very hot weather.
lNATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) Decisions
TheScottish Medicines Consortiumhas advised (July 2017 )
that glycopyrronium bromide (Sialanar®) is accepted for
use within NHS Scotland for the symptomatic treatment of
severe sialorrhoea (chronic pathological drooling) in
children and adolescents aged 3 years and older with
chronic neurological disorders.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral solution
Tablet
▶Glycopyrronium bromide (Non-proprietary)
Glycopyrronium bromide 1 mgGlycopyrronium bromide 1 mg
tablets| 30 tabletP£ 180. 00 – £ 230. 77 DT = £ 230. 54
Glycopyrronium bromide 2 mgGlycopyrronium bromide 2 mg
tablets| 30 tabletP£ 198. 00 – £ 254. 24 DT = £ 254. 23
Solution for injection
▶Glycopyrronium bromide (Non-proprietary)
Glycopyrronium bromide 200 microgram per
1mlGlycopyrronium bromide 200 micrograms/ 1 ml solution for
injection ampoules| 10 ampouleP£ 5. 72 – £ 14. 00 DT = £ 12. 22
Glycopyrronium bromide 600 micrograms/ 3 ml solution for injection
ampoules| 3 ampouleP£ 8. 00 | 10 ampouleP£ 9. 61 – £ 13. 97
Oral solution
▶Glycopyrronium bromide (Non-proprietary)
Glycopyrronium bromide 200 microgram per
1mlGlycopyrronium bromide 1 mg/ 5 ml oral solution sugar free
sugar-free| 150 mlP£ 91. 00 DT = £ 91. 00BNFC 2018 – 2019 Anaesthesia adjuvants 811
Anaesthesia15