glycopyrrolate (inhalation)

General

**Off Market Drug**
This medication is no longer available in the United States. Information provided here is for reference purposes only.

Pronunciation:
glye-koe-pye-roe-late

Trade Name(s)

Lonhala Magnair

Ther. Class.

bronchodilators

Pharm. Class.

anticholinergics

Indications

Maintenance treatment of COPD.

Action

Inhibits the action of acetylcholine at the muscarinic receptor, M3, in the bronchial smooth muscle, leading to bronchodilation.

Therapeutic Effect(s):

Bronchodilation with decreased airflow obstruction.

Pharmacokinetics

Absorption: 40% systemically absorbed from lungs and GI tract following inhalation.

Distribution: Unknown.

Metabolism and Excretion: Undergoes hydroxylation to inactive metabolites. Eliminated primarily unchanged in the urine and bile.

Half-life: 33–53 hr.

TIME/ACTION PROFILE (blood levels)

ROUTE	ONSET	PEAK	DURATION
Inhaln	unknown	5 min	unknown

Contraindication/Precautions

Contraindicated in:

Hypersensitivity to any components or severe hypersensitivity to milk proteins;
Acute attack of COPD (onset of action is delayed).

Use Cautiously in:

Narrow-angle glaucoma;
Urinary retention, prostatic hyperplasia, bladder-neck obstruction;
OB: Safety not established in pregnancy
Lactation: Safety not established in breastfeeding
Pedi: Safety and effectiveness not established in children.

Adverse Reactions/Side Effects

EENT: nasopharyngitis, rhinitis, sinusitis

GI: diarrhea, nausea

MS: arthralgia

Neuro: fatigue

Resp: dyspnea, paradoxical bronchospasm, upper respiratory tract infection

Misc: HYPERSENSITIVITY REACTIONS (including angioedema, urticaria, or rash)

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

Interactions

Drug-Drug

↑ risk of adverse anticholinergic adverse reactions when used concurrently with other anticholinergics ; avoid concurrent use.

Route/Dosage

Inhaln (Adults): Lonhala Magnair: 1 vial (25 mcg) twice daily; Seebri Neohaler: 1 capsule (15.6 mcg) twice daily.

Availability

Solution for oral inhalation (Lonhala Magnair): 25 mcg/mL

In Combination with: budesonide and formoterol (Breztiri Aerosphere); formoterol (Bevespi Aerosphere); see combination drugs.

Assessment

Assess lung sounds, pulse, and BP before administration and during peak of medication. Note amount, color, and character of sputum produced. Closely monitor patients on higher dose for adverse effects.
Monitor pulmonary function tests before initiating and periodically during therapy to determine effectiveness.
Observe for paradoxical bronchospasm (wheezing, dyspnea, tightness in chest) and hypersensitivity reaction (rash; urticaria; swelling of the face, lips, or eyelids). If condition occurs, withhold medication and notify health care professional immediately.
Monitor ECG periodically during therapy. May cause prolonged QTc interval.
Monitor patient for signs of hypersensitivity reactions (difficulties in breathing or swallowing, swelling of tongue, lips and face), urticaria, or skin rash) throughout therapy. Discontinue therapy and consider alternative if reaction occurs.

Lab Test Considerations:

May cause ↑ serum glucose and decreased serum potassium.

Potential Diagnoses

Ineffective airway clearance (Indications)

Implementation

Inhaln
Administer as 2 inhalations twice daily, morning and evening.
- For Longhala: Only administer with Magnair nebulizer; do not swallow or inject solution. Remove vial from foil pouch immediately before use. Discard unopened vials after 7 days. Throw away plastic dispensing vials immediately after use; may risk choking in young children due to small size. Discard Magnair Handset parts after use with 60 vials; use replacement parts with next 60 vials.

Patient/Family Teaching

Instruct patient to use medication as directed. Do not discontinue therapy without discussing with health care professional, even if feeling better. If a dose is missed skip dose and take next dose at regularly scheduled time. Do not double doses. Use a rapid-acting bronchodilator if symptoms occur before next dose is due. Caution patient not to use more than 2 times a day; may cause adverse effects, paradoxical bronchospasm, or loss of effectiveness of medication. Instruct patient to review Medication Guide before starting therapy and with each Rx refill in case of changes.
Caution patient not to use medication to treat acute symptoms. A rapid-acting inhaled beta-adrenergic bronchodilator should be used for relief of acute asthma attacks. Notify health care professional immediately if symptoms get worse or more inhalations than usual are needed from rescue inhaler.
Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or nausea, vomiting, shakiness, headache, fast or irregular heartbeat, sleeplessness, or signs and symptoms of narrow angle glaucoma (eye pain or discomfort, blurred vision, visual halos or colored images, red eyes) or urinary retention (difficulty passing urine, painful urination) occur.
Advise patient to consult health care professional before taking any Rx, OTC, or herbal products or alcohol concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants.
Advise patient to notify health care professional if pregnancy is planned or suspected, or if breast feeding.
Longhala Magnair: See manufacturer's instructions for set up and use of Magnair nebulizer. Once Magnair nebulizer handset is set up, insert 1 vial into bottom of medication cap until it clicks. Make sure aerosol head is installed before attaching medication cap; medicine could leak and not deliver full treatment. Place medication cap with vial on the top of the handset body. To attach medication cap to handset body, turn medication cap in a clockwise direction until click is heard. Notch in medication cap (at the base of opening) should line up with blue line on handset body. Insert mouthpiece into mouth. Do not tilt handset, loosen or remove medication cap, or unclasp handset body until treatment is complete or full treatment will not be delivered. Press on button and breath normally. Magnair will beep at end of treatment and controller will automatically shut off. Treatment usually takes 2 to 3 minutes.

Evaluation/Desired Outcomes