Glycopyrrolate: It's time to review

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Medication shortages impact anesthesia practices, particularly for widely used drugs like glycopyrrolate (Robinul).
• Glycopyrrolate is frequently used with neostigmine for reversing neuromuscular blockade (NMB).

Purpose of the Study:

• To review historical studies on glycopyrrolate's efficacy and safety in NMB reversal compared to atropine.
• To determine the optimal dosage ratio of glycopyrrolate to neostigmine for NMB reversal.

Main Methods:

• Meta-analysis of studies published between 1972 and 1986.
• Inclusion of studies with varying patient selection, dosage, and drug combination criteria.

Main Results:

• Glycopyrrolate demonstrated superior efficacy and a better adverse effect profile than atropine for NMB reversal.
• A concomitant dosage ratio of 0.2 mg glycopyrrolate to 1 mg neostigmine (max 1 mg glycopyrrolate, 5 mg neostigmine) showed the greatest efficacy with minimal adverse effects.

Conclusions:

• The established practice of using a 0.2 mg glycopyrrolate to 1.0 mg neostigmine ratio for NMB reversal is supported by historical data.
• Current medication shortages and the lack of recent studies highlight the need for updated research on glycopyrrolate and neostigmine dosing.