Glycopyrrolate / Neostigmine Dosage

Medically reviewed by Drugs.com. Last updated on Jan 5, 2024.

Applies to the following strengths: 0.6 mg-3 mg/3 mL

Usual Adult Dose for Reversal of Nondepolarizing Muscle Relaxants

Recommended dose:

Neostigmine 0.03 mg/kg-glycopyrrolate 0.006 mg/kg intravenously
For reversal of neuromuscular blocking agents (NMBAs) with shorter half-lives, or when the first twitch response is greater than 10% of baseline, or when a second twitch is present.
Neostigmine 0.07 mg/kg-glycopyrrolate 0.014 mg/kg intravenously
For reversal of NMBAs with longer half-lives or when the first twitch response is close to 10% of baseline or there is a need for rapid recovery.

Maximum total dose: 0.07 mg/kg neostigmine or up to a total of 5 mg neostigmine, whichever is less.

Comments:

The recommended doses will achieve a twitch ratio of 90% within 10 to 20 minutes of administration, with minimal neostigmine-induced bradycardia.
Dose selection should be based on the extent of spontaneous recovery at the time of administration, the half-life of the NMBA being reversed, and if there is a need to rapidly reverse the NMBA.

Use: For the reversal of the effects of non-depolarizing neuromuscular blocking agents (NMBAs) in adult patients after surgery, while decreasing the peripheral muscarinic effects associated with cholinesterase inhibition following NMBA reversal.

Usual Pediatric Dose for Reversal of Nondepolarizing Muscle Relaxants

Recommended dose:

Neostigmine 0.03 mg/kg-glycopyrrolate 0.006 mg/kg intravenously
For reversal of neuromuscular blocking agents (NMBAs) with shorter half-lives, when the first twitch response is greater than 10% of baseline, or when a second twitch is present.
Neostigmine 0.07 mg/kg-glycopyrrolate 0.014 mg/kg intravenously
For reversal of NMBAs with longer half-lives or when the first twitch response is close to 10% of baseline or there is a need for rapid recovery.

Maximum dose: 0.07 mg/kg neostigmine or up to a total of 5 mg neostigmine, whichever is less.

Comments:

The recommended doses will achieve a twitch ratio of 90% within 10 to 20 minutes of administration, with minimal neostigmine-induced bradycardia.
Dose selection should be based on the extent of spontaneous recovery at the time of administration, the half-life of the NMBA being reversed, and if there is a need to rapidly reverse the NMBA.

Use: For the reversal of the effects of non-depolarizing neuromuscular blocking agents (NMBAs) in pediatric patients 2 years old and above after surgery, while decreasing the peripheral muscarinic effects associated with cholinesterase inhibition following NMBA reversal.

Renal Dose Adjustments

No adjustment recommended; however, close monitoring is required

Liver Dose Adjustments

No adjustment recommended; however, close monitoring is required

Precautions

CONTRAINDICATIONS:

Hypersensitivity to any of this drug's active components or inactive ingredients.
Peritonitis or mechanical obstruction of the intestinal or urinary tract.
Glaucoma; obstructive uropathy; obstructive disease of the gastrointestinal tract; paralytic ileus, intestinal atony of the elderly or debilitated patient; unstable cardiovascular status in acute hemorrhage; severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; myasthenia gravis.

Safety and efficacy have not been established in patients younger than 2 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

For intravenous use only and should be injected slowly over a period of at least one minute.
Should be administered by a trained healthcare provider familiar with this drug class.
Doses should be individualized, and a peripheral nerve stimulator should be used to determine the time of initiation and the need for additional doses.
Ensure that the patient is well-ventilated and maintains a clear airway before and after administration. The response to peripheral nerve stimulator and muscle tone should be assessed to determine a satisfactory recovery.

Storage requirements:

Store at 20C to 25C (68F to 77F); excursions permitted to 15C to 30C (59F to 86F)
Protect from light
Store in carton until time to use.

Reconstitution/preparation techniques:

The manufacturer's product information should be consulted for detailed instructions for use and appropriate technique.

General:

Use caution when administering to elderly adult patients and monitor for longer periods due to this drug's prolonged duration of action in the elderly.

Monitoring:

Train-of-four (TOF): Twitch response to the first stimulus of at least 10% of baseline level; continue monitoring for the extent of recovery and need for additional doses.
Full recovery: Based on the patient's medical condition, neuromuscular blocking agents (NMBA) used, and pharmacokinetics of neostigmine.

Patient advice:

Patients with glaucoma should seek medical care if they experience symptoms of acute closure glaucoma.
This drug may cause drowsiness and blurred vision. Do not operate machinery or perform hazardous work until these are resolved.