Glycopyrrolate / Neostigmine Side Effects

Medically reviewed by Drugs.com. Last updated on Apr 12, 2025.

Applies to glycopyrrolate / neostigmine: intravenous solution.

Serious side effects

Along with its needed effects, glycopyrrolate/neostigmine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking glycopyrrolate / neostigmine:

Other side effects

Some side effects of glycopyrrolate / neostigmine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

For healthcare professionals

Applies to glycopyrrolate / neostigmine: intravenous solution.

General adverse events

The most common adverse effects of glycopyrrolate (glycopyrronium) include xerostomia, urinary hesitancy and retention, blurred vision, and photophobia due to mydriasis, cycloplegia, increased ocular tension, tachycardia, bradycardia, and decreased sweating. The most common adverse effects of neostigmine are bradycardia, nausea, vomiting, blurred vision, and photophobia.^[Ref]

Cardiovascular

• Common (1% to 10%): Increased/decreased heart rate
• Uncommon (0.1% to 1%): Supraventricular extrasystoles, ventricular extrasystoles (0.4%), procedural hypertension, chest discomfort, bradycardia, hypertension

Glycopyrrolate (glycopyrronium):

• Frequency not reported: Tachycardia, palpitation
• Postmarketing reports: Arrhythmias (including bradycardia, ventricular tachycardia, ventricular fibrillation), cardiac arrest, hypertension, hypotension, heart block, QTc interval prolongation

Neostigmine:

• Frequency not reported: Bradycardia, hypotension, tachycardia/increased heart rate
• Postmarketing reports: Cardiac arrest, cardiac arrhythmias (A-V block, nodal rhythm), hypotension, nonspecific electrocardiogram (EKG) changes, syncope^[Ref]

Dermatologic

• Uncommon (0.1% to 1%): Hyperhidrosis, erythema, pruritus

Glycopyrrolate (glycopyrronium):

• Frequency not reported: Decreased sweating, urticaria, pruritus, dry skin
• Postmarketing reports: Pruritus, edema, erythema, pain at the injection site

Neostigmine:

• Frequency not reported: Pruritus
• Postmarketing reports: Rash, urticaria, flushing increased diaphoresis^[Ref]

Gastrointestinal

• Common (1% to 10%): Nausea, dry mouth
• Uncommon (0.1% to 1%): Abdominal pain, dyspepsia, vomiting

Glycopyrrolate (glycopyrronium):

• Frequency not reported: Xerostomia, nausea, vomiting, constipation, bloated feeling

Neostigmine:

• Frequency not reported: Dry mouth, nausea, post-procedural nausea, vomiting, increased salivation
• Postmarketing reports: Bowel cramps, diarrhea, flatulence, increased peristalsis^[Ref]

Musculoskeletal

• Common (1% to 10%): Muscle weakness

Neostigmine:

• Postmarketing reports: Arthralgia, muscle cramps, spasms, weakness^[Ref]

Genitourinary

Glycopyrrolate (glycopyrronium):

• Frequency not reported: Urinary hesitancy and retention, impotence, micturition urgency

Neostigmine:

• Postmarketing reports: Urinary frequency^[Ref]

Hepatic

• Uncommon (0.1% to 1%): Increased glutamyl transferase^[Ref]

Hypersensitivity

Glycopyrrolate (glycopyrronium):

• Frequency not reported: Severe allergic reactions (including anaphylactic/anaphylactoid reactions), hypersensitivity

Neostigmine:

• Postmarketing reports: Allergic reactions (including anaphylaxis), hypersensitivity, angioedema^[Ref]

Nervous system

• Uncommon (0.1% to 1%): Involuntary muscle contraction, somnolence, prolonged neuromuscular blockade
• Frequency not reported: Confusion (especially in elderly adults)

Glycopyrrolate (glycopyrronium):

• Frequency not reported: Loss of taste, headache, nervousness, drowsiness, dizziness

Neostigmine:

• Frequency not reported: Dizziness, headache, prolonged neuromuscular blockade^[Ref]

Ocular

• Uncommon (0.1% to 1%): Visual accommodation disorder
• Frequency not reported: Dilatation of the pupils, angle closure glaucoma

Glycopyrrolate (glycopyrronium):

• Frequency not reported: Blurred vision, photophobia (due to mydriasis), cycloplegia, increased ocular tension^[Ref]

Other

• Uncommon (0.1% to 1%): Decreased blood total protein, increased urine beta 2 microglobulin, incision site complication

Glycopyrrolate (glycopyrronium):

• Frequency not reported: Weakness, suppression of lactation
• Postmarketing reports: Malignant hyperthermia

Neostigmine:

• Frequency not reported: Procedural complication, procedural pain, incision site complication, postoperative shivering^[Ref]

Psychiatric

• Uncommon (0.1% to 1%): Restlessness, sleep disorder, dizziness

Glycopyrrolate (glycopyrronium):

• Frequency not reported: Insomnia, mental confusion/excitement (especially in elderly adults)

Neostigmine:

• Frequency not reported: Insomnia^[Ref]

Renal

• Uncommon (0.1% to 1%): Albuminuria^[Ref]

Respiratory

• Uncommon (0.1% to 1%): Productive cough

Glycopyrrolate (glycopyrronium):

• Postmarketing reports: Respiratory arrest, decreased bronchial secretion

Neostigmine:

• Frequency not reported: Pharyngolaryngeal pain, dyspnea, less than 90% oxygen desaturation, increased oropharyngeal secretion
• Postmarketing reports: Bronchospasm (increased oral, pharyngeal, and bronchial secretions), respiratory arrest, respiratory depression^[Ref]

See also:

Further information

Glycopyrrolate/neostigmine side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer