GLYCOPYRROLATE

Fetal Risk Summary

Glycopyrrolate is an anticholinergic agent. In pregnant sheep, the transfer of glycopyrrolate (0.025 mg/kg) across the placenta was significantly less than that of atropine (0.05 mg/kg) (1). No change in maternal or fetal arterial pressure, fetal heart rate, or beat-to-beat variability was observed. In pregnant dogs, the placental passage of glycopyrrolate was again significantly less than that of atropine (2).

In a large prospective study, 2,323 patients were exposed to this class of drugs during the 1st trimester, only 4 of whom took glycopyrrolate (3). A possible association was found between the total group and minor malformations. Glycopyrrolate has been used before cesarean section to decrease gastric secretions (4,5,6 and 7). Maternal heart rate, but not blood pressure, was increased. Uterine activity increased as expected for normal labor. Fetal heart rate and variability were not changed significantly, confirming the limited placental transfer of this quaternary ammonium compound. No effects in the newborns were observed.

Glycopyrrolate has been recommended as the anticholinergic of choice during anesthesia for electroconvulsive therapy in pregnant patients (8).

Breast Feeding Summary

No data are available (see also Atropine).

References

1. Murad SHN, Conklin KA, Tabsh KMA, Brinkman CR III, Erkkola R, Nuwayhid B. Atropine and glycopyrrolate: hemodynamic effects and placental transfer in the pregnant ewe. Anesth Analg 1981;60:710–4.
2. Proakis AG, Harris GB. Comparative penetration of glycopyrrolate and atropine across the blood-brain and placental barriers in anesthetized dogs. Anesthesiology 1978;48:339–44.
3. Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA:Publishing Sciences Group, 1977:346–53.
4. Diaz DM, Diaz SF, Marx GF. Cardiovascular effects of glycopyrrolate and belladonna derivatives in obstetric patients. Bull NY Acad Med 1980;56:245–8.
5. Abboud TK, Read J, Miller F, Chen T, Valle R, Henriksen EH. Use of glycopyrrolate in the parturient: effect on the maternal and fetal heart and uterine activity. Obstet Gynecol 1981;57:224–7.
6. Roper RE, Salem MG. Effects of glycopyrrolate and atropine combined with antacid on gastric acidity. Br J Anaesth 1981;53:1277–80.
7. Abboud T, Raya J, Sadri S, Grobler N, Stine L, Miller F. Fetal and maternal cardiovascular effects of atropine and glycopyrrolate. Anesth Analg 1983;62:426–30.
8. Wise MG, Ward SC, Townsend-Parchman W, Gilstrap LC III, Hauth JC. Case report of ECT during high-risk pregnancy. Am J Psychiatry 1984;141:99–101.