DESCRIPTION SECTION.

11 DESCRIPTION. Glycopyrrolate tablets, USP contain synthetic anticholinergic glycopyrrolate. Glycopyrrolate is quaternary ammonium compound with the following chemical name: 3-[(cyclopentyl hydroxyphenylacetyl)oxy]-1,1-dimethylpyrrolidinium bromide. The molecular formula for glycopyrrolate is C19H28BrNO3, the molecular weight is 398.3 g/mol, and the structural formula is: Each glycopyrrolate tablets, USP contains glycopyrrolate, USP mg or mg, as the active ingredient. The inactive ingredients are dibasic calcium phosphate, lactose monohydrate, magnesium stearate, povidone, and sodium starch glycolate. Chemical Structure.

ADVERSE REACTIONS SECTION.

6 ADVERSE REACTIONS. The following serious or otherwise important adverse reactions are discussed elsewhere in the labeling: Precipitation of Acute Glaucoma [see Warnings and Precautions (5.1)] Partial or Complete Mechanical Intestinal Obstruction [see Warnings and Precautions (5.2)] Gastrointestinal Adverse Reactions due to Decreased Gastrointestinal Motility [see Warnings and Precautions (5.3)] Cognitive and Visual Adverse Reactions [see Warnings and Precautions (5.4)] Heat Prostration at High Environmental Temperatures [see Warnings and Precautions (5.5)] Other Conditions Exacerbated by Anticholinergic Adverse Reactions [see Warnings and Precautions (5.6)] Increased Risk of Anticholinergic Adverse Reactions in Geriatric Patients [see Warnings and Precautions (5.7)] The following adverse reactions associated with the use of glycopyrrolate, or other anticholinergic drugs, were identified in clinical studies or postmarketing reports. Because some of these reactions are reported voluntarily from population of uncertain size, it is not always possible to reliably estimate their frequency or establish causal relationship to drug exposure. Cardiac Disorders: chest, pain, hypertension, tachycardia Endocrine Disorders: decreased sweating Eye Disorders: blurred vision, cycloplegia, dilatation of the pupil, increased ocular tension Gastrointestinal Disorders: bloated feeling, constipation, dry mouth, dysgeusia, nausea, vomiting Immune System Disorders: anaphylaxis [see Contraindications (4)] Nervous System Disorders: agitation, dizziness, drowsiness, headache, insomnia, mental confusion, nervousness, weakness Respiratory Disorders: respiratory depression, throat irritation Renal and Urinary Disorders: urinary hesitancy, urinary retention Reproductive System and Breast Disorders: impotence, suppression of lactation Vascular Disorders: flushing Precipitation of Acute Glaucoma [see Warnings and Precautions (5.1)] Partial or Complete Mechanical Intestinal Obstruction [see Warnings and Precautions (5.2)] Gastrointestinal Adverse Reactions due to Decreased Gastrointestinal Motility [see Warnings and Precautions (5.3)] Cognitive and Visual Adverse Reactions [see Warnings and Precautions (5.4)] Heat Prostration at High Environmental Temperatures [see Warnings and Precautions (5.5)] Other Conditions Exacerbated by Anticholinergic Adverse Reactions [see Warnings and Precautions (5.6)] Increased Risk of Anticholinergic Adverse Reactions in Geriatric Patients [see Warnings and Precautions (5.7)] Adverse reactions include blurred vision, drowsiness, decreased sweating, flushing, vomiting, constipation, dry mouth, tachycardia, and urinary retention. (6)To report SUSPECTED ADVERSE REACTIONS, contact Aurobindo Pharma USA, Inc. at 1-866-850-2876 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

CARCINOGENESIS & MUTAGENESIS & IMPAIRMENT OF FERTILITY SECTION.

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility. Reproduction studies in rats resulted in diminished rates of conception in dose-related manner. Studies in dogs suggest that diminished rates of conception may be due to diminished seminal secretion, which is evident at high doses of glycopyrrolate.

CLINICAL PHARMACOLOGY SECTION.

12 CLINICAL PHARMACOLOGY. 12.1 Mechanism of Action. Glycopyrrolate, an anticholinergic (antimuscarinic) agent, inhibits the action of acetylcholine on parietal cells in the stomach and decreases the volume and acidity of gastric secretions. 12.2 Pharmacodynamics. No formal pharmacodynamic studies have been conducted with glycopyrrolate. 12.3 Pharmacokinetics. Patients with Renal Impairment In the published literature, glycopyrrolate mcg/kg was administered intravenously (glycopyrrolate tablets are not recommended for intravenous use) in uremic patients undergoing renal transplantation surgery. The mean AUC (10.6 mcg.h/L) and 24-hour urinary excretion (7%) for glycopyrrolate were significantly different from normal healthy adult subjects undergoing general surgery (3.7 mcg.h/L, and 65%, respectively) [see Use in Specific Populations (8.6)].

CONTRAINDICATIONS SECTION.

4 CONTRAINDICATIONS. Glycopyrrolate tablets are contraindicated in: Patients at risk for anticholinergic toxicity due to an underlying medical condition, including: Glaucoma [see Warnings and Precautions (5.1)] Obstructive uropathies, including prostatic hypertrophyMechanical obstructive diseases of the gastrointestinal tract (e.g., pyloroduodenal stenosis, strictures) [see Warnings and Precautions (5.2)] Gastrointestinal motility disorders (e.g., achalasia, paralytic ileus, intestinal atony) [see Warnings and Precautions (5.3)] Bleeding gastrointestinal ulcer Active inflammatory or infectious colitis which can lead to toxic megacolonHistory of or current toxic megacolon Myasthenia gravis Patients with hypersensitivity to glycopyrrolate or any of the inactive ingredients in glycopyrrolate tablets [see Adverse Reactions (6) and Description (11)]. Patients at risk for anticholinergic toxicity due to an underlying medical condition, including: Glaucoma [see Warnings and Precautions (5.1)] Obstructive uropathies, including prostatic hypertrophyMechanical obstructive diseases of the gastrointestinal tract (e.g., pyloroduodenal stenosis, strictures) [see Warnings and Precautions (5.2)] Gastrointestinal motility disorders (e.g., achalasia, paralytic ileus, intestinal atony) [see Warnings and Precautions (5.3)] Bleeding gastrointestinal ulcer Active inflammatory or infectious colitis which can lead to toxic megacolonHistory of or current toxic megacolon Myasthenia gravis Glaucoma [see Warnings and Precautions (5.1)] Obstructive uropathies, including prostatic hypertrophy. Mechanical obstructive diseases of the gastrointestinal tract (e.g., pyloroduodenal stenosis, strictures) [see Warnings and Precautions (5.2)] Gastrointestinal motility disorders (e.g., achalasia, paralytic ileus, intestinal atony) [see Warnings and Precautions (5.3)] Bleeding gastrointestinal ulcer Active inflammatory or infectious colitis which can lead to toxic megacolon. History of or current toxic megacolon Myasthenia gravis Patients with hypersensitivity to glycopyrrolate or any of the inactive ingredients in glycopyrrolate tablets [see Adverse Reactions (6) and Description (11)]. Patients at risk for anticholinergic toxicity due to various underlying medical conditions. (4, 5.1, 5.2, 5.3)Hypersensitivity to glycopyrrolate or the inactive ingredients. (4). Patients at risk for anticholinergic toxicity due to various underlying medical conditions. (4, 5.1, 5.2, 5.3). Hypersensitivity to glycopyrrolate or the inactive ingredients. (4).

DOSAGE & ADMINISTRATION SECTION.

2 DOSAGE AND ADMINISTRATION. Important Dosing Information (2.1)Glycopyrrolate tablets mg are not recommended for patients initiating treatment or receiving maintenance treatment with glycopyrrolate tablets mg or another mg dosage strength of oral glycopyrrolate tablets.Recommended Dosage (2.2)The recommended initial dosage of glycopyrrolate tablets mg is mg three times daily (in the morning, early afternoon, and at bedtime). Some patients may require mg at bedtime to assure overnight control of symptoms. For maintenance, dosage of mg twice day is frequently adequate.The recommended dosage of glycopyrrolate tablets mg for adults is mg two or three times daily at equally spaced intervals.The maximum recommended daily dosage is mg.Use the lowest effective dosage of glycopyrrolate to control symptoms. If patients can be titrated to lower dose, switch from glycopyrrolate tablets mg to glycopyrrolate tablets mg or another mg oral tablet of glycopyrrolate.. Glycopyrrolate tablets mg are not recommended for patients initiating treatment or receiving maintenance treatment with glycopyrrolate tablets mg or another mg dosage strength of oral glycopyrrolate tablets.. The recommended initial dosage of glycopyrrolate tablets mg is mg three times daily (in the morning, early afternoon, and at bedtime). Some patients may require mg at bedtime to assure overnight control of symptoms. For maintenance, dosage of mg twice day is frequently adequate.. The recommended dosage of glycopyrrolate tablets mg for adults is mg two or three times daily at equally spaced intervals.. The maximum recommended daily dosage is mg.. Use the lowest effective dosage of glycopyrrolate to control symptoms. If patients can be titrated to lower dose, switch from glycopyrrolate tablets mg to glycopyrrolate tablets mg or another mg oral tablet of glycopyrrolate.. 2.1 Important Dosing Information. Glycopyrrolate tablets mg are not recommended for patients in whom lower dosage strength of oral glycopyrrolate (e.g., glycopyrrolate tablets mg or another mg tablet strength) is appropriate for initial or maintenance treatment because the dosage strength of glycopyrrolate tablets may exceed the recommended initial and maintenance dosage of oral glycopyrrolate tablets.. Glycopyrrolate tablets mg are not recommended for patients in whom lower dosage strength of oral glycopyrrolate (e.g., glycopyrrolate tablets mg or another mg tablet strength) is appropriate for initial or maintenance treatment because the dosage strength of glycopyrrolate tablets may exceed the recommended initial and maintenance dosage of oral glycopyrrolate tablets.. 2.2 Recommended Dosage. The recommended initial dosage of glycopyrrolate tablets mg for adults is mg three times daily (in the morning, early afternoon, and at bedtime). Some patients may require mg at bedtime to assure overnight control of symptoms. For maintenance, dosage of mg twice day is frequently adequate. The recommended dosage of glycopyrrolate tablets mg for adults is mg two or three times daily at equally spaced intervals. The maximum recommended daily dosage of glycopyrrolate is mg.Use the lowest effective dosage of glycopyrrolate to control symptoms. If patients can be titrated to lower dose, switch from glycopyrrolate tablets mg to glycopyrrolate tablets mg or another mg oral tablet of glycopyrrolate. The recommended initial dosage of glycopyrrolate tablets mg for adults is mg three times daily (in the morning, early afternoon, and at bedtime). Some patients may require mg at bedtime to assure overnight control of symptoms. For maintenance, dosage of mg twice day is frequently adequate. The recommended dosage of glycopyrrolate tablets mg for adults is mg two or three times daily at equally spaced intervals. The maximum recommended daily dosage of glycopyrrolate is mg.. Use the lowest effective dosage of glycopyrrolate to control symptoms. If patients can be titrated to lower dose, switch from glycopyrrolate tablets mg to glycopyrrolate tablets mg or another mg oral tablet of glycopyrrolate.

DOSAGE FORMS & STRENGTHS SECTION.

3 DOSAGE FORMS AND STRENGTHS. Tablets: mg, white to off-white, round, beveled edge uncoated tablets, debossed with and break line on one side and 08 on the other side.2 mg, white to off-white, round, beveled edge uncoated tablets, debossed with and break line on one side and 51 on the other side.. mg, white to off-white, round, beveled edge uncoated tablets, debossed with and break line on one side and 08 on the other side.. mg, white to off-white, round, beveled edge uncoated tablets, debossed with and break line on one side and 51 on the other side.. Tablets: mg (functionally scored) and mg (functionally scored) (3). Tablets: mg (functionally scored) and mg (functionally scored) (3).

DRUG INTERACTIONS SECTION.

7 DRUG INTERACTIONS. Other Anticholinergic Drugs: Concomitant use is not recommended. (5.3, 5.4, 5.6, 7.1)Drugs with Altered Absorption due to Decreased GI Motility: Concomitant use is not recommended. (7.2)GI Toxicity with Solid Oral Dosage Forms of Potassium Chloride: Concomitant use is not recommended. (7.3). Other Anticholinergic Drugs: Concomitant use is not recommended. (5.3, 5.4, 5.6, 7.1). Drugs with Altered Absorption due to Decreased GI Motility: Concomitant use is not recommended. (7.2). GI Toxicity with Solid Oral Dosage Forms of Potassium Chloride: Concomitant use is not recommended. (7.3). 7.1 Other Anticholinergic Drugs. There is potential for an additive interaction between glycopyrrolate and concomitantly used anticholinergic drugs (e.g., tricyclic antidepressants, anti-epileptics, class antiarrhythmics, anti-spasmodics, amantadine) resulting in increased anticholinergic adverse reactions. Coadministration of antipsychotics with glycopyrrolate may lead to worsening of tardive dyskinesia. Glycopyrrolate is not recommended in patients taking other anticholinergic drugs [see Warnings and Precautions (5.3, 5.4, 5.6)]. 7.2 Drugs with Altered Absorption due to Decreased Gastrointestinal Motility and Increased Transit Time. Decreased gastrointestinal motility by glycopyrrolate may impact absorption of other drugs leading toincreased or decreased drug exposure. Glycopyrrolate is not recommended in patients taking other drugs that are affected by altered gastrointestinal motility [see Warnings and Precautions (5.3)]. 7.3 Gastrointestinal Toxicity with Solid Dosage Forms of Potassium Chloride. Oral glycopyrrolate may worsen gastrointestinal mucosal injury reported with solid oral dosage forms of potassium chloride due to decreased gastric motility and increased transit time, leading to prolonged contact with the gastrointestinal mucosa. Glycopyrrolate is not recommended in patients taking solid oral dosage forms of potassium chloride.

GERIATRIC USE SECTION.

8.5 Geriatric Use. Geriatric patients 65 years of age and older may be more sensitive to the anticholinergic adverse reactions of glycopyrrolate leading to complications of urinary retention, bowel obstruction, heat prostration, arrhythmias, delirium, and falls or fractures; therefore, glycopyrrolate is not recommended in geriatric patients and may be contraindicated in some geriatric patients with underlying medical conditions [see Contraindications (4) and Warnings and Precautions (5)].

HOW SUPPLIED SECTION.

16 HOW SUPPLIED/STORAGE AND HANDLING. Glycopyrrolate tablets USP, mg are white to off-white, round, beveled edge uncoated tablets, debossed with and break line on one side and 08 on the other side. Blistercards of 30 NDC 0615-8617-39Glycopyrrolate tablets USP, mg are white to off-white, round, beveled edge uncoated tablets, debossed with and break line on one side and 51 on the other side.Store at 20C to 25C (68F to 77F); excursions permitted to 15C to 30C (59F to 86F) [See USP Controlled Room Temperature]. Keep this and all medication out of the reach of children.Dispense in tight container.

INDICATIONS & USAGE SECTION.

1 INDICATIONS AND USAGE. Glycopyrrolate tablets are indicated in adults to reduce symptoms of peptic ulcer as an adjunct to treatment of peptic ulcer. Limitations of Use Glycopyrrolate tablets are not indicated as monotherapy for the treatment of peptic ulcer because effectiveness in peptic ulcer healing has not been established.. Glycopyrrolate tablets are anticholinergics indicated in adults to reduce symptoms of peptic ulcer as an adjunct to treatment of peptic ulcer. (1)Limitations of Use:Not indicated as monotherapy for the treatment of peptic ulcer because effectiveness in peptic ulcer healing has not been established. (1).

INFORMATION FOR PATIENTS SECTION.

17 PATIENT COUNSELING INFORMATION. Precipitation of Acute Glaucoma Advise patients to discontinue glycopyrrolate and promptly seek medical care if they experience symptoms of acute angle-closure glaucoma (pain and reddening of the eyes accompanied by dilated pupils) [see Warnings and Precautions (5.1)]. Partial or Complete Mechanical Intestinal Obstruction Advise patients to contact their healthcare provider if diarrhea occurs, especially in patients with ileostomy or colostomy [see Warnings and Precautions (5.2)]. Gastrointestinal Adverse Reactions Due to Decreased Gastrointestinal Motility Inform patients that glycopyrrolate may cause adverse reactions related to decreased gastrointestinal motility and report to their healthcare provider if they experience symptoms such as vomiting, early satiety, abdominal distention, and constipation [see Warnings and Precautions (5.3)]. Cognitive and Visual Adverse Reactions Inform patients that glycopyrrolate may cause cognitive or visual impairment and not operate motor vehicles or other dangerous machinery or perform other hazardous tasks until they are reasonably certain that glycopyrrolate do not affect them adversely. Advise patients to discontinue glycopyrrolate immediately and contact their healthcare provider if symptoms develop (e.g., drowsiness or blurred vision) [see Warnings and Precautions (5.4)]. Heat Prostration at High Environmental Temperatures Inform patients that glycopyrrolate can reduce sweating, leading to the possibility of heat exhaustion or heat stroke. Advise patients to avoid exposure to hot or very warm environmental temperatures [see Warnings and Precautions (5.5)]. Trademarks are the property of their respective owners. Distributed by: Aurobindo Pharma USA, Inc. 279 Princeton-Hightstown Road East Windsor, NJ 08520 Manufactured by: Aurobindo Pharma Limited Hyderabad-500 032, India Revised: 05/2023.

LABOR & DELIVERY SECTION.

8.2 Lactation. Risk SummaryThere are no data on the presence of glycopyrrolate in either human or animal milk, the effects on the breastfed infant, or the effects on milk production. As with other anticholinergic drugs, glycopyrrolate may cause suppression of lactation. The developmental and health benefits of breastfeeding should be considered along with the mothers clinical need for glycopyrrolate and any potential adverse effects on the breastfed infant from glycopyrrolate.

MECHANISM OF ACTION SECTION.

12.1 Mechanism of Action. Glycopyrrolate, an anticholinergic (antimuscarinic) agent, inhibits the action of acetylcholine on parietal cells in the stomach and decreases the volume and acidity of gastric secretions.

NONCLINICAL TOXICOLOGY SECTION.

13 NONCLINICAL TOXICOLOGY. 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility. Reproduction studies in rats resulted in diminished rates of conception in dose-related manner. Studies in dogs suggest that diminished rates of conception may be due to diminished seminal secretion, which is evident at high doses of glycopyrrolate.

OVERDOSAGE SECTION.

10 OVERDOSAGE. Signs and symptoms of glycopyrrolate overdosage are related to excessive anti-muscarinic anticholinergic activity and are generally peripheral (e.g., flushing, hyperthermia, tachycardia, ileus, urinary retention, loss of ocular accommodation, and light sensitivity due to mydriasis), but central nervous system toxicity (agitation, seizures, hyperthermia) may also occur. If over-exposure occurs, call the Poison Control Center at 1-800-222-1222 for current information on the management of glycopyrrolate poisoning and overdosage.Management of glycopyrrolate overdosage is based upon presenting signs and symptoms, including close observation for severe or life-threatening complications which may require respiratory and cardiovascular monitoring and support. Consider administration of activated charcoal and/or use of reversible anticholinesterase as appropriate or recommended by Poison Control.

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL.

PRINCIPAL DISPLAY PANEL. PRINCIPAL DISPLAY PANEL.

PEDIATRIC USE SECTION.

8.4 Pediatric Use. Safety and effectiveness in pediatric patients have not been established.

PHARMACODYNAMICS SECTION.

12.2 Pharmacodynamics. No formal pharmacodynamic studies have been conducted with glycopyrrolate.

PHARMACOKINETICS SECTION.

12.3 Pharmacokinetics. Patients with Renal Impairment In the published literature, glycopyrrolate mcg/kg was administered intravenously (glycopyrrolate tablets are not recommended for intravenous use) in uremic patients undergoing renal transplantation surgery. The mean AUC (10.6 mcg.h/L) and 24-hour urinary excretion (7%) for glycopyrrolate were significantly different from normal healthy adult subjects undergoing general surgery (3.7 mcg.h/L, and 65%, respectively) [see Use in Specific Populations (8.6)].

PREGNANCY SECTION.

8.1 Pregnancy. Risk Summary Over decades of use, there is an absence of published data on orally administered glycopyrrolate in pregnant women, including an absence of any reports of drug-associated risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. In animal studies, at non-maternally toxic doses of oral glycopyrrolate, there were no adverse developmental effects in rats or rabbits. pre- and post-natal development study of oral glycopyrrolate in rats showed decrease in pup mean bodyweight that recovered post nursing, with no other developmental effects observed (see Data). The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.DataAnimal Data At non-maternally toxic doses of oral glycopyrrolate, there were no effects on embryo-fetal development or toxicity in rats or rabbits. pre- and post-natal development study of oral glycopyrrolate in rats showed decrease in pup mean bodyweight that recovered post nursing, with no other developmental effects observed. In published reproductive and developmental study, male and female rats were administered glycopyrrolate in the diet at mg/kg/day, 32.5 mg/kg/day, 63 mg/kg/day, and 130 mg/kg/day for weeks to weeks and through up to three consecutive litters. There was no indication of abnormalities in the pups of treated dams. There was decreased rate of conception and in survival rate at weaning for all treated animals in dose-related manner. Diminished rates of conception may be due to diminished seminal secretion [see Nonclinical Toxicology (13.1)].

SPL UNCLASSIFIED SECTION.

2.1 Important Dosing Information. Glycopyrrolate tablets mg are not recommended for patients in whom lower dosage strength of oral glycopyrrolate (e.g., glycopyrrolate tablets mg or another mg tablet strength) is appropriate for initial or maintenance treatment because the dosage strength of glycopyrrolate tablets may exceed the recommended initial and maintenance dosage of oral glycopyrrolate tablets.. Glycopyrrolate tablets mg are not recommended for patients in whom lower dosage strength of oral glycopyrrolate (e.g., glycopyrrolate tablets mg or another mg tablet strength) is appropriate for initial or maintenance treatment because the dosage strength of glycopyrrolate tablets may exceed the recommended initial and maintenance dosage of oral glycopyrrolate tablets.

USE IN SPECIFIC POPULATIONS SECTION.

8 USE IN SPECIFIC POPULATIONS. Renal Impairment: Monitor patients with renal impairment; if anticholinergic adverse reactions occur, discontinue use. (8.6). Renal Impairment: Monitor patients with renal impairment; if anticholinergic adverse reactions occur, discontinue use. (8.6). 8.1 Pregnancy. Risk Summary Over decades of use, there is an absence of published data on orally administered glycopyrrolate in pregnant women, including an absence of any reports of drug-associated risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. In animal studies, at non-maternally toxic doses of oral glycopyrrolate, there were no adverse developmental effects in rats or rabbits. pre- and post-natal development study of oral glycopyrrolate in rats showed decrease in pup mean bodyweight that recovered post nursing, with no other developmental effects observed (see Data). The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.DataAnimal Data At non-maternally toxic doses of oral glycopyrrolate, there were no effects on embryo-fetal development or toxicity in rats or rabbits. pre- and post-natal development study of oral glycopyrrolate in rats showed decrease in pup mean bodyweight that recovered post nursing, with no other developmental effects observed. In published reproductive and developmental study, male and female rats were administered glycopyrrolate in the diet at mg/kg/day, 32.5 mg/kg/day, 63 mg/kg/day, and 130 mg/kg/day for weeks to weeks and through up to three consecutive litters. There was no indication of abnormalities in the pups of treated dams. There was decreased rate of conception and in survival rate at weaning for all treated animals in dose-related manner. Diminished rates of conception may be due to diminished seminal secretion [see Nonclinical Toxicology (13.1)]. 8.2 Lactation. Risk SummaryThere are no data on the presence of glycopyrrolate in either human or animal milk, the effects on the breastfed infant, or the effects on milk production. As with other anticholinergic drugs, glycopyrrolate may cause suppression of lactation. The developmental and health benefits of breastfeeding should be considered along with the mothers clinical need for glycopyrrolate and any potential adverse effects on the breastfed infant from glycopyrrolate.. 8.4 Pediatric Use. Safety and effectiveness in pediatric patients have not been established.. 8.5 Geriatric Use. Geriatric patients 65 years of age and older may be more sensitive to the anticholinergic adverse reactions of glycopyrrolate leading to complications of urinary retention, bowel obstruction, heat prostration, arrhythmias, delirium, and falls or fractures; therefore, glycopyrrolate is not recommended in geriatric patients and may be contraindicated in some geriatric patients with underlying medical conditions [see Contraindications (4) and Warnings and Precautions (5)].. 8.6 Renal Impairment. Glycopyrrolate is substantially excreted by the kidney [see Clinical Pharmacology (12.3)]. Monitor patients with renal impairment for anticholinergic adverse reactions [see Adverse Reactions (6)]. If anticholinergic adverse reactions occur, discontinue glycopyrrolate.

WARNINGS AND PRECAUTIONS SECTION.

5 WARNINGS AND PRECAUTIONS. Precipitation of Acute Glaucoma: May increase intraocular pressure; if symptoms occur, discontinue use and promptly seek medical care. (4, 5.1)Partial or Complete Mechanical Intestinal Obstruction: Diarrhea may be an early symptom, especially in patients with ileostomy or colostomy. If the obstruction is suspected, discontinue use and evaluate the patient for obstruction. (4, 5.2)GI Adverse Reactions Due to Decreased GI Motility: Delayed gastric emptying, constipation, and intestinal pseudo-obstruction may occur and precipitate or aggravate paralytic ileus and toxic megacolon; not recommended for use with anticholinergics or other medications that decrease GI peristalsis. (4, 5.3, 7.1)Cognitive and Visual Adverse Reactions: May impair mental and/or physical function. Inform patients not to operate motor vehicles or perform other hazardous tasks until reasonably certain they are not adversely affected; discontinue use if signs or symptoms develop. (5.4, 7.1)Heat Prostration at High Environmental Temperatures: Heat prostration resulting in fever and heatstroke can occur, especially in geriatric patients. Avoid exposure to hot or very warm environmental temperatures. (5.5, 5.7)Other Conditions Exacerbated by Anticholinergic Adverse Reactions: Use is not recommended in patients with autonomic neuropathy, hyperthyroidism, cardiac disease, hiatal hernia, etc. (5.6, 7.1)Increased Risk of Anticholinergic Adverse Reactions in Geriatric Patients: Complications include urinary retention, bowel obstruction, heat prostration, arrhythmias, delirium, and falls or fractures. Not recommended in geriatric patients and may be contraindicated in some patients with underlying medical conditions. (4, 5.7, 8.5). Precipitation of Acute Glaucoma: May increase intraocular pressure; if symptoms occur, discontinue use and promptly seek medical care. (4, 5.1). Partial or Complete Mechanical Intestinal Obstruction: Diarrhea may be an early symptom, especially in patients with ileostomy or colostomy. If the obstruction is suspected, discontinue use and evaluate the patient for obstruction. (4, 5.2). GI Adverse Reactions Due to Decreased GI Motility: Delayed gastric emptying, constipation, and intestinal pseudo-obstruction may occur and precipitate or aggravate paralytic ileus and toxic megacolon; not recommended for use with anticholinergics or other medications that decrease GI peristalsis. (4, 5.3, 7.1). Cognitive and Visual Adverse Reactions: May impair mental and/or physical function. Inform patients not to operate motor vehicles or perform other hazardous tasks until reasonably certain they are not adversely affected; discontinue use if signs or symptoms develop. (5.4, 7.1). Heat Prostration at High Environmental Temperatures: Heat prostration resulting in fever and heatstroke can occur, especially in geriatric patients. Avoid exposure to hot or very warm environmental temperatures. (5.5, 5.7). Other Conditions Exacerbated by Anticholinergic Adverse Reactions: Use is not recommended in patients with autonomic neuropathy, hyperthyroidism, cardiac disease, hiatal hernia, etc. (5.6, 7.1). Increased Risk of Anticholinergic Adverse Reactions in Geriatric Patients: Complications include urinary retention, bowel obstruction, heat prostration, arrhythmias, delirium, and falls or fractures. Not recommended in geriatric patients and may be contraindicated in some patients with underlying medical conditions. (4, 5.7, 8.5). 5.1 Precipitation of Acute Glaucoma. Glycopyrrolate may cause increased intraocular pressure in patients with glaucoma and reduce the effects of antiglaucoma agents. Instruct patients to discontinue glycopyrrolate and promptly seek medical care if they experience symptoms of acute angle-closure glaucoma (pain and reddening of the eyes accompanied by dilated pupils) [see Contraindications (4)]. 5.2 Partial or Complete Mechanical Intestinal Obstruction. Glycopyrrolate may worsen intestinal mechanical obstruction, and diarrhea may be an early symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. If partial or complete intestinal obstruction is suspected, discontinue the use of glycopyrrolate and evaluate for potential intestinal obstruction [see Contraindications (4)]. 5.3 Gastrointestinal Adverse Reactions Due to Decreased Gastrointestinal Motility. Glycopyrrolate reduces gastrointestinal motility and may result in delayed gastric emptying, constipation, and intestinal pseudo-obstruction and may precipitate or aggravate paralytic ileus and toxic megacolon [see Contraindications (4)]. The risk of gastrointestinal adverse reactions is further increased with the use of other anticholinergics and other medications that decrease gastrointestinal peristalsis. Monitor patients for symptoms of decreased gastrointestinal motility. Concomitant use of glycopyrrolate and other anticholinergics or other medications that decrease GI peristalsis is not recommended [see Drug Interactions (7.2)]. 5.4 Cognitive and Visual Adverse Reactions. Glycopyrrolate may produce drowsiness and blurred vision and impair the mental and/or physical abilities required for the performance of hazardous tasks such as driving motor vehicle, operating machinery, or performing other hazardous work [see Adverse Reactions (6)]. Concomitant use of other drugs that have anticholinergic properties may increase these effects [see Drug Interactions (7.1)]. Inform patients not to operate motor vehicles or other dangerous machinery or perform other hazardoustasks until they are reasonably certain that glycopyrrolate does not affect them adversely. Discontinue glycopyrrolate if signs or symptoms of cognitive or visual impairment develop. 5.5 Heat Prostration at High Environmental Temperatures. In the presence of high environmental temperature, heat prostration resulting in fever and heatstroke can occur with the use of glycopyrrolate due to decreased sweating, particularly in geriatric patients [see Adverse Reactions (6)]. Advise patients to avoid exposure to hot or very warm environmental temperatures when taking glycopyrrolate. Glycopyrrolate is not recommended in geriatric patients [see Warnings and Precautions (5.7)]. 5.6 Other Conditions Exacerbated by Anticholinergic Adverse Reactions. Glycopyrrolate is not recommended in patients with other conditions exacerbated by anticholinergic adverse reactions (e.g., autonomic neuropathy, hyperthyroidism, cardiac disease, and hiatal hernia associated with reflux esophagitis) and in patients taking other anticholinergic medications [see Drug Interactions (7.1)]. 5.7 Increased Risk of Anticholinergic Adverse Reactions in Geriatric Patients. Geriatric patients 65 years of age and older are at increased risk of anticholinergic adverse reactions that may lead to complications of urinary retention, bowel obstruction, heat prostration, arrhythmias, delirium, and falls or fractures. Glycopyrrolate is not recommended in geriatric patients and may be contraindicated in some geriatric patients with underlying medical conditions [see Contraindications (4), Warnings and Precautions (5.2, 5.5), Adverse Reactions (6) and Use in Specific Populations (8.5)].