Glycopyrronium Bromide: Effects, Uses & Risks

Glycopyrronium bromide is a drug of the parasympatholytic group. It is used as an agent to reduce secretions in chronic obstructive pulmonary disease (COPD). As an anticholinergic, it suppresses the action of acetylcholine in the parasympathetic nervous system.

What is glycopyrronium bromide?

Glycopyrronium bromide is used as an active ingredient to reduce secretions in chronic obstructive pulmonary disease (COPD). Glycopyrronium bromide is a chemically complicated active ingredient with a quaternary ammonium structure. As an inner salt, it consists of an organic cation and the anion bromide. It is also chemically related to atropine. As a pure substance, it exists as a white crystalline powder. Due to its salt structure, it is easily soluble in water and insoluble in fats b. w. It is insoluble in fats and oils. Glycopyrronium bromide has a bronchodilator effect and is therefore used in the treatment of COPD. It acts very quickly, but also in the long term, so it needs to be used only once a day. The treatment is administered as a powder inhalation. Due to its low fat solubility, it can hardly cross the bloodbrain barrier and thus does not cause any serious psychological side effects when used. The only side effects that occur are those related to decreased secretion in the mucous membranes and sweat glands.

Pharmacological effect

Glycopyrronium bromide exerts its influence at the muscarinic receptors of the parasympathetic nervous system. In doing so, it inhibits the action of acetylcholine, thereby indirectly suppressing nerve conduction in the parasympathetic nervous system (parasympathetic nervous system). Along with the sympathetic and enteric nervous systems (intestinal nervous system), the parasympathetic nervous system belongs to the so-called autonomic nervous system. The parasympathetic and sympathetic nervous systems act as opponents. The parasympathetic nervous system is responsible for the internal functions of the body at rest, while the sympathetic nervous system promotes external activities. With increased activity of the parasympathetic nervous system, there is greater secretion of mucus in the bronchi and sweat from the sweat glands. There is also increased motility of the gastrointestinal tract. Inhibition of acetylcholine at the muscarinic receptors of the parasympathetic nervous system naturally reduces secretion, sweating, and gastrointestinal motility. In addition, a lowering of the heart rate still takes place. For symptomatic treatment in some diseases or for preparation of operations, such reductions of certain body functions are necessary.

Medical application and use

Glycopyrronium bromide is mainly used in the symptomatic treatment of COPD, chronic obstructive pulmonary disease. Here, it is intended to reduce mucus secretion by dilating the bronchial tubes. The drug is inhaled daily as a powder. It is not possible to cure the disease in this way, but by combating the symptoms, the patient’s quality of life is significantly improved. The drug is also used in the extremely severe disease condition of rales breathing. Here, the patient is no longer able to cough up the secretion formed and is in danger of suffocating. The same applies to dysphagia with increased salivation. Glycopyrronium bromide is also used before operations to reduce saliva and mucus secretion. Since muscarinic receptors respond well to glycopyrronium bromide, the effect on reducing salivation, for example, occurs at a dosage where side effects do not yet play a role. Another application of glycopyrronium bromide is in the induction of anesthesia, also to reduce secretion and heart rate. The drugs also show good efficacy in gastrointestinal disorders. Thus, the increased intestinal activity is decreased and gastric juice secretion is reduced. Hyperhidrosis should also be mentioned as another indication. Hyperhidrosis is a condition in which excessive sweating occurs.

Risks and side effects

As with all medications, side effects occur with the use of glycopyrronium bromide. The side effects may include dry mouth, constipation, headache, insomnia, urinary tract infections and also visual disturbances. It should be said that these side effects are usually relatively mild. Only in case of specific hypersensitivity to glycopyrronium bromide, its use is contraindicated.In addition, glycopyrronium bromide must not be used in combination with other parasympatholytics. Severe side effects of glycopyrronium bromide can already be prevented because the positive effects occur even at low doses and the effect lasts relatively long. Furthermore, glycopyrronium bromide is fat-insoluble due to its ionic structure and thus cannot cross the bloodbrain barrier. As a result, the active ingredient cannot cause severe central nervous disorders, such as memory impairment, confusional states, or hallucinations.