Glycopyrrolate

A Selective and Sensitive Method Development and Validation of 1,1-Dimethyl-3-Hydroxy-Pyrrolidinium Bromide Impurity in Glycopyrrolate Oral Solution by Liquid Chromatography-Tandem Mass Spectroscopy

OBJECTIVE

A selective and sensitive liquid chromatography-tandem mass spectrometer (LC-MS/MS) method has been developed for the quantification of 1,1-dimethyl-3-hydroxy-pyrrolidinium bromide impurity in glycopyrrolate oral solution.

MATERIALS AND METHOD

The LC-MS/MS analysis was done on X Bridge HILIC (100 × 4.6 mm, 5 μm) analytical column, and the mobile phase used was10 mM ammonium formate with 0.2% formic acid as mobile phase-A and acetonitrile as mobile phase-B with a gradient programme of 5.0 min. The flow rate used was 1.2 mL/min. Triple quadrupole mass detector coupled to positive electrospray ionization operated in multiple reactions monitoring mode was used for the quantification at m/z 116.10 ± 0.5.

RESULTS

Retention time of impurity was found ~3.2 min. The method was validated in terms of specificity, linearity, accuracy, precision, range, limit of detection, limit of quantitation (LOQ) and robustness. Relative standard deviation (RSD) for system suitability was found 1.3%. Calibration plot was linear over the range of 0.050-2.000 μg/mL. Limit of detection and limit of quantification were found 0.017 and 0.051 μg/mL, respectively. The intra- and inter-day precision RSD was 2.3% and the obtained recovery at LOQ to 200% was in between 86.7 and 107.4%.

CONCLUSION

The low RSD values and high recoveries of the method confirm the suitability of the method.

Pharmacology, toxicology and clinical safety of glycopyrrolate

The clinical use of the anticholinergic glycopyrrolate dates back to the early 1960s when it was first approved in the U.S. Since then, oral and inhalation formulations have been developed as therapeutic agents inhibiting the muscarinic acetylcholine receptor in various indications including chronic obstructive pulmonary disease (COPD), excessive salivation, and peptic ulcers. More recently, topical formulations of glycopyrrolate (GPB, also known as glycopyrronium bromide) have gained interest as a treatment option for excessive sweating (hyperhidrosis). The U.S. Food and Drug Administration (FDA) approved the first topical glycopyrronium product for the treatment of hyperhidrosis in 2018. Glycopyrrolate, as a quaternary amine, shows minimal penetration of the blood brain barrier which limits CNS side effects. In addition, lack of phototoxicity, genotoxicity and carcinogenicity makes it suitable for chronic indications. The information on the nonclinical and clinical safety profile of glycopyrronium supporting various therapeutically approved uses has been obtained from published literature, our own data as well as summary documents issued by regulatory bodies. Collectively, these data support the conclusion that the benefits of glycopyrronium generally outweigh the risks in chronic use indications that require muscarinic receptor antagonism to provide therapeutic effects.

Comparison of the efficacy of dexmedetomidine with that of esmolol in attenuating laryngoscopic and intubation response after rapid sequence induction

CONTEXT

Laryngoscopy and tracheal intubation produce sympathetic overdrive by catecholamine release resulting in hypertension and tachycardia. Various agents are being tried to combat the intubation response over years.

AIMS

This study is aimed at comparing dexmedetomidine which is a highly selective alpha-2 agonist with an ultra-short acting beta blocker, esmolol to see which among the two is better in attenuating the hemodynamic response to laryngoscopy and tracheal intubation.

SETTINGS AND DESIGN

This was a prospective randomized double-blind control study.

SUBJECTS AND METHODS

Sixty patients scheduled for general anesthesia were divided into two groups, D and E with 30 patients in each group. Group-D patients received dexmedetomidine 0.5 mcg/kg and Group-E patients received esmolol 0.5 mg/kg as intravenous premedication over 5 min before a rapid sequence induction and tracheal intubation. Systolic, diastolic and mean arterial pressures along with heart rate were measured using invasive arterial line at various time points. The percentage change of hemodynamic parameters at those time points from the baseline was compared between the groups.

STATISTICAL ANALYSIS USED

Descriptive and inferential statistical methods were used to analyze the data.

RESULTS

The percentage change of all hemodynamic parameters from base line were less in the dexmedetomidine group than in esmolol group at all-time points of measurement. However, a statistically significant difference was observed often at the time points within 1 min after tracheal intubation.

CONCLUSIONS

Dexmedetomidine is superior to esmolol in attenuating the hemodynamic response to laryngoscopy and tracheal intubation.

Pharmacological assessment of the duration of action of glycopyrrolate vs tiotropium and ipratropium in guinea-pig and human airways

1. Our study was aimed at investigating the duration of the bronchodilator action of the antimuscarinc drug glycopyrrolate compared to tiotropium and ipratropium. In the guinea-pig isolated trachea, the time (t1/2) necessary for a contractile response to carbachol (0.3 microM) to return to 50% recovery after washout of the antagonist was studied. The offset of the antagonist effect of glycopyrrolate, tiotropium and ipratropium (10 nM each) was t1/2 = 4.0 +/- 0.5, > 4.5 and 0.5 +/- 0.1 h, respectively. At 4.5 h from the washout of the antagonist, the recovery of the response to carbachol was 50 +/- 8, 10 +/- 4 and 70 +/- 7%, respectively. 2. In the human isolated bronchus, the offset of the bronchodilator effects of glycopyrrolate (3 nM), tiotropium (1 nM) and ipratropium (10 nM) was t1/2 = 3.7 +/- 0.2; > 6 and 3.0 +/- 0.2 h, respectively. At 6.0 h from the washout of the antagonist, the recovery of the response to carbachol (1 microM) was 101 +/- 10, 27 +/- 3 and 110 +/- 10%, respectively. 4. In anaesthetized guinea-pigs, acetylcholine-induced bronchoconstriction was markedly reduced by intratracheal instillation of glycopyrrolate (3 nmol kg(-1); 88.1 +/- 4% inhibition), tiotropium (1.3 nmol kg(-1); 86.2 +/- 5% inhibition) or ipratropium (1.45 nmol kg(-1); 88.1 +/- 10% inhibition). These inhibitory effects assessed 3 or 24 h after antagonist administration were reduced to 69.9 +/- 5 and 29.7 +/- 6%; 28.3 +/- 5 and 14.2 +/- 5% for glycopyrrolate and ipratropium, respectively, whereas they remained stable (83.5 +/- 4; 70.6 +/- 6) for tiotropium. The residual inhibitory effect of glycopyrrolate was also assessed at 16 h from administration, and proved to be as low as that found at 24 h (31.2 +/- 10 vs 29.7 +/- 6%, respectively). 5. In conclusion, glycopyrrolate-induced bronchodilation has a longer duration than that of ipratropium, but less than that of tiotropium. The efficacy of a possible glycopyrrolate-based therapy for asthma or chronic obstructive pulmonary disease given once-a-day is not guaranteed by the present investigation.

Effect of Anticholinergics (Atropine, Glycopyrrolate) and Prokinetics (Metoclopramide, Cisapride) on Gastric Motility in Beagles and Labrador Retrievers

The effect of atropine, glycopyrrolate, metoclopramide and cisapride on the antral motility was investigated in eight dogs (four Beagles and four Labradors) using passive telemetry. Both anticholinergics induced a pronounced and lasting reduction of the intensity and frequency of the contractions. A definite dose-related inhibition of the antral motility was seen in Beagles, similar for both active substances. Low doses of atropine (0.02 mg/kg BW i.m.) and glycopyrrolate (0.005 mg/kg BW i.m.) completely inhibited the gastric motility for at least 30 min, whereas higher doses (0.04 or 0.01 mg/kg BW) caused a cessation of activity for more than 3 h. In Labradors, the effects of both active substances were not so dose related and the effect of glycopyrrolate lasted at least 6 h, whereas the effect of atropine gradually decreased after 3 h. A distinct breed difference regarding the effect of the two prokinetics on the antral motility was also observed. In Beagles, the prokinetics, at a low dose (metoclopramide 0.3 mg/kg BW, cisapride 0.2 mg/kg BW), resulted in a significant increase in the amplitude integral. Higher doses (metoclopramide 0.6 mg/kg BW, cisapride 0.5 mg/kg BW) also increased the integrals of the pressure profiles, but significantly less than with the lower doses. In Labradors, both medications, mainly at higher doses, resulted in an increase of the contraction amplitudes. The low dose had no (cisapride) or only a transient effect (metoclopramide). The frequency of the antral contractions was not at all influenced by cisapride, and only in Beagles metoclopramide resulted in a dose-related increase. It is not clear if the different results in Labradors and Beagles are because of breed or body weight.

Glycopyrrolate versus atropine in post-ECT amnesia in the elderly

The neurotransmitter acetylcholine is important in memory function, and low brain concentrations may be associated with cognitive impairment. Our hypothesis was that atropine, a centrally acting anticholinergic drug known to cause amnesia, confusion, and delirium, may further exacerbate the amnesia and/or confusion resulting from electroconvulsive therapy (ECT) when used as a preanesthetic, and that the peripherally acting glycopyrrolate would by comparison decrease these side effects. We randomly administered glycopyrrolate versus atropine in equivalent doses as the preanesthetic agent to 20 consecutively admitted geriatric patients with major depression, for whom ECT was the clinical treatment of choice. Patients were matched for age, Hamilton Scale for Depression, and baseline performance on the Buschke Selective Reminding Task (BSRT). We found no significant difference in outcome between patients treated prior to ECT with atropine versus glycopyrrolate, as assessed by the above measures. We conclude from this study that atropine is no more deleterious to memory than is glycopyrrolate when given before ECT.

Anaesthetic-related recovery room complications

A prospective survey was conducted over a one-month period in all surgical patients admitted to the recovery room of a university-affiliated teaching hospital. Complications arising in the recovery room were documented by the nursing staff according to predefined criteria and were critically evaluated. A total of 443 patients were admitted to the recovery room and in 133 (30%) of these, some form of complication was noted. There were 86 patients with complications referable to the central nervous system, 68 with abnormal cardiovascular parameters, 24 with nausea and/or vomiting and 10 with abnormalities referable to the respiratory system. Many patients had more than one complication. The results are discussed, with emphasis on their relevance to current anaesthetic practice. It is concluded that many patients exhibit recovery room complications when they are specifically sought. The recovery period remains a time of great potential danger to patients.

Dose-response studies on glycopyrrolate and atropine in conscious cardiac patients

The dose-heart rate response relationship for the two anticholinergics, atropine and glycopyrrolate, were studied in non-anaesthetised patients about to undergo coronary artery surgery. Two methods were used, the administration of increasing doses to different groups of patients, and an incremental dose technique in the same patient. Both drugs increased heart rate in a dose-related manner with glycopyrrolate being approximately twice as potent as atropine. Glycopyrrolate is as effective as atropine in correcting bradycardia prior to open heart surgery.

Atropine and glycopyrrolate: changes in cardiac rate and rhythm in conscious and anaesthetised children

Heart rate and rhythm were studied in conscious children and children under nitrous oxide and halothane anaesthesia following intravenous administration of atropine or glycopyrrolate. Both drugs produced a similar increase in heart rate when the potency of glycopyrrolate is considered twice that of atropine. There is no difference in the response of anaesthetised and awake children. Junctional rhythm is the main dysrhythmia observed which appears to occur more frequently in anaesthetised children. The administration of both drugs is safe in paediatric patients.