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Prevduo
neostigmine/ glycopyrrolate
Adult Dosing .
Dosage forms: INJ (pre-filled syringe): 1 mg/0.2 mg per mL
Special Note
- [strength clarification]
- Info: dosing based on neostigmine component
nondepolarizing neuromuscular blockade reversal
- [0.03-0.07 mg/kg/dose IV x1]
- Max: 0.07 mg/kg up to 5 mg total dose; Info: dose varies by neuromuscular blocker half-life, train-of-four response, recovery time; may give additional dose prn
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: INJ (pre-filled syringe): 1 mg/0.2 mg per mL
Special Note
- [strength clarification]
- Info: dosing based on neostigmine component
nondepolarizing neuromuscular blockade reversal
- [2 yo and older]
- Dose: 0.03-0.07 mg/kg/dose IV x1; Max: 0.07 mg/kg up to 5 mg total dose; Info: dose varies by neuromuscular blocker half-life, train-of-four response, recovery time; may give additional dose prn
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- GI obstruction
- GU tract obstruction
- peritonitis
- glaucoma, angle-closure
- paralytic ileus
- intestinal atony (elderly or debilitated pts)
- acute hemorrhage w/ unstable cardiovascular status
- toxic megacolon
- toxic megacolon hx
- colitis, inflammatory
- colitis, infectious
- myasthenia gravis
- caution: elderly pts
- caution: peds pts
- caution: renal impairment
- caution: CAD
- caution: CHF
- caution: HTN
- caution: hypotension
- caution: acute coronary syndrome, recent
- caution: arrhythmia
- caution: bradycardia
- caution: seizure disorder
- caution: asthma
- caution: hyperthyroidism
- caution: environmental temperature, high
Drug Interactions .
Overview
glycopyrrolate
anticholinergic
- alters gallbladder contraction/motility
- anticholinergic effects
- CNS depression
- tachycardia
neostigmine
cholinesterase inhibitor
- bradycardia
- cholinergic effects
Contraindicated
- potassium chloride
- potassium citrate
Avoid/Use Alternative
- aclidinium inhaled
- benztropine
- brigatinib
- butalbital
- ceritinib
- clonidine
- clozapine
- codeine
- crizotinib
- doxylamine
- dronabinol
- eluxadoline
- ephedra
- epinephrine inhaled
- ethanol
- etrasimod
- fexinidazole
- fingolimod
- glucagon
- glycopyrrolate
- glycopyrrolate inhaled
- glycopyrronium topical
- haloperidol
- hydrocodone
- ipratropium inhaled
- isocarboxazid
- kava
- kratom
- landiolol
- lofexidine
- metaxalone
- methacholine inhaled
- metoclopramide
- midazolam
- neostigmine
- olanzapine
- oxybate
- ozanimod
- phenelzine
- ponesimod
- pramlintide
- promethazine
- revefenacin inhaled
- rivastigmine
- ropeginterferon alfa-2b
- siponimod
- sofpironium topical
- thalidomide
- tiotropium inhaled
- tranylcypromine
- trimethobenzamide
- zuranolone
Monitor/Modify Tx
- acebutolol
- adenosine
- albuterol
- albuterol inhaled
- aldesleukin
- alectinib
- alfentanil
- alprazolam
- amiodarone
- amitriptyline
- amoxapine
- amphetamine
- apraclonidine ophthalmic
- arformoterol inhaled
- armodafinil
- arsenic trioxide
- articaine
- atazanavir
- atenolol
- atomoxetine
- atropine
- baclofen intrathecal
- benzphetamine
- betamethasone
- betaxolol
- betaxolol ophthalmic
- bisoprolol
- brompheniramine
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- butorphanol
- caffeine
- caffeine citrate
- cannabis
- carbamazepine
- carbinoxamine
- carteolol ophthalmic
- carvedilol
- chlordiazepoxide
- chloroprocaine
- chlorpheniramine
- chlorpromazine
- clemastine
- clidinium
- clobazam
- clomipramine
- clonazepam
- clorazepate
- cocaine
- cortisone
- cyproheptadine
- daridorexant
- desflurane
- desipramine
- dexamethasone
- dexmedetomidine
- dexmedetomidine injection
- dexmethylphenidate
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- diethylpropion
- digoxin
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- dimenhydrinate
- diphenhydramine
- disopyramide
- dobutamine
- donepezil
- dopamine
- doxepin
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- droperidol
- dulaglutide
- eliglustat
- ensartinib
- ephedrine injection
- ephedrine oral
- epinephrine
- esketamine
- esmolol
- estazolam
- eszopiclone
- ethanol (in some formulations)
- etomidate
- fentanyl
- fesoterodine
- flecainide
- fluphenazine
- flurazepam
- formoterol inhaled
- fosphenytoin
- gabapentin
- gabapentin enacarbil
- galantamine
- guanfacine
- homatropine
- hoodia
- hydrocortisone
- hydromorphone
- hydroxyzine
- hyoscyamine
- ifosfamide
- imipramine
- isoflurane
- isoproterenol
- ivabradine
- ketamine
- labetalol
- lacosamide
- lamotrigine
- lanreotide
- lasmiditan
- lemborexant
- levalbuterol inhaled
- levobunolol ophthalmic
- levomilnacipran
- levorphanol
- lidocaine
- lifileucel
- liraglutide
- lisdexamfetamine
- lithium
- lopinavir/ritonavir
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- lorlatinib
- meclizine
- mefloquine
- meperidine
- mepivacaine
- metformin
- methadone
- methamphetamine
- methohexital
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- methylphenidate
- methylprednisolone
- metoprolol
- midodrine
- milnacipran
- mirtazapine
- modafinil
- morphine
- nadolol
- nalbuphine
- nebivolol
- nelarabine
- nortriptyline
- octreotide
- oliceridine
- olodaterol inhaled
- opicapone
- opium
- orphenadrine
- oxazepam
- oxybutynin
- oxycodone
- oxymorphone
- pasireotide
- pentazocine
- pentobarbital
- perphenazine
- phendimetrazine
- pheniramine
- phenobarbital
- phentermine
- phenylephrine ophthalmic
- phenytoin
- pindolol
- praziquantel
- prednisolone
- prednisone
- pregabalin
- primidone
- procainamide
- prochlorperazine
- propafenone
- propofol
- propranolol
- protriptyline
- pseudoephedrine
- pyridostigmine
- pyrilamine
- quazepam
- quinidine (antiarrhythmic)
- quinine
- regadenoson
- remifentanil
- remimazolam
- ritonavir
- ropivacaine
- rotigotine transdermal
- salmeterol inhaled
- scopolamine
- sevoflurane
- sincalide
- solriamfetol
- sotalol
- succinylcholine
- sufentanil
- sugammadex
- suvorexant
- tapentadol
- temazepam
- terbutaline
- thioridazine
- thiothixene
- ticagrelor
- timolol
- timolol ophthalmic
- tolterodine
- tramadol
- triamcinolone
- triazolam
- trimipramine
- triprolidine
- trospium
- umeclidinium inhaled
- verapamil
- vilanterol inhaled
- viloxazine
- yohimbe
- zaleplon
- ziconotide
- zolpidem
Caution Advised
- 5-HTP
- allopurinol
- almotriptan
- alosetron
- amantadine
- amifampridine
- apomorphine
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- asenapine
- atropine ophthalmic
- baclofen
- barium
- belladonna alkaloids
- bethanechol
- botulinum toxin
- brexpiprazole
- brimonidine ophthalmic
- brimonidine topical
- brivaracetam
- bromocriptine
- buspirone
- cannabidiol
- cariprazine
- carisoprodol
- cenobamate
- cetirizine
- cevimeline
- chamomile, German
- chlophedianol
- chlorzoxazone
- cisapride
- citalopram
- cyclobenzaprine
- cyclopentolate ophthalmic
- dantrolene
- darifenacin
- desvenlafaxine
- deutetrabenazine
- dexbrompheniramine
- dexchlorpheniramine
- dichlorphenamide
- difelikefalin
- difenoxin
- diphenoxylate
- dipyridamole
- domperidone
- doxazosin
- doxepin topical
- duloxetine
- efavirenz
- eletriptan
- entacapone
- entrectinib
- erenumab
- erythromycin
- escitalopram
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fenfluramine
- flavoxate
- flibanserin
- fluoxetine
- fluvoxamine
- foslevodopa
- frovatriptan
- ganaxolone
- gepotidacin
- glofitamab
- hydrochlorothiazide
- iloperidone
- ipratropium nasal
- levetiracetam
- levocetirizine
- levodopa
- linvoseltamab
- loperamide
- loxapine
- lumateperone
- lurasidone
- melatonin
- meprobamate
- methocarbamol
- methsuximide
- methyldopa
- metyrapone
- metyrosine
- mexiletine
- mirabegron
- mitotane
- molindone
- mosunetuzumab
- mycophenolate mofetil
- naltrexone
- naratriptan
- nefazodone
- oxcarbazepine
- paliperidone
- paroxetine
- passion flower
- perampanel
- pilocarpine
- pilocarpine ophthalmic
- pimozide
- potassium acid phosphate
- potassium gluconate
- potassium phosphate
- pramipexole
- procarbazine
- quetiapine
- quinidine (CYP2D6 inhibitor)
- ramelteon
- rasagiline
- repotrectinib
- risperidone
- rizatriptan
- ropinirole
- rufinamide
- safinamide
- selegiline
- selegiline transdermal
- selinexor
- sertraline
- solifenacin
- stiripentol
- sumatriptan
- tasimelteon
- tetrabenazine
- thiotepa
- tiagabine
- tizanidine
- tolcapone
- topiramate
- trazodone
- trifluoperazine
- trihexyphenidyl
- tropicamide ophthalmic
- valbenazine
- valerian
- valproic acid
- venlafaxine
- vibegron
- vigabatrin
- vilazodone
- ziprasidone
- zolmitriptan
- zonisamide
Adverse Reactions .
Serious Reactions
- hypersensitivity rxn
- anaphylaxis
- arrhythmia
- bradycardia
- AV block
- cardiac arrest
- syncope
- hypotension, severe
- respiratory arrest
- respiratory depression
- bronchospasm
- seizures
- heat stroke
- intestinal obstruction
Common Reactions
- hypotension
- bradycardia
- tachycardia
- dyspnea
- oxygen saturation decr.
- nausea
- vomiting
- xerostomia
- rigors
- headache
- dizziness
- insomnia
- pruritus
- constipation
- photophobia
- drowsiness
- urinary retention
- lactation suppression
Safety/Monitoring .
Monitoring Parameters
ECG, BP, HR
Pregnancy/Lactation .
Pregnancy
Clinical Summary
neostigmine: weigh risk/benefit during pregnancy; no known risk of teratogenicity, though possible risk of transient fetal bradycardia based on limited human data; possible risk of preterm labor based on drug's mechanism of action
glycopyrrolate: weigh risk/benefit during pregnancy; risk of fetal harm not expected based on limited human data; no known risk of teratogenicity based on animal data w/ injectable form at up to 5x MRHD and w/ PO form at 320x MRHD
Lactation
Clinical Summary
neostigmine: weigh risk/benefit while breastfeeding; inadequate human data available to assess risk of infant harm, though possible drug excretion into milk based on drug properties; no human data available to assess effects on milk production
glycopyrrolate: weigh risk/benefit while breastfeeding; no human data available, though risk of infant harm not expected based on drug properties; inadequate human data available, though possible decr. milk production
Pharmacology .
Metabolism: for neostigmine: liver; CYP450: unknown; for glycopyrrolate: unknown; CYP450: unknown
Excretion: for neostigmine: urine (50% unchanged); Half-life: 24-113min; for glycopyrrolate: urine 85% (>80% unchanged), bile 5% (>80% unchanged); Half-life: 0.83h
Subclass: Anesthesia Adjuncts ; Toxicity: Drugs
Mechanism of Action
neostigmine reversibly binds to and inactivates acetylcholinesterase (cholinesterase inhibitor); glycopyrrolate antagonizes acetylcholine receptors (anticholinergic)
Formulary .
No Formulary Selected
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