Supotaria50 mg

In Anesthesia: As a pre-operative antimuscarinic agent to reduce salivary, tracheobronchial and pharyngeal sections and to reduce the acidity of the gastric contents. As a pre-operative or intra-operative antimuscarinic to attenuate or prevent intraoperative bradycardia with the use of suxamethonium or due to cardiac vagal reflexes. To protect against the peripheral muscarinic actions of anticholinesterases such as neostigmine and pyridostigmine, used to reverse residual neuromuscular blockade produced by non- depolarising muscle relaxants. In Peptic Ulcer: For use in adults as adjunctive therapy for the treatment of peptic ulcer when rapid anticholinergic effect is desired or when oral medication is not tolerated.Hyperhidrosis, Sialorrhea, Cerebral palsy.

Anticholinergics (antimuscarinics)/ Anti-spasmodics

Glycopyrronium bromide is a quarternary ammonium antimuscarinic. It blocks acetylcholine at parasympathomimetic sites and induces smooth muscle relaxation. It also reduces gastric acid secretions and controls pharyngeal, tracheal and bronchial secretions. It antagonises muscarinic symptoms such as bronchorrhoea, bronchospasm, bradycardia and intestinal hypermotility induced by anticholinesterases.

For IM/IV administration- Pre-Anaesthetic Use: Adults: 0.2 mg to 0.4 mg intravenously or intramuscularly before the induction of anesthesia. Alternatively, a dose of 0.004 to 0.005 mg/kg. Children (1 month to 12 years of age): 0.004 to 0.008 mg/kg up. Larger doses may result in profound and prolonged antisialogogue effect which may be unpleasant for the patient. Intraoperative Use: Adults: A single dose of 0.2 to 0.4 mg (or 0.004 to 0.005 mg/kg) by intravenous injection should be used. Children: (1 month to 12 years of age) - A single dose of 0.004 to 0.008 mg/kg by intravenous injection should be used. This dose may be repeated if necessary. Reversal of Neuromuscular Blockade: Adults: 0.2 mg intravenously per 1 mg neostigmine or the equivalent dose of pyridostigmine. Children (1 month to 12 years of age) - 0.01 mg/kg intravenously with 0.05 mg/kg neostigmine or the equivalent dose of pyridostigmine. Supotaria may be administered simultaneously from the same syringe with the anticholinesterase; greater cardiovascular stability results from this method of administration. For oral administration- Initiate dosing at 0.02 mg/kg orally three times daily and titrate in increments of 0.02 mg/kg every 5-7 days based on therapeutic response and adverse reactions. The maximum recommended dosage is 0.1 mg/kg three times daily not to exceed 1.5-3 mg per dose based upon weight.During the four-week titration period, dosing can be increased with the recommended dose titration schedule while ensuring that the anticholinergic adverse events are tolerable. Prior to each increase in dose, review the tolerability of the current dose level with the patient's caregiver.Supotaria 50 mg should be dosed at least one hour before or two hours after meals. The presence of high fat food reduces the oral bioavailability of Supotaria 50 mg if taken shortly after a meal

Decreases levodopa effects. Effects may be enhanced by using drugs with antimuscarinic properties or MAOIs concurrently. May antagonise the Gl effects of cisapride, metoclopramide and dompeidone.

Angle-closure glaucoma; myasthenia gravis (large doses of quaternary ammonium compounds have been shown to block end plate nicotinic receptors); paralytic ileus; pyloric stenosis; prostatic enlargement. Anticholinesterase-antimuscarinic combinations such as neostigmine plus glycopyrronium should be avoided in patients with a prolonged QT interval.

Anticholinergic symptoms (mydriasis, hyperthermia, tachycardia, cardiac arrhythmia), Dry mouth, Dry skin, Anhidrosis, Flushing, Blurred vision, Cycloplegia, Photophobia, Palpitation, Xerophthalmia, Constipation, Urinary retention

Pregnancy Category B. Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

Antimuscarinics should be used with caution (due to increased risk of side effects) in Down's syndrome, in children and in the elderly.They should also be used with caution in gastro-esophageal reflux disease, diarrhea, ulcerative colitis, acute myocardial infarction, hypertension, conditions characterized by tachycardia (including hyperthyroidism, cardiac insufficiency, cardiac surgery) because of the increase in heart rate produced by their administration, coronary artery disease and cardiac arrhythmias, pyrexia (due to inhibition of sweating), pregnancy and breastfeeding.Because of prolongation of renal elimination, repeated or large doses of glycopyrronium bromide should be avoided in patients with uremia.Large doses of quaternary anticholinergic compounds have been shown to block end plate nicotinic receptors. This should be considered before using Supotaria 50 mg in patients with myasthenia gravis.It is known that the administration of anticholinergic agents during inhalation anesthesia can result in ventricular arrhythmias.Lactation: Excretion in milk unknown; use with caution