Package leaflet: Information for the Patient Glycopyrronium Bromide 1 mg/5 ml Oral Solution Read all of this leaflet carefully before your of this medicine. This is because of an child starts taking this medicine because it increased risk of other side effects such contains important information for them. as dry mouth, retention of urine and ■ Keep this leaflet. You may need to read it constipation when glycopyrronium bromide again. and similar medicines are taken together. ■ If you have any further questions, ask your Please tell the doctor if your child is taking or doctor or pharmacist. have recently taken: ■ This medicine has been prescribed for your ■ Antidepressants such as amitriptyline, child only. Do not pass it on to others. It clomipramine, lofepramine or imipramine may harm them, even if their signs of (known as tricyclic antidepressants) or illness are the same as your child’s. monoamine oxidase inhibitors (MAOIs) ■ If you get any side effects, talk to your such as phenelzine, moclobemide, doctor or pharmacist. This includes any rasagiline, selegiline or tranylcypromine possible side effects not listed in this ■ Phenothiazines such as chlorpromazine, leaflet. See section 4. fluphenazine, prochlorperazine or What is in this leaflet trifluoperazine, used to treatmental problems or nausea, vomiting or vertigo 1. What Glycopyrronium Bromide oral solution ■ is and what it is used for Antihistamines such as promethazine, used to treat allergies 2. What you need to know before you give ■ Glycopyrronium Bromide oral solution Parasympathomimetics such as carbachol, 3. How to use Glycopyrronium Bromide neostigmine or physostigmine which affect oral solution the transmission of nerve impulses to muscles 4. Possible side effects ■ 5. How to store Glycopyrronium Bromide Corticosteroids such as prednisolone, used oral solution to treat various conditions including asthma and inflammation 6. Contents of the pack and other information ■ Inhaled anaesthetics, given before surgery (including at the dentist) 1. What Glycopyrronium Bromide oral ■ Clozapine or haloperidol, used to treat solution is and what it is used for schizophrenia ■ Nefopam, used to treat acute and chronic This medicine is called Glycopyrronium pain Bromide and belongs to a group of medicines ■ Domperidone or metoclopramide, used to called anticholinergic or antimuscarinic drugs. treat nausea and vomiting It contains the active substance ■ Amantadine or levodopa, used to treat glycopyrronium bromide. Each 5 ml dose of Parkinson’s disease oral solution contains 1 mg of glycopyrronium ■ Memantine, used to treat Alzheimer’s bromide. disease ■ Glycopyrronium Bromide is used to treat ■ Slow-dissolving digoxin tablets, excessive production of saliva (sialorrhoea) disopyramide or atenolol, used to treat in children and adolescents aged 3 years heart problems and older. Sialorrhoea (drooling or excessive ■ Metformin, used to treat type 2 diabetes salivation) is a common symptom of many ■ Glyceryl trinitrate tablets, used to treat diseases of the muscles or nerves. It is angina. These may not dissolve under the mainly caused by poor control of muscles in tongue as well as usual because this the face. Acute sialorrhoea may be medicine can cause a dry mouth associated with inflammation, dental or ■ Topiramate or zonisamide, used to treat mouth infections. Glycopyrronium Bromide epilepsy and to prevent migraines oral solution acts on the salivary glands to ■ Potassium chloride containing solid dose reduce production of saliva. products (see section 2 “Do not give Glycopyrronium Bromide oral solution if”) 2. What you need to know before ■ Anticholinergic medicines. (see section 2 you give Glycopyrronium “Do not give Glycopyrronium Bromide oral Bromide oral solution solution if”) Long term use efficacy and safety of Do not give Glycopyrronium Bromide oral Glycopyrronium Bromide oral solution has not solution if the child: been studied beyond the recommended 24 ■ is allergic (hypersensitive) to glycopyrronium weeks of use. Continued use should be bromide or any of the other ingredients of discussed with the child’s doctor every 3 this medicine (listed in section 6) months to check that Glycopyrronium Bromide ■ has glaucoma (increased pressure in oral solution is still right for the child. the eye) Pregnancy and breastfeeding ■ has a condition called myasthenia gravis which leads to muscle weakness and fatigue Glycopyrronium Bromide oral solution must ■ has an obstruction of the stomach (pyloric not be given if the patient is pregnant or stenosis) or bowel causing vomiting, breastfeeding (see section 2. “Do not give abdominal pain and swelling (paralytic ileus) Glycopyrronium Bromide oral solution if”). ■ has an enlarged prostate gland (prostatic Discuss the need for contraception with the hypertrophy) doctor. ■ is unable to completely empty the bladder Driving and using machines (urinary retention) Glycopyrronium Bromide may make the patient ■ suffers fromchronic end stage kidney feel drowsy or cause their eyesight to become disease and require dialysis blurred and this could interfere with their ■ is pregnant or breastfeeding ability to drive or operate machinery safely. ■ is taking potassium chloride solid dose Do not drive or operate machinery until these products effects have fully cleared. If there is any doubt, ■ is taking anticholinergic medicines ask your doctor for advice. Warnings and precautions Glycopyrronium Bromide oral solution Talk to a doctor or pharmacist before giving contains E420 (sorbitol), E217 and E219 Glycopyrronium Bromide if the child: ■ This medicine contains sorbitol (E420). If ■ has gastric reflux (a condition in which the you have been told by the doctor that your liquid stomach contents backs up into the child has an intolerance to some sugars, gullet) contact the doctor before giving this ■ has ulcerative colitis (a chronic medicinal product. inflammation of the large intestine (colon) ■ This medicine contains sodium propyl which can cause abdominal pain, diarrhoea parahydroxybenzoate (E217) and sodium and bleeding from the back passage) methyl parahydroxybenzoate (E219). These ■ has just had a heart attack or are suffering may cause allergic reactions (possibly from heart disease, irregular heartbeats or delayed) and exceptionally, bronchospasms high blood pressure, because this medicine (a narrowing of the airways). can cause a change to their normal heart ■ This medicinal product contains less than rate 1 mmol sodium (23 mg) per maximum dose, ■ has a condition characterised by a faster i.e. essentially is ‘sodium free’. heartbeat than normal (this can be caused by conditions such as an overactive thyroid gland, heart failure or heart surgery) 3. How to use Glycopyrronium ■ is due to have surgery (including at the Bromide oral solution dentist) during which they will be ‘put to sleep’ using inhalation anaesthesia. This is Always give this medicine exactly as the because this medicine may cause a change doctor has told you. Check with your doctor in their normal heart rhythm or pharmacist if you are not sure. ■ has diarrhoea, especially if they have had This medicine is for oral use only. an ileostomy or colostomy This medicine should be given at least one ■ has a high temperature (fever) or the hour before or two hours after a meal. environmental temperature is high, as this Children and adolescents aged 3 years medicine will reduce the amount they sweat, and older: making it harder for their body to cool down ■ has kidney disease, because this medicine’s The initial dose will be calculated based on the dose may need to be decreased weight of the child. The dose will be decided by ■ has compromised blood brain barrier the doctor, using the table below as a guide, ■ has been told by their doctor that they have and will depend on both the effect of an intolerance to some sugars, because this Glycopyrronium Bromide oral solution and any medicine contains sorbitol side effects the patient is experiencing. Section 4 includes possible side effects related In addition, stop treatment and talk to their to the use of Glycopyrronium Bromide oral doctor if the child is suffering with the solution. These should be discussed with the following: ■ child’s doctor, including those for dose seem unwell with a very fast or very slow increases and decreases, and at any other time heart rate ■ should you be concerned. The child should be constipation monitored at regular intervals to check that ■ pneumonia ■ Glycopyrronium Bromide oral solution is still changes in behaviour the right treatment for them. The doctor will decide if treatment should continue and if there should be a dose Weight Dose Dose Dose Dose Dose reduction, after evaluating any of these events. (kg) Level 1 Level 2 Level 3 Level 4 Level 5 If you are not sure any of the above applies (ml) (ml) (ml) (ml) (ml) to your child, talk to a doctor or pharmacist 13-17 1.5 3 4.5 6 7.5 before giving Glycopyrronium Bromide oral solution. 18-22 2 4 6 8 10 Glycopyrronium Bromide oral solution reduces 23-27 2.5 5 7.5 10 12.5 salivation which can increase the risk of dental disease, therefore teeth should be brushed 28-32 3 6 9 12 15 daily and have regular dental checks. 33-37 3.5 7 10.5 14 15 Children 38-42 4 8 12 15 15 This medicine is not recommended for children younger than 3 years. Talk to a doctor 43-47 4.5 9 13.5 15 15 or pharmacist before taking this medicine or if ≥48 5 10 15 15 15 this medicine has been prescribed for a child less than 3 years. Directions for use Other medicines and Glycopyrronium ■ Give the dose prescribed by your doctor Bromide oral solution to the child three times each day. Tell the doctor or pharmacist if your child is ■ Remove the child-resistant taking, have recently taken, or might take any closure from the bottle. Insert other medicines. This includes medicines you the syringe adaptor with the hole have bought without a prescription. into the neck of the bottle (this ■ If their doctor tells you to give both this may have been done already by medicine and one or more similar the pharmacist).