Glycopyrrolate shortage hits human, veterinary medicine
Atropine suggested as a replacement
February 24, 2011 (published)
preanesthetic agent that veterinarians administer to dogs and cats
before surgery is in short supply with the nation's two manufacturers
of it reporting that they won't restock distributors until March, at the
What prompted the shortage of glycopyrrolate injection has not been made
public, though human and veterinary medicine equally are affected.
Glycopyrrolate, as a parenteral solution, is indicated for human use to
treat peptic ulcers or in anesthesia to reduce salivary,
tracheobronchial and pharyngeal secretions. Veterinarians turn to
glycopyrrolate during surgery for the same reasons — to reduce drooling
and respiratory tract secretions in patients — but also combine it with
other anesthetic agents to increase cardiac activity or treat
dangerously low heart rates.
Doctors in human and veterinary medicine use identical versions of the drug, despite differences in how it's labeled.
That might make restocking veterinary practices more difficult, with
human hospitals taking precedence. American Regent manufactures the
generic solution in its Shirley, N.Y., facility and reports that it
can't keep up with demand. When contacted by the VIN News Service,
representatives of Baxter, based in Deerfield, Ill., confirmed the
shortage and stated that "competitor issues" created a surge in demand
for glycopyrrolate that the company could not meet. Baxter officials did
not expand on that except to report that the company is increasing its
production of the drug. It notified pharmacists of the shortage on Feb.
7, days before supply problems were evident at American Regent.
Boarded veterinary anesthesiologist Dr. Lydia Love suggests turning to
atropine as a replacement for glycopyrrolate during the shortage. In
fact, atropine is preferable in emergency situations because it treats
bradycardia (extremely low heart rate) more efficiently, she says.
"It works faster and is a little more effective at increasing heart
rate," says Love, a consultant on the Veterinary Information Network, an
online community for the profession and parent of the VIN News Service.
"It's the drug of choice for CPCR (cardiopulmonary cerebral
resuscitation) or with very low heart rates. But atropine can really
drive the heart and cause tachycardia, and it crosses the blood brain barrier, where glycopyrrolate does not."
She continues: "While this shortage is annoying and would affect my
practice, it wouldn't tie my hands. You can use atropine in every
situation where you would glycopyrrolate, and healthy animals can
typically handle that."
American Regent primarily supplies distributors with glycopyrrolate on
the human side, though Baxter is known to work with distributors in
veterinary medicine. The VIN News Service contacted major distributors
servicing veterinary practices, including Webster Veterinary Supply,
Butler Schein Animal Health, MWI Veterinary Supply, Midwest Veterinary
Supply and Northeast Veterinary Supply Co. None are carrying
Baxter reports a shortage of its generic brand of glycopyrrolate 0.2
mg/ml injection in 1-ml, 2-ml, 5-ml and 20-ml vials. Additionally, its
brand-name Robinul Injectable is also not available in 1-ml, 2-ml and
(At one time, Robinul was relabeled for use in animal health under the
brand name Robinul-V and vetted by the U.S. Food and Drug Administration
for safety and efficacy. Wyeth, now part of Pfizer, originally
trademarked Robinul but discontinued it. The Wyeth subsidiary Fort Dodge
Animal Health has not sold Robinul-V since 2007.)
American Regent reports plans to release 2-ml vials as early as Feb. 28,
though it will take days for those supplies to reach wholesalers. Vials
in sizes 1 ml, 5 ml and 20 ml should be available to distributors in
A representative with American Regent reports that the company does not
list its glycopyrrolate with any veterinary-specific distributors.
Veterinarians can use a location feature on the company's website to find a distributor that carries American Regent products.