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Glycopyrrolate shortage hits human, veterinary medicine

Atropine suggested as a replacement

Published: February 24, 2011
By Jennifer Fiala
A popular 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 earliest.

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 glycopyrrolate injection.

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 20-ml vials.

(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 March.

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.

VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email news@vin.com.

Information and opinions expressed in letters to the editor are those of the author and are independent of the VIN News Service. Letters may be edited for style. We do not verify their content for accuracy.

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