Glycopyrronium Shortage: What Providers and Prescribers Need to Know in 2026

Glycopyrronium (glycopyrrolate) is a versatile anticholinergic prescribed across multiple specialties — from anesthesiology and pulmonology to pediatric neurology and dermatology. When supply disruptions occur, the clinical impact varies significantly by formulation. This guide is designed for prescribers and pharmacy teams managing glycopyrrolate availability challenges in 2026.

Current Availability Status by Formulation (2026)

Prescribers should distinguish between the formulations when assessing supply risk:

Oral tablets (generic, 1 mg/2 mg): Multiple generic manufacturers; generally available. No active FDA shortage as of early 2026.

Injectable solution (0.2 mg/mL): Historically shortage-prone. Check ASHP.org and your institutional pharmacy for current status. Substitution protocols with atropine are well-established.

Oral solution (Cuvposa, 1 mg/5 mL): Limited commercial manufacturers; pharmacy may need to order. Compounded formulations available as alternative.

Qbrexza topical cloth (2.4%): Brand-only; no generic equivalent. Access barriers are primarily insurance/PA-related rather than supply-related. Route through specialty pharmacies.

COPD inhalation products (Seebri Neohaler, Lonhala Magnair, Bevespi Aerosphere): Generally available. Multiple LAMA alternatives available if needed.

Injectable Glycopyrrolate Shortage: Clinical Background

Injectable glycopyrrolate (0.2 mg/mL) is used perioperatively as an antisialagogue and vagolytic agent, and in ICU/palliative settings to reduce excessive secretions (the "death rattle" phenomenon). It is also used to reverse neuromuscular blockade in combination with neostigmine. Because it does not cross the blood-brain barrier — unlike atropine — it produces peripheral anticholinergic effects without CNS effects.

Sterile injectable glycopyrrolate has repeatedly appeared on ASHP shortage lists due to the well-documented vulnerabilities of the sterile injectable supply chain: few manufacturers, thin margins, complex manufacturing requirements, and limited redundancy. Manufacturing quality issues at a single facility can reduce national supply by 30–50% or more.

Substitution Protocols: Injectable Glycopyrrolate

When injectable glycopyrrolate is unavailable, clinical substitution options include:

Atropine sulfate (IV/IM): The most common substitute. Crosses the blood-brain barrier, so CNS effects (confusion, agitation, tachycardia) are more pronounced, particularly in elderly patients. Effective for vagal blockade and preanesthetic use at 0.4–0.6 mg per dose.

Scopolamine (hyoscine) injection: Alternative antisialagogue; also crosses the BBB. Used in palliative settings for secretion management.

Neostigmine-only reversal (without anticholinergic): Sugammadex (Bridion) as an alternative reversal agent for rocuronium/vecuronium eliminates the need for neostigmine + glycopyrrolate in many settings.

Managing Patients on Oral Glycopyrrolate: Drooling and Peptic Ulcer

For pediatric patients on Cuvposa for sialorrhea associated with neurological conditions (e.g., cerebral palsy, ALS-related sialorrhea in adults):

Compounded glycopyrrolate oral suspension is a viable option when commercial Cuvposa is unavailable. Confirm the compounding pharmacy's concentration and stability data.

Botulinum toxin A (intraparotid/submandibular injections) provides 3–6 months of sialorrhea control and is widely used as an alternative or adjunct.

Scopolamine transdermal patch (off-label) may be considered in adults with sialorrhea when oral agents are unavailable, though CNS effects limit use in children and cognitively vulnerable patients.

Managing COPD Patients on Inhaled Glycopyrronium

COPD patients receiving inhaled glycopyrronium (Seebri Neohaler, Lonhala Magnair, or Bevespi Aerosphere) should generally be transitioned to an equivalent LAMA rather than discontinuing bronchodilator therapy. Options include:

Tiotropium (Spiriva): Most widely used LAMA. Once-daily Handihaler or Respimat. Extensive safety data.

Umeclidinium (Incruse Ellipta): Once-daily dry powder inhaler; available as monotherapy or in combination with vilanterol (Anoro Ellipta) or vilanterol+fluticasone (Trelegy Ellipta).

Revefenacin (Yupelri): Once-daily nebulized LAMA for patients requiring nebulizer delivery.

Communicating with Patients About Availability Issues

When patients contact your practice about glycopyrronium availability, consider these communication best practices:

Proactively identify patients on formulations at higher shortage risk (injectable, Cuvposa) and have contingency plans documented in the chart.

Advise patients to refill 1–2 weeks early rather than waiting until they run out, especially for chronic-use oral formulations.

Direct patients to medfinder.com/providers to learn about the provider-facing tools available for pharmacy location support.

Ensure prescriptions for Qbrexza are routed to appropriate specialty pharmacies at the time of prescribing — do not send to a retail pharmacy that doesn't carry it.

Resources for Providers

FDA Drug Shortage Database: accessdata.fda.gov/scripts/drugshortages

ASHP Drug Shortage Bulletins: ashp.org/drug-shortages

medfinder provider tools: medfinder.com/providers

For a step-by-step provider guide on helping patients locate glycopyrronium, see our related post: How to Help Your Patients Find Glycopyrronium in Stock.