Sandoz Glycopyrrolate · DIN 02039508 · 0.2mg/mL · injection solution
Limited Use — Reason for Use code 481 requiredMarketed · checked 2026-09-02
StatusLimited Use — Reason for Use code 481 required
Write on scriptLU code 481 (patient must meet the criteria below)
Patient paysPatient pays: program not supplied; amount cannot be determined.
Private plan unknown: ask. If yes, check its coverage and payer coordination; if no, see the public routes below.
Ontario Limited Use criteria — code 481
Reason for Use code 481
For the management of patients receiving palliative care*.
Coverage limit:
LU Authorization Period: 1 year
Coverage limit:
*The patient must have a progressive life-limiting illness and require this medication for palliative purposes.
1 brand, same coverage
Sandoz Glycopyrrolate · DIN 02039508
Manufacturer: Sandoz Canada Inc.; listing date 2017-07-31
Health Canada: Marketed since 2005-09-21 · brand GLYCOPYRROLATE INJECTION USP · ATC A03AB02 GLYCOPYRRONIUM · form Solution · route Intravenous, Intramuscular · ingredients GLYCOPYRROLATE 0.2 MG/ML · company Sandoz canada incorporated · schedule Ethical
Sandoz Glycopyrrolate: Formulary list price $2.7825/unit (unit not stated in source; not the patient's cost)
Ministry pays: $2.7825 per source unit.
Source explanation: The formulary price is what ODB pays; the cash price at the counter is set by the pharmacy.
Formulary data: Ontario extract of Aug 26, 2026 · Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=14577 · Verify on the e-Formulary ↗ (DIN 02039508)
Source record
DIN 02039508: Sandoz Glycopyrrolate
Raw flags: sec12=Y, sec3=Y
Item: 120808010; group id 214; item number 0388; lccId 00288; manufacturer id SDZ
Source form: Inj Sol; strength: 0.2mg/mL
Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below
Source prices (unrounded): $2.7825; ministry $2.7825
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02039508
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=14577
Interchangeable products
Glycopyrrolate Injection · DIN 02382857 · $2.7825
Glycopyrrolate Injection USP · DIN 02473879 · $2.7825
Robinul · DIN 02043610 · not recorded
Shortage status: resolved shortage (ended 2026-03-30); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada)
Source: https://healthproductshortages.ca/search?term=02039508
Shortage record checked 2026-09-13T08:10:21.292534+00:00