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GLYCOPYRROLATE

All injection strengths: Limited Use (codes 481)

Glycopyrrolate Injection USP · DIN 02513749 · 0.4mg/2mL · injection solution (Preservative Free)

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
Glycopyrrolate Injection USP · DIN 02513749 Manufacturer: Jamp Pharma Corporation; listing date 2024-08-30 Health Canada: Marketed since 2022-04-01 · brand GLYCOPYRROLATE INJECTION USP · ATC A03AB02 GLYCOPYRRONIUM · form Solution · route Intramuscular, Intravenous · ingredients GLYCOPYRROLATE 0.2 MG/ML · company Jamp pharma corporation · schedule Ethical
Check this DIN again · Health Canada product record

Glycopyrrolate Injection USP: 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=100293 · Verify on the e-Formulary ↗ (DIN 02513749)

Source record
DIN 02513749: Glycopyrrolate Injection USP Raw flags: sec12=Y, sec3=Y Item: 120808014; group id 214; item number 0389; lccId 00288; manufacturer id JPC Source form: Inj Sol (Preservative Free); strength: 0.4mg/2mL 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=02513749 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=100293
Interchangeable products
Glycopyrrolate Injection USP · DIN 02473895 · $2.7825 Robinul · DIN 09858163 · not recorded
Shortage status: no shortage or discontinuation reported (checked 2026-09-13T08:10:21.292534+00:00); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada) Source: https://healthproductshortages.ca/search?term=02513749
Shortage record checked 2026-09-13T08:10:21.292534+00:00
Other drugs in the same formulary class (12:08:08 Antimuscarinics/Antispasmodics) and how they are covered

Matched class: 12:08:08 Antimuscarinics/Antispasmodics

Drug-class inventory only. Lists recorded Ontario formulary products, not every Canadian medication; does not recommend treatment. Covered without a code on the Ontario formulary: TIOTROPIUM BROMIDE MONOHYDRATE, UMECLIDINIUM 12:08:08 Antimuscarinics/Antispasmodics

TIOTROPIUM BROMIDE MONOHYDRATE

· 4 products · General benefit · strengths: 18mcg, 2.5mcg/Actuation · Inh Cap, Inh Sol-60 Actuation Pk

UMECLIDINIUM

· 1 products · General benefit · strengths: 62.5mcg · Blister Pd Inh-30 Dose Pk

HYOSCINE BUTYLBROMIDE

· 1 products · Limited Use, codes 481 · strengths: 20mg/mL · Inj Sol

TIOTROPIUM BROMIDE MONOHYDRATE & OLODATEROL HYDROCHLORIDE

· 1 products · Limited Use, codes 459 · strengths: 2.5mcg & 2.5mcg/Actuation · Inh Sol-60 Actuation Pk Source: formulary-ed43-front-matter.txt Part V; ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26; class 12:08:08
Full class listing Related classes: Same formulary class, not same indication: class membership alone does not establish equivalent uses.
What the Health Canada label says it is for
1. Indications GLYCOPYRROLATE INJECTION USP is indicated for: • Gastrointestinal Disorders: GLYCOPYRROLATE INJECTION USP may be used in the management of gastrointestinal disorders amenable to anticholinergic therapy when oral medication is not tolerated or a rapid anticholinergic effect is desired. • Anesthesia: GLYCOPYRROLATE INJECTION USP is of value as a preanesthetic antimuscarinic agent. Due to its benzyl alcohol content, GLYCOPYRROLATE INJECTION USP when packaged in multidose vials should not be used in children less than 3 years of age or in newborns. See 2 Contraindications. • Reversal of Neuromuscular Blockade: During reversal of neuromuscular blockade induced by nondepolarizing muscle relaxants, it protects against the peripheral muscarinic effects (e.g. bradycardia and excessive secretions) of cholinergic agents such as neostigmine and pyridostigmine. 1.1. Pediatrics Pediatrics (<18 years of age): No data are available to Health Canda on the use of GLYCOPYRROLATE INJECTION USP in the management of gastrointestinal disorders in children; therefore Health Canada has not authorized this indication for pediatric use. … https://pdf.hres.ca/dpd_pm/00082645.PDF PM date: 2025-12-02 Source product: GLYCOPYRROLATE INJECTION USP; DIN 02039508; fetched 2026-09-10 Product monograph posted by Health Canada; excerpt for lookup only.