Ipratropium bromide
Ipratropium bromide (Atrovent)
Ipratropium bromide
(eye-prah- TROH-pee-um)
Pregnancy Category: B Alti-Ipratropium Bromide Apo-Ipravent Atrovent Novo-Ipramide PMS-Ipratropium (Rx)

Classification: Anticholinergic, quaternary ammonium compound

See Also: See also Cholinergic Blocking Agents .

Action/Kinetics: Chemically related to atropine. Antagonizes the action of acetylcholine. Prevents the increase in intracellular levels of cyclic guanosine monophosphate, which is caused by the interaction of acetylcholine with muscarinic receptors in bronchial smooth muscle; this leads to bronchodilation which is primarily a local, site-specific effect. Poorly absorbed into the systemic circulation. About 50% of unchanged drug excreted through the urine. t 1/2, elimination: 2 hr after inhalation.

Uses: Aerosol or solution: Bronchodilation in COPD, including chronic bronchitis and emphysema. Nasal spray: Symptomatic relief (using 0.03%) of rhinorrhea associated with allergic and nonallergic perennial rhinitis in clients over 6 years of age. Symptomatic relief (using 0.06%) of rhinorrhea associated with the common cold in those aged 5 and older. NOTE: The use of ipratropium with sympathomimetic bronchodilators, methylxanthines, steroids, or cromolyn sodium (all of which are used in treating COPD) are without side effects.

Contraindications: Hypersensitivity to atropine, ipratropium, or derivatives. Hypersensitivity to soy lecithin or related food products, including soy bean or peanut (inhalation aerosol). Use for initial treatment of acute bronchospasms.

Special Concerns: Use with caution in clients with narrow-angle glaucoma, prostatic hypertrophy, or bladder neck obstruction and during lactation. Safety and efficacy of the aerosol and solution have not been determined in children less than 12 years of age, of the nasal spray, 0.03%, in children less than 6 years of age, and of the nasal spray, 0.06%, in children less than 5 years of age. Use of ipratropium as a single agent for the relief of bronchospasm in acute COPD has not been studied adequately.

Side Effects: Inhalation aerosol. CNS: Cough, nervousness, dizziness, headache, fatigue, insomnia, drowsiness, difficulty in coordination, tremor. GI: Dryness of oropharynx, GI distress, dry mouth, nausea, constipation. CV: Palpitations, tachycardia, flushing. Dermatologic: Itching, hives, alopecia. Miscellaneous: Irritation from aerosol, worsening of symptoms, rash, hoarseness, blurred vision, difficulty in accommodation, drying of secretions, urinary difficulty, paresthesias, mucosal ulcers.
Inhalation solution. CNS: Dizziness, insomnia, nervousness, tremor, headache. GI: Dry mouth, nausea, constipation. CV: Hypertension, aggravation of hypertension, tachycardia, palpitations. Respiratory: Worsening of COPD symptoms, coughing, dyspnea, bronchitis, bronchospasm, increased sputum, URI, pharyngitis, rhinitis, sinusitis. Miscellaneous: Urinary retention, UTIs, urticaria, pain, flu-like symptoms, back or chest pain, arthritis.

How Supplied: Aerosol: 0.018 mg/inh; Nasal Spray: 0.03%, 0.06%; Solution for Inhalation: 0.02%

Dosage
?Respiratory Aerosol Treat bronchospasms.
Adults: 2 inhalations (36 mcg) q.i.d. Additional inhalations may be required but should not exceed 12 inhalations/day.
?Solution for Inhalation Treat bronchospasms.
Adults: 500 mcg (1-unit-dose vial) given t.i.d.-q.i.d. by oral nebulization with doses 6-8 hr apart.
?Nasal Spray, 0.03% Perennial rhinitis.
Children, 6 years and older: 2 sprays (42 mcg) per nostril b.i.d.-t.i.d. for a total daily dose of 168-252 mcg/day. Optimum dose varies.
?Nasal Spray, 0.06% Rhinitis due to the common cold.
Children, 5 years and older: 2 sprays (84 mcg) per nostril t.i.d.-q.i.d. for a total daily dose of 504-672 mcg/day. The safety and efficacy for use for the common cold for more than 4 days have not been determined.