Ipratropium

Pronunciation

(i pra TROE pee um)


U.S. Brand Names

Atrovent®; Atrovent® HFA



Synonyms

Ipratropium Bromide



Generic Available

Yes: Excludes solution for oral inhalation



Canadian Brand Names

Alti-Ipratropium; Apo-Ipravent®; Atrovent®; Gen-Ipratropium; Novo-Ipramide; Nu-Ipratropium; PMS-Ipratropium



Use

Anticholinergic bronchodilator used in bronchospasm associated with COPD, bronchitis, and emphysema; symptomatic relief of rhinorrhea associated with the common cold and allergic and nonallergic rhinitis



Pregnancy Risk Factor

B



Pregnancy Implications

Teratogenic effects were not observed in animal studies.



Lactation

Excretion in breast milk unknown/use caution



Contraindications

Hypersensitivity to ipratropium, atropine, its derivatives, or any component of the formulation

In addition, Atrovent® inhalation aerosol is contraindicated in patients with hypersensitivity to soya lecithin or related food products (eg, soybean and peanut). Note: Other formulations may include these components; refer to product-specific labeling.

Warnings/Precautions

Not indicated for the initial treatment of acute episodes of bronchospasm; use with caution in patients with myasthenia gravis, narrow-angle glaucoma, benign prostatic hyperplasia (BPH), or bladder neck obstruction



Adverse Reactions

Inhalation aerosol and inhalation solution:

>10%: Bronchitis (10% to 23%), upper respiratory tract infection (13%)

1% to 10%:

Cardiovascular: Palpitation

Central nervous system: Dizziness (2% to 3%)

Dermatologic: Rash (1%)

Gastrointestinal: Nausea, xerostomia, stomach upset, dry mucous membranes

Renal: Urinary tract infection

Respiratory: Nasal congestion, dyspnea (10%), sputum increased (1%), bronchospasm (2%), pharyngitis (3%), rhinitis (2%), sinusitis (5%)

Miscellaneous: Flu-like syndrome

<1%: Anaphylactic reaction, angioedema, atrial fibrillation, bitter taste, blurred vision, constipation, hypersensitivity reactions, insomnia, laryngospasm, mucosal ulcers, nervousness, rash, stomatitis, supraventricular tachycardia, tremor, urinary retention, urticaria

Nasal spray: Respiratory: Epistaxis (8%), nasal dryness (5%), nausea (2%)

Overdosage/Toxicology

Symptoms of overdose include dry mouth, drying of respiratory secretions, cough, nausea, GI distress, blurred vision or impaired visual accommodation, headache, and nervousness. Acute overdose with ipratropium by inhalation is unlikely since it is so poorly absorbed. However, if poisoning occurs, it can be treated like any other anticholinergic toxicity. An anticholinergic overdose with severe life-threatening symptoms may be treated with physostigmine 1-2 mg SubQ or I.V. slowly.



Drug Interactions

Anticholinergics: Concurrent use with ipratropium may increase risk of adverse events.



Stability

Store at 15°C to 30°C (59°F to 86°F); do not store near heat or open flame.



Mechanism of Action

Blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation



Pharmacodynamics/Kinetics

Onset of action: Bronchodilation: 1-3 minutes

Peak effect: 1.5-2 hours

Duration:

4 hours

Absorption: Negligible

Distribution: Inhalation: 15% of dose reaches lower airways

Dosage

Nebulization:

Infants and Children

12 years: 125-250 mcg 3 times/day

Children >12 years and Adults: 500 mcg (one unit-dose vial) 3-4 times/day with doses 6-8 hours apart

Oral inhalation: MDI:

Children 3-12 years: 1-2 inhalations 3 times/day, up to 6 inhalations/24 hours

Children >12 years and Adults: 2 inhalations 4 times/day, up to 12 inhalations/24 hours

Intranasal: Nasal spray:

Symptomatic relief of rhinorrhea associated with the common cold (safety and efficacy of use beyond 4 days in patients with the common cold have not been established):

Children 5-11 years: 0.06%: 2 sprays in each nostril 3 times/day

Children

5 years and Adults: 0.06%: 2 sprays in each nostril 3-4 times/day

Symptomatic relief of rhinorrhea associated with allergic/nonallergic rhinitis: Children

6 years and Adults: 0.03%: 2 sprays in each nostril 2-3 times/day

Administration

Atrovent®: Shake inhaler before each use; rinsing mouth after each use decreases dry mouth side effect

Atrovent® HFA: Prime inhaler by releasing 2 test sprays into the air. If the inhaler has not been used for >3 days, reprime.

Dietary Considerations

Some dosage forms may contain soya lecithin. Do not use in patients allergic to soya lecithin or related food products such as soybean and peanut.



Patient Education

Inform prescriber of all prescriptions, OTC medications, or herbal products you are taking, and any allergies you have. Do not take any new medication during therapy without consulting prescriber. Use exactly as directed (see below). Do not use more often than recommended. Store solution away from light. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. May cause sensitivity to heat (avoid extremes in temperature); nervousness, dizziness, or fatigue (use caution when driving or engaging in tasks requiring alertness until response to drug is known); dry mouth, unpleasant taste, stomach upset (small, frequent meals, frequent mouth care, chewing gum, or sucking hard candy may help); or difficulty urinating (always void before treatment). Report unresolved GI upset, dizziness or fatigue, vision changes, palpitations, persistent inability to void, nervousness, or insomnia. Consult prescriber if breast-feeding.

Breast-feeding precaution:

Inhaler: Follow instructions for use accompanying the product. Close eyes when administering ipratropium; blurred vision may result if sprayed into eyes. Effects are enhanced by holding breath 10 seconds after inhalation; wait at least 1 full minute between inhalations.

Nebulizer: Wash hands before and after treatment. Wash and dry nebulizer after each treatment. Twist open the top of one unit dose vial and squeeze the contents into the nebulizer reservoir. Connect the nebulizer reservoir to the mouthpiece or face mask. Connect nebulizer to compressor. Sit in a comfortable, upright position. Place mouthpiece in your mouth or put on the face mask and turn on the compressor. If a face mask is used, avoid leakage around the mask (temporary blurring of vision, worsening of narrow-angle glaucoma, or eye pain may occur if mist gets into eyes). Breathe calmly and deeply until no more mist is formed in the nebulizer (about 5 minutes). At this point, treatment is finished.

Nursing Implications

Teach patients how to use the inhaler



Dental Health: Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Xerostomia and changes in salivation (normal salivary flow resumes upon discontinuation), and dry mucous membranes.



Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions



Mental Health: Effects on Mental Status

Nervousness, dizziness, and fatigue are common; may cause insomnia



Mental Health: Effects on Psychiatric Treatment

Concurrent use with psychotropics may produce additive anticholinergic effects



Dosage Forms

Solution for nebulization, as bromide: 0.02% (2.5 mL)

Solution for oral inhalation, as bromide (Atrovent®): 18 mcg/actuation (14 g) [contains soya lecithin and chlorofluorocarbons]

Solution for oral inhalation. as bromide (Atrovent® HFA): 17 mcg/actuation (12.9 g)

Solution, intranasal spray, as bromide (Atrovent®): 0.03% (30 mL); 0.06% (15 mL)

References

Adlung J, Hohle KD, Zeren S, et al, "Studies of Pharmacokinetics and Biotransformation of Ipratropium Bromide in Man,"Arzneimittelforschung, 1976, 26(5a):1005-10.

Connolly CK, "Adverse Reaction to Ipratropium Bromide,"Br Med J (Clin Res Ed), 1982, 285(6346):934-5.

Cugell DW, "Clinical Pharmacology and Toxicology of Ipratropium Bromide,"Am J Med, 1986, 81(5A):18-22.

Gross NJ, "Ipratropium Bromide,"N Engl J Med, 1988, 319(8):486-94.

Henry RI, Hiller EG, Milner AD, et al, "Nebulised Ipratropium Bromide and Sodium Cromoglycate in the First 2 Years of Life,"Arch Dis Child, 1984, 59(1):54-7.

Hughes DT, "The Use of Anticholinergic Drugs in Nocturnal Asthma,"Postgrad Med J, 1987, 63(Suppl 1):47-51.

Mann NP and Hiller RG, "Ipratropium Bromide in Children With Asthma,"Thorax, 1982, 37(1):72-4.

Osmond MH and Klassen TP, "Efficacy of Ipratropium Bromide in Acute Childhood Asthma: A Meta-Analysis,"Acad Emerg Med, 1995, 2(7):651-6.

Roberts TE and Pearson DJ, "Wide-Eyed and Breathless,"Br Med J, 1989, 299:1348.

Schuh S, Johnson DW, Canny G, et al, "Efficacy of Adding Nebulized Ipratropium Bromide to Nebulized Albuterol Therapy in Acute Bronchiolitis,"Pediatrics, 1992, 90(6):920-3.

Schuh S, Johnson DW, Callahan S, et al, "Efficacy of Frequent Nebulized Ipratropium Added to Frequent High-Dose Albuterol Therapy in Severe Childhood Asthma,"J Pediatr, 1995, 126(4):639-45.

Wang EE, Milner R, Allen U, et al, "Bronchodilators for Treatment of Mild Bronchiolitis: A Factorial Randomized Trial,"Arch Dis Child, 1992, 67(3):289-93.

Wilkie RA and Bryan MH, "Effect of Bronchodilators on Airway Resistance in Ventilator-dependent Neonates With Chronic Lung Disease,"J Pediatr, 1987, 111(2):278-82.

International Brand Names

Aerovent® (IL); Alti-Ipratropium (CA); Alvent® (BR); Apo-Ipravent® (CA); Apoven® (AU, IL); Atem® (CY, EG, IT, JO, KW, LB, SY); Atronase® (AT, BE, LU); Atrovent Aerocaps® (GB); Atrovent® (AR, AT, AU, BE, BG, BR, CA, CH, CL, CO, CR, CY, CZ, DE, DK, DO, EG, ES, FI, FR, GB, GT, HK, HN, HR, HU, ID, IE, JO, JP, KW, LB, LU, MT, MX, NL, NO, NZ, PA, PL, PT, RO, RU, SE, SG, SI, SV, TH, TR); Atrovent Autohaler® (GB); Atrovent® Nasal (AR, ES, FI, SE); Atrovent Nasal Spray 0.03%® (CL, SI); Atrovent® Nazal (RO); Bromuro de ipratopio MK® (CO); Chem mart Ipratropium® (AU); Ciplatropiun® (CO); DBL Ipratropium® (AU); Gen-Ipratropium (CA); GenRX Ipratropium® (AU); Healthsense Ipratropium® (AU); Iprabon® (BR); Ipratrin® (AU); Ipratropium Aguettant® (FR); Ipratropium Bromide® (GB); Ipratropium Steri Neb® (GB, NZ); Ipravent® (AU, IN, RO); Itrop® (AT, CZ, DE); Neorinol® (CL); Novo-Ipramide (CA); Nu-Ipratropium (CA); PMS-Ipratropium (CA); Respontin® (GB, NO); Rhinovent® (CH); Rinatec® (GB, IE); Rinovagos® (IT); Steri-Neb Ipratropium® (GB, IE, PL); Terry White Chemists Ipratropium® (AU); Tropiovent® (GB); Tropium® (DO, GT, HN, SV)



Review Date: 1969-12-31 Reviewed By: Keywords: ,
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