Look Up > Drugs > Ipratropium
Ipratropium
Pronunciation
U.S. Brand Names
Generic Available
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Stability
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Administration
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(i pra TROE pee um)

U.S. Brand Names
Atrovent®

Generic Available

No


Synonyms
Ipratropium Bromide

Pharmacological Index

Anticholinergic Agent


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


Contraindications

Hypersensitivity to atropine or its derivatives


Warnings/Precautions

Not indicated for the initial treatment of acute episodes of bronchospasm; use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder neck obstruction; ipratropium has not been specifically studied in the elderly, but it is poorly absorbed from the airways and appears to be safe in this population.


Adverse Reactions

Note: Ipratropium is poorly absorbed from the lung, so systemic effects are rare

Central nervous system: Nervousness, dizziness, fatigue, headache

Gastrointestinal: Nausea, xerostomia, stomach upset

Respiratory: Cough

1% to 10%:

Cardiovascular: Palpitations, hypotension

Central nervous system: Insomnia

Genitourinary: Urinary retention

Neuromuscular & skeletal: Trembling

Ocular: Blurred vision

Respiratory: Nasal congestion

<1%: Rash, urticaria, stomatitis


Overdosage/Toxicology

Symptoms of overdose include dry mouth, drying of respiratory secretions, cough, nausea, GI distress, blurred vision or impaired visual accommodation, headache, nervousness

Acute overdosage 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 (0.5 mg or 0.02 mg/kg for children) S.C. or I.V., slowly.


Drug Interactions

Increased effect with albuterol

Increased toxicity with anticholinergics or drugs with anticholinergic properties, dronabinol


Stability

Compatible for 1 hour when mixed with albuterol in a nebulizer


Mechanism of Action

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


Pharmacodynamics/Kinetics

Onset of bronchodilation: 1-3 minutes after administration

Peak effect: Within 1.5-2 hours

Duration: Up to 4-6 hours

Absorption: Not readily absorbed into the systemic circulation from the surface of the lung or from the GI tract

Distribution: Inhalation: 15% of dose reaches the lower airways


Usual Dosage

Nebulization:

Infants and Children less than or equal to 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

Metered dose inhaler:

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

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 greater than or equal to 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 greater than or equal to 6 years and Adults: 0.03%: 2 sprays in each nostril 2-3 times/day


Administration

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


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


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

>10% of patients experience dry mouth


Patient Information

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). You may experience 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 (frequent small 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. Breast-feeding precautions: Consult prescriber if breast-feeding.

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 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; shake inhaler before administering


Dosage Forms

Solution, as bromide:

Nasal spray: 0.03% (30 mL); 0.06% (15 mL)

Nebulizing: 0.02% (2.5 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.

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.


Copyright © 1978-2000 Lexi-Comp Inc. All Rights Reserved