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Pronunciation |
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(i
pra TROE pee
um) |
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U.S. Brand
Names |
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Atrovent® |
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Generic
Available |
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No |
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Synonyms |
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Ipratropium Bromide |
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Pharmacological Index |
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Anticholinergic Agent |
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Use |
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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 |
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Pregnancy Risk
Factor |
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B |
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Contraindications |
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Hypersensitivity to atropine or its derivatives |
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Warnings/Precautions |
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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. |
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Adverse
Reactions |
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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 |
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Overdosage/Toxicology |
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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. |
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Drug
Interactions |
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Increased effect with albuterol
Increased toxicity with anticholinergics or drugs with anticholinergic
properties, dronabinol |
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Stability |
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Compatible for 1 hour when mixed with albuterol in a
nebulizer |
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Mechanism of
Action |
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Blocks the action of acetylcholine at parasympathetic sites in bronchial
smooth muscle causing bronchodilation |
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Pharmacodynamics/Kinetics |
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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
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Usual Dosage |
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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 |
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Administration |
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Shake inhaler before each use; rinsing mouth after each use decreases dry
mouth side effect |
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Mental Health: Effects
on Mental Status |
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Nervousness, dizziness, and fatigue are common; may cause
insomnia |
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Mental Health:
Effects on Psychiatric
Treatment |
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Concurrent use with psychotropics may produce additive anticholinergic
effects |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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>10% of patients experience dry mouth |
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Patient
Information |
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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.
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Nursing
Implications |
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Teach patients how to use the inhaler; shake inhaler before
administering |
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Dosage Forms |
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Solution, as bromide:
Nasal spray: 0.03% (30 mL); 0.06% (15 mL)
Nebulizing: 0.02% (2.5 mL) |
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References |
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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.
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