Ipratropium Bromide
Brand Name: Atrovent
Generic Available*
Common Dosage Forms:
Atrovent HFA aerosol: Each actuation of the aerosol delivers 17 mcg of ipratropium. Net weight is 12.9 grams per canister with delivers 200 inhalations.
Oral inhalation solution*: 0.02% (500 mcg) in 2.5 mL vials
Nasal spray*: 0.03% (21 mcg per actuation), 0.06% (42 mcg per actuation)
FDA Indications/Dosages:
Maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema (aerosol and oral inhalation): Two inhalations of the aerosol or one unit-dose vial of the inhalation solution via nebulizer three to four times a day. Maximum of 12 inhalation every 24 hours.
Treatment of rhinorrhea associated with allergic and nonallergic perennial rhinitis in patients over the age of 12 years (0.03% spray): Two sprays in each nostril two to three times a day.
Treatment of rhinorrhea associated with the common cold in patients over the age of 12 years (0.06% spray): Two sprays in each nostril three to four times a day.
Pharmacology/Pharmacokinetics: Ipratropium bromide is an anticholinergic agent with appears to inhibit vagally mediated reflexes by antagonizing the action of acetylcholine. This action prevents the increases in intracellular concentration of cyclic guanosine monophosphate (cyclic-GMP) which are caused by the interaction of acetylcholine with the muscarinic receptor on bronchial smooth muscle. Ipratropium bromide has anti-secretory properties and inhibits and inhibits secretions from the serous and seromucous glands lining the nasal mucosa. Atrovent works as a local, site-specific drug, not a systemic one. It is poorly absorbed from the GI tract, nasal mucosa, and lung.
Drug Interactions: No known clinically significant drug interactions.
Contraindications/Precautions: Contraindicated in patients with known hypersensitivity to atropine or ipratropium. For maintenance therapy, not for acute attacks. Use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder-neck obstruction. Pregnancy Category B.
Adverse Effects: Aerosol: Cough (6%), oropharynx dryness (5%), nervous, dizziness, headache, GI dryness, and dry mouth (3%). Nasal spray: Headache, upper respiratory infection (10%), epistaxis (9%), pharyngitis (8%), and nasal dryness (5%).
Patient Consultation:
Store in a cool, dry place away from sunlight and children.
If a dose is missed, take it as soon as possible. If it is closer to the time of your next dose than the dose you missed, skip the missed dose, and return to your dosing schedule.
Directions for aerosol use:
Shake thoroughly.
Enclose mouthpiece with the lips, canister base up. Keep eyes closed. Exhale deeply, then inhale slowly while pressing firmly on the canister base. Continue to inhale deeply. Hold breath for a few second after inhalation.
Repeat after 15 seconds as directed.
Wash mouthpiece with hot water.
Contact a physician if the above side effects are severe or persistent.
Inhalation solution may be mixed with albuterol if used within one hour.
This formation is not intended for occasional use, use consistently for maximum effectiveness.
Directions for nasal spray priming:
If not used for more than 24 hours, the pump will require two actuations. If not used for more than 7 days, the pump will require 7 actuations.
