Ipratropium Nasal Spray

What is Ipratropium Nasal Spray?

• Ipratropium Nasal Spray (Atrovent Nasal Spray) is an anticholinergic agent, as a nasal solution sprayed into the nostrils can reduce rhinorrhea but will not help nasal congestion.

Ipratropium

Ipratropium bromide

Ipratropium

Ipratropiumbromid

What are the uses of this medicine?

• Ipratropium nasal spray is available in two strengths that are used to treat different conditions.
• Ipratropium Nasal Spray 0.03% is used for the symptomatic relief of rhinorrhea associated with allergic and nonallergic perennial rhinitis in adults and children age 6 years and older.
• Ipratropium Bromide Nasal Solution 0.06% is indicated for the symptomatic relief of rhinorrhea associated with the common cold or seasonal allergic rhinitis for adults and children age 5 years and older.

Limitations of use:

• Ipratropium nasal spray does not relieve nasal congestion, sneezing, or postnasal drip caused by these conditions.
• The safety and effectiveness of the use of Ipratropium Bromide Nasal Solution 0.06% beyond four days in patients with the common cold have not been established.
• The safety and effectiveness of the use of Ipratropium Bromide Nasal Solution 0.06% beyond three weeks in patients with seasonal allergic rhinitis have not been established.

How does this medicine work?

• Ipratropium bromide is an anticholinergic (parasympatholytic) agent which, based on animal studies, appears to inhibit vagally-mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released at the neuromuscular junctions in the lung.
• In humans, ipratropium bromide has anti-secretory properties and, when applied locally, inhibits secretions from the serous and seromucous glands lining the nasal mucosa.
• Ipratropium bromide is a quaternary amine that minimally crosses the nasal and gastrointestinal membranes and the blood-brain barrier, resulting in a reduction of the systemic anticholinergic effects (e.g., neurologic, ophthalmic, cardiovascular, and gastrointestinal effects) that are seen with tertiary anticholinergic amines.

Who Should Not Use this medicine ?

This medicine cannot be used in patients who:

• in patients with a history of hypersensitivity to atropine or its derivatives, or to any of the other ingredients.

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Be sure to mention any of the following:

• antihistamines
• ipratropium oral inhalation (Atrovent HFA, Combivent)
• medications for irritable bowel disease, motion sickness, Parkinson's disease, ulcers, or urinary problems

Is this medicine FDA approved?

• Ipratropium bromide was patented in 1966, and approved for medical use in 1974.
• pratropium is available as a generic medication.
• In 2020, it was the 312th most commonly prescribed medication in the United States, with more than 900 thousand prescriptions.

How should this medicine be used?

Recommended dosage:

• The recommended dose of ATROVENT Nasal Spray 0.03% is two sprays (42 mcg) per nostril two or three times daily (total dose 168 to 252 mcg/day) for the symptomatic relief of rhinorrhea associated with allergic and nonallergic perennial rhinitis in adults and children age 6 years and older.

For Symptomatic Relief of Rhinorrhea Associated with the Common Cold:

• The recommended dose of Ipratropium Bromide Nasal Solution 0.06% is two sprays (84 mcg) per nostril three or four times daily (total dose 504 to 672 mcg/day) in adults and children age 12 years and older.
• The recommended dose of Ipratropium Bromide Nasal Solution 0.06% for children age 5-11 years is two sprays (84 mcg) per nostril three times daily (total dose of 504 mcg/day).

For Symptomatic Relief of Rhinorrhea Associated with Seasonal Allergic Rhinitis:

• The recommended dose of Ipratropium Bromide Nasal Solution 0.06% is two sprays (84 mcg) per nostril four times daily (total dose 672 mcg/day) in adults and children age 5 years and older.

Administration:

• Ipratropium comes as a spray to use in the nose.
• Use ipratropium nasal spray at around the same times every day.
• Do not spray ipratropium nasal spray in or around your eyes.
• If this occurs, immediately flush your eyes with cool tap water for several minutes.
• If you spray the medication in your eyes, you may experience the following symptoms: blurred vision, seeing visual halos or colored images, red eyes, development or worsening of narrow-angle glaucoma, widened pupils, sudden eye pain, and increased sensitivity to light.
• If you spray ipratropium in your eyes or experience any of these symptoms, contact your doctor immediately.
• Do not change the size of the opening of the nasal spray as this would affect the amount of medication you receive.
• Initial pump priming requires seven sprays of the pump.
• If used regularly as recommended, no further priming is required.
• If not used for more than 24 hours, the pump will require two sprays, or if not used for more than seven days, the pump will require seven sprays to reprime.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Ipratropium Bromide Nasal Solution 0.06%
• Ipratropium Bromide Nasal Spray 0.03%

This medicine is available in fallowing brand namesː

• Atrovent Nasal Spray

What side effects can this medication cause?

The most common side effects of this medicine include:

• Headache
• Upper respiratory tract infection
• Epistaxis
• Rhinitis
• Nasal dryness
• Nasal irritation
• Other nasal symptoms
• Pharyngitis
• Nausea
• nosebleeds
• dry throat or mouth
• sore throat
• changes in taste
• headache
• diarrhea

• Anticholinergic agents can precipitate acute narrow angle glaucoma and acute urinary retention.

What special precautions should I follow?

• Immediate hypersensitivity reactions may occur after administration of ipratropium bromide, as demonstrated by urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema. If such a reaction occurs, therapy with Ipratropium Bromide Nasal spray should be stopped at once and alternative treatment should be considered.
• Ipratropium Bromide Nasal Spray should be used with caution in patients with narrow-angle glaucoma, prostatic hyperplasia, or bladder neck obstruction, particularly if they are receiving an anticholinergic by another route.
• Ipratropium Bromide Nasal Spray has not been studied in patients with hepatic or renal insufficiency. It should be used with caution in those patient populations.
• Patients should be advised that temporary blurring of vision, precipitation or worsening of narrow-angle glaucoma, mydriasis, increased intraocular pressure, acute eye pain or discomfort, visual halos or colored images in association with red eyes from conjunctival and corneal congestion may result if Ipratropium Bromide Nasal Spray comes into direct contact with the eyes.
• Patients should be instructed to avoid spraying Ipratropium Bromide Nasal Spray in or around the eyes.
• Patients who experience eye pain, blurred vision, excessive nasal dryness or episodes of nasal bleeding should be instructed to contact their doctor.
• To ensure proper dosing, patients should be advised not to alter the size of the nasal spray opening.
• Dizziness, accommodation disorder, mydriasis, and blurred vision may occur with use of Ipratropium Bromide Nasal Spray, patients should be cautioned about engaging in activities requiring balance and visual acuity such as driving a car or operating appliances, machinery, etc.
• It is known that some ipratropium bromide is systemically absorbed following nasal administration; however the portion which may be excreted in human milk is unknown. Caution should be exercised when Ipratropium Bromide Nasal Spray is administered to a nursing mother.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• Acute overdosage by intranasal administration is unlikely since ipratropium bromide is not well absorbed systemically after intranasal or oral administration.

Management of overdosage:

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.

Can this medicine be used in pregnancy?

• Pregnancy Category B.
• There are no adequate and well-controlled studies for Ipratropium Bromide Nasal Spray in pregnant women.
• Because animal reproduction studies are not always predictive of human response, Ipratropium Bromide Nasal Spray should be used during pregnancy only if clearly needed.

Can this medicine be used in children?

• The safety and effectiveness of Ipratropium Bromide Nasal Solution 0.06% (Nasal Spray) in pediatric patients under 5 years of age have not been established.
• The safety and effectiveness of ATROVENT Nasal Spray 0.03% in patients under 6 years of age have not been established.

What are the active and inactive ingredients in this medicine?

Active ingredients:

• IPRATROPIUM BROMIDE

Inactive ingredients:

• BENZALKONIUM CHLORIDE
• EDETATE DISODIUM
• SODIUM CHLORIDE
• SODIUM HYDROXIDE
• HYDROCHLORIC ACID
• WATER

Who manufactures and distributes this medicine?

ATROVENT Nasal Spray 0.03%:

Distributed by:

• Boehringer Ingelheim Pharmaceuticals, Inc.
• Ridgefield, CT USA

Licensed from:

• Boehringer Ingelheim International GmbH

Ipratropium Bromide Nasal Solution 0.06% (Nasal Spray):

Distributed by:

• Bausch + Lomb, a division of
• Bausch Health US, LLC
• Bridgewater, NJ USA

Manufactured by:

• Bausch Health Companies Inc.
• Laval, Quebec, Canada

What should I know about storage and disposal of this medication?

• Store tightly closed at 25°C (77°F); excursions permitted to 15°-30°C (59°-86°F).
• Avoid freezing.
• Keep out of reach of children.

• Dailymed label info on Ipratropium Nasal Spray
• FDA Ipratropium Nasal Spray

Ipratropium Nasal Spray Resources
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