Ipratropium bromide

What is Ipratropium?

• Ipratropium (Atrovent HFA) is an anticholinergic, used to prevent wheezing, shortness of breath, coughing, and chest tightness in people with chronic obstructive pulmonary disease such as chronic bronchitis and emphysema.

Ipratropium

Ipratropium bromide

Ipratropium

Ipratropiumbromid

What are the uses of this medicine?

• Ipratropium (Atrovent HFA) is used as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.

How does this medicine work?

• The bromide salt form of ipratropium, a synthetic derivative of the alkaloid atropine with anticholinergic properties.
• Ipratropium antagonizes the actions of acetylcholine at parasympathetic, postganglionic, effector-cell junctions.
• When inhaled, ipratropium binds competitively to cholinergic receptors in the bronchial smooth muscle thereby blocking the bronchoconstrictor actions of the acetylcholine mediated vagal impulses.
• Inhibition of the vagal tone leads to dilation of the large central airways resulting in bronchodilation.

Who Should Not Use this medicine ?

This medicine cannot be used in patients:

• Hypersensitivity to ipratropium bromide or other components.
• Hypersensitivity to atropine or any of its derivatives.

What drug interactions can this medicine cause?

• Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.

Be sure to mention any of the following:

• antihistamines
• medications for irritable bowel disease, motion sickness, Parkinson's disease, ulcers, or urinary problems.

Is this medicine FDA approved?

• Ipratropium was approved for use in the United States in 1986 as a respiratory inhalant and indications include maintenance treatment of bronchospasm associated with chronic bronchitis and emphysema. Ipratropium is available in various formulations generically and under the brand names Atrovent and Combivent for use as an inhalant.

How should this medicine be used?

Recommended dosage:

• For oral inhalation only.
• Two inhalations four times a day, not to exceed 12 inhalations in 24 hours.

Administration:

• Ipratropium comes as a solution (liquid) to inhale by mouth using a nebulizer and as an aerosol to inhale by mouth using an inhaler. The nebulizer solution is usually used three or four times a day, once every 6 to 8 hours. The aerosol is usually used four times a day.
• If you are using the inhaler, your medication will come in canisters.
• Each canister of ipratropium aerosol is designed to provide 200 inhalations.
• After the labeled number of inhalations has been used, later inhalations may not contain the correct amount of medication.
• You should keep track of the number of inhalations you have used. You can divide the number of inhalations in your inhaler by the number of inhalations you use each day to find out how many days your inhaler will last.
• Dispose of the canister after you have used the labeled number of inhalations even if it still contains some liquid and continues to release a spray when it is pressed.
• Do not float the canister in water to see if it still contains medication.
• Be careful not to get ipratropium into your eyes.
• If you are using the inhaler, keep your eyes closed when you use the medication.
• If you are using the nebulizer solution, you should use a nebulizer with a mouthpiece instead of a face mask.
• If you must use a face mask, ask your doctor how you can prevent the medication from leaking.
• If you get ipratropium in your eyes, you may develop narrow angle glaucoma (a serious eye condition that may cause loss of vision).
• If you already have narrow angle glaucoma, your condition may worsen. You may experience widened pupils (black circles in the center of the eyes), eye pain or redness, blurred vision, and vision changes such as seeing halos around lights.
• The inhaler that comes with ipratropium aerosol is designed for use only with a canister of ipratropium.
• Never use it to inhale any other medication, and do not use any other inhaler to inhale ipratropium.
• Do not use your ipratropium inhaler when you are near a flame or source of heat.
• The inhaler may explode if it is exposed to very high temperatures.

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

This medicine is available in fallowing doasage form:

• As a solution (liquid) to inhale by mouth
• As an aerosol to inhale by mouth

This medicine is available in fallowing brand namesː

• Atrovent HFA

What side effects can this medication cause?

The most common side effects of this medicine may include:

• Back pain
• Headache
• Influenza-like symptoms
• Dizziness
• Dyspepsia
• Mouth dry
• Nausea
• Bronchitis
• COPD exacerbation
• Dyspnea
• Sinusitis
• Urinary tract infection

Less common, but serious side effects may include:

• Hypersensitivity reactions, including anaphylaxis
• Paradoxical bronchospasm
• Ocular effects
• Urinary retention

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

What special precautions should I follow?

• Not indicated for the initial treatment of acute episodes of bronchospasm where rescue therapy is required for rapid response.
• Hypersensitivity reactions, including urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema, may occur after the administration of ATROVENT HFA. Advise patients to immediately discontinue ATROVENT HFA and consult a physician.
• ATROVENT HFA can produce paradoxical bronchospasm that can be life-threatening. If paradoxical bronchospasm occurs, patients should discontinue using ATROVENT HFA.
• Caution patients to avoid spraying the aerosol into their eyes and be advised that this may result in precipitation or worsening of narrow-angle glaucoma, mydriasis, increased intraocular pressure, acute eye pain or discomfort, temporary blurring of vision, visual halos or colored images in association with red eyes from conjunctival and corneal congestion. Patients should also be advised that should any combination of these symptoms develop, they should consult their physician immediately.
• Since dizziness, accommodation disorder, mydriasis, and blurred vision may occur with use of ATROVENT HFA, patients should be cautioned about engaging in activities requiring balance and visual acuity such as driving a car or operating appliances or machinery.
• ATROVENT HFA may cause urinary retention and should be advised to consult their physicians if they experience difficulty with urination.
• The action of ATROVENT HFA should last 2 to 4 hours. Advise patients not to increase the dose or frequency of ATROVENT HFA without patients consulting their physician. Advise patients to seek immediate medical attention if treatment with ATROVENT HFA becomes less effective for symptomatic relief, their symptoms become worse, and/or patients need to use the product more frequently than usual.
• There are no data on the presence of ipratropium in either human or animal milk, the effects on the breastfed infant, or the effects on milk production.
• Ipratropium has not been implicated in causing liver enzyme elevations or clinically apparent acute liver injury.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• Acute overdose by inhalation is unlikely since ipratropium bromide is not well absorbed systemically after inhalation 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?

• Ipratropium is negligibly absorbed systemically following oral inhalation; therefore, maternal use is not expected to result in fetal exposure to the drug.

Can this medicine be used in children?

• Safety and effectiveness in the pediatric population have not been established.

What are the active and inactive ingredients in this medicine?

• Active ingredient:ipratropium bromide (as the monohydrate)
• Inactive ingredients:none

Who manufactures and distributes this medicine?

Distributed by:

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

Licensed from:

• Boehringer Ingelheim International GmbH

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

• Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).
• For optimal results, the canister should be at room temperature before use.
• Do not puncture.
• Do not use or store near heat or open flame.
• Exposure to temperatures above 120°F may cause bursting.
• Never throw the inhaler into a fire or incinerator.
• Keep out of reach of children.
• Avoid spraying in eyes.

• Dailymed label info on Ipratropium bromide
• FDA Ipratropium bromide

Ipratropium bromide Resources
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