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Ipratropium Bromide

Pronunciation

Pronunciation: IH-pruh-TROE-pee-uhm BROE-mide
Class: Anticholinergic

Trade Names

Atrovent HFA
- Aerosol Each actuation delivers 17 mcg

Ipratropium Bromide
- Solution for Inhalation 0.02% (500 mcg/vial)
- Nasal Spray 0.03%. Each spray delivers 21 mcg
- Nasal Spray 0.06%. Each spray delivers 42 mcg

Apo-Ipravent (Canada)
Gen-Ipratropium (Canada)
ratio-Ipratropium (Canada)
ratio-Ipratropium UDV (Canada)

Pharmacology

Antagonizes action of acetylcholine on bronchial smooth muscle in lungs, causing bronchodilation.

Slideshow: Flashback: FDA Drug Approvals 2013

Pharmacokinetics

Absorption

Mean bioavailability is 7% (inhalation). Ipratropium is not readily absorbed.

Distribution

0 to 9% is protein bound.

Metabolism

Partially metabolized.

Elimination

The t ½ is approximately 2 h (inhalation or IV). Following IV administration, approximately half of the dose is excreted unchanged in the urine.

Special Populations

Renal Function Impairment

Pharmacokinetics not studied.

Hepatic Function Impairment

Pharmacokinetics not studied.

Indications and Usage

Maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and emphysema, used alone or in combination with other bronchodilators (inhalation); symptomatic relief of rhinorrhea associated with allergic and nonallergic rhinitis and symptomatic relief of rhinorrhea associated with the common cold (intranasal).

Contraindications

Hypersensitivity to atropine or any anticholinergic derivatives or to soya lecithin or related food products.

Dosage and Administration

Adults

Aerosol/Inhalation 2 inhalations 4 times daily. Do not exceed 12 inhalations in 24 h. Solution 500 mcg (1 unit dose vial) administered 3 to 4 times a day by oral nebulization, with doses 6 to 8 h apart. The solution can be mixed in the nebulizer with albuterol if used within 1 h.

Spray 0.03 formulation: 2 sprays (42 mcg) per nostril 2 or 3 times daily (optimum dose varies). 0.06 formulation: 2 sprays (84 mcg) per nostril 3 or 4 times daily (optimum dose varies).

General Advice

  • Inhalation
  • Allow 1 to 2 min between inhalations.
  • If patient is also receiving an inhaled beta 2 -agonist, give beta 2 -agonist before administering ipratropium.
  • Use spacing device (eg, Aerochamber ) to facilitate intrapulmonary deposition.
  • HFA inhaler
  • Initial priming: Release 2 test sprays into the air away from the face. if not used for more than 3 days, prime inhaler again.
  • Nasal spray
  • Initial pump priming: 7 actuations of the pump. For regular use, no further priming is required. If not used for more than 24 h, 2 actuations are needed. If not used for more than 7 days, 7 actuations are needed.

Storage/Stability

Aerosol

Store at 77°F; excursions permitted between 59° and 86°F. Do not puncture. Do not use or store near heat or open flame.

Nasal spray

Store upright between 59° and 86°F. Avoid freezing.

Solution

Store at room temperature. Protect from light. Store unused vials in the foil pouch.

Drug Interactions

Anticholinergics

There is some potential for additive anticholinergic effects when administered with other anticholinergic agents.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Palpitations; hypertension; aggravated hypertension; hypotension, tachycardia, superventricular tachycardia and/or atrial fibrillation (postmarketing).

Respiratory

Cough; exacerbation of symptoms; bronchitis dyspnea, upper respiratory tract infection, bronchospasm (including paradoxical bronchospasm).

CNS

Nervousness; dizziness; headache.

EENT

Acute eye pain; blurred vision; local irritation; mydriasis; epistaxis, nasal dryness, nasal congestion, nasal burning, conjunctivitis, hoarseness, increased intraocular pressure, pharyngitis, rhinitis, sinusitis (0.06% nasal spray formulation only).

GI

Nausea; dry mouth; GI distress; constipation; taste perversion; dyspepsia.

Miscellaneous

Allergic-type reactions (rash; pruritus; angioedema of the tongue, lips, and face; urticaria; laryngospasm; anaphylacitc reactions), arthritis, back pain, influenza-like symptoms, rash, urinary retention, UTI.

Precautions

Pregnancy

Category B .

Lactation

Undetermined.

Children

Safety and efficacy in children younger than 12 yr of age not established for solution; younger than 6 yr of age for 0.03% nasal spray; younger than 5 yr of age for 0.06% nasal spray; safety and efficacy not established (HFA inhaler).

Hypersensitivity

May occur immediately.

Special Risk Patients

Use drug with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, prostatic hyperplasia, or bladder neck obstruction due to increased risk for precipitation or worsening of underlying disease.

Acute bronchospasm

Not indicated for initial treatment of acute episodes of bronchospasm in which rapid response is required. For relief of bronchospasms in acute exacerbations of COPD, drugs with faster onset may be preferable as initial therapy. The combination of ipratropium and beta agonists in the relief of bronchospasms associated with COPD has not been demonstrated to be more efficacious than either drug alone.

Paradoxical bronchospasm

May occur.

Patient Information

  • Instruct patient on proper use of inhaler. Explain value of using spacing device.
  • Instruct patient on proper sequencing and timing if using more than 1 inhaled agent.
  • Teach patient how to determine when canister is empty and needs to be replaced.
  • Teach patient how to properly use the nasal spray.
  • Caution patient not to rely on ipratropium for acute bronchospasm.
  • For relief of dry mouth, suggest use of saliva substitute, practice of good oral hygiene, rinsing of mouth after inhalation. Instruct patient to take sips of water frequently, suck on ice chips or sugarless hard candy, or chew sugarless gum.
  • Caution patient to avoid spraying aerosol in eyes; temporary blurred vision may result.
  • Advise patients using aerosol to seek immediate medical attention if recommended dosage does not provide relief or if symptoms worsen.
  • Advise patients not to use other inhaled drugs unless prescribed while taking ipratropium inhalation aerosol.
  • Use a nebulizer with a mouthpiece for the solution rather than a face mask to reduce the likelihood of the solution reaching the eyes.
  • Instruct patient to notify health care provider if condition worsens or if the following symptoms occur: dizziness, nausea, headache, palpitations, or cough.
  • Advise patient using nasal spray to avoid spraying in or around eyes. Patient should contact health care provider if experiencing eye pain, blurred vision, excessive nasal dryness, or nasal bleeding.
  • Advise patient that drug may cause dizziness and to use caution while driving or performing other tasks requiring mental alertness.

Copyright © 2009 Wolters Kluwer Health.

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