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Ipratropium (Nasal)

Pronunciation

Pronunciation

(i pra TROE pee um)

Index Terms

  • Ipratropium Bromide

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Nasal, as bromide:

Atrovent: 0.03% (30 mL [DSC]); 0.06% (15 mL [DSC])

Generic: 0.03% (30 mL); 0.06% (15 mL)

Brand Names: U.S.

  • Atrovent [DSC]

Pharmacologic Category

  • Anticholinergic Agent

Pharmacology

Local application to nasal mucosa inhibits serous and seromucous gland secretions.

Absorption

<20%

Metabolism

To inactive metabolites via ester hydrolysis

Excretion

Urine (50%, as metabolites and unchanged drug)

Half-Life Elimination

1.6 hours

Use: Labeled Indications

Symptomatic relief of rhinorrhea associated with the common cold and allergic and nonallergic rhinitis

Contraindications

Hypersensitivity to ipratropium, atropine (and its derivatives), or any component of the formulation

Dosing: Adult

Colds (symptomatic relief of rhinorrhea): Safety and efficacy of use beyond 4 days not established: Intranasal: Nasal spray (0.06%): 2 sprays in each nostril 3-4 times/day

Allergic/nonallergic rhinitis: Intranasal: Nasal spray (0.03%): 2 sprays in each nostril 2-3 times/day

Seasonal allergic rhinitis (safety and efficacy of use beyond 3 weeks in patients with seasonal allergic rhinitis has not been established): Intranasal: Nasal spray (0.06%): 2 sprays in each nostril 4 times/day

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Colds (symptomatic relief of rhinorrhea): Intranasal: 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 ≥12 years and Adults: 0.06%: 2 sprays in each nostril 3-4 times/day

Allergic/nonallergic rhinitis: Intranasal: Children ≥6 years: Refer to adult dosing.

Seasonal allergic rhinitis: Intranasal: Children ≥5 years: Refer to adult dosing.

Dosing: Renal Impairment

No dosage adjustment provided in manufacturer’s labeling (has not been studied); use with caution.

Dosing: Hepatic Impairment

No dosage adjustment provided in manufacturer’s labeling (has not been studied); use with caution.

Administration

Avoid spraying into the eyes. Prior to initial use, prime inhaler by releasing 7 test sprays into the air. If the inhaler has not been used for >24 hours, reprime by releasing 2 test sprays into the air.

Storage

Store at controlled room temperature of 25°C (77°F). Do not store near heat or open flame.

Drug Interactions

AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Monitor therapy

Acetylcholinesterase Inhibitors: Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Acetylcholinesterase Inhibitors may diminish the therapeutic effect of Anticholinergic Agents. Monitor therapy

Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Analgesics (Opioid): Anticholinergic Agents may enhance the adverse/toxic effect of Analgesics (Opioid). Specifically, the risk for constipation and urinary retention may be increased with this combination. Monitor therapy

Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy

Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol. Monitor therapy

Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Monitor therapy

Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination

Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination

Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy

Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Avoid combination

Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination

Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy

Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination

Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy

Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Monitor therapy

Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Avoid combination

OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy

Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination

Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Consider therapy modification

Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy

RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Monitor therapy

Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid using drugs with substantial anticholinergic effects in patients receiving secretin whenever possible. If such agents must be used in combination, monitor closely for a diminished response to secretin. Consider therapy modification

Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination

Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy

Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Adverse Reactions

1% to 10%:

Central nervous system: Headache (4% to 10%)

Gastrointestinal: Dysgeusia (≤4%), xerostomia (1% to 4%), diarrhea (2%), nausea (2%)

Respiratory: Upper respiratory tract infection (5% to 10%), epistaxis (6% to 9%), pharyngitis (≤8%), dry nose (≤5%), nasal mucosa irritation (2%), nasal congestion (1%)

<2% (Limited to important or life-threatening): Anaphylaxis, angioedema, blurred vision, burning sensation of the nose, conjunctivitis, cough, dizziness, eye irritation, hoarseness, increased thirst, laryngospasm, palpitations, skin rash, tachycardia, tinnitus, urticaria

Warnings/Precautions

Concerns related to adverse effects:

• Hypersensitivity reactions: Immediate hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm) have been reported.

Disease-related concerns:

• Glaucoma: Use with caution in patients with narrow-angle glaucoma.

• Myasthenia gravis: Use with caution in patients with myasthenia gravis.

• Prostatic hyperplasia/bladder neck obstruction: Use with caution in patients with prostatic hyperplasia or bladder neck obstruction.

Pregnancy Risk Factor

B

Pregnancy Considerations

Adverse events have not been observed in animal reproduction studies.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Have patient report immediately to prescriber severe nasal irritation, severe nosebleeds, or vision changes (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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