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Ipratropium

  • Medical and Pharmacy Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Brand Name: Atrovent, Atrovent HFA

Generic Name: Ipratropium

Drug Class: Anticholinergics, Respiratory

What Is Ipratropium and How Does It Work?

Ipratropium is used to treat a runny nose caused by the common cold or seasonal allergies. It works by reducing the amount of fluid/mucus released from inside your nose.

Ipratropium does not relieve symptoms of stuffy nose or sneezing.

Ipratropium is available under the following different brand names: Atrovent, and Atrovent HFA.

Dosages of Ipratropium:

Metered-dose inhaler

  • 17 mcg/actuation

Nasal spray (adult only)

  • 0.03%

Nebulized solution

  • 0.02%

Dosage Considerations – Should be Given as Follows:

Chronic Obstructive Pulmonary Disease

  • Maintenance treatment of bronchospasm, including chronic bronchitis and emphysema
  • Inhaler: 2 actuations every 6 hours, then additional actuations as needed; not to exceed 12 actuations/day
  • Nebulizer: 2.5 mL (500 mcg) every 6-8 hours

Perennial Allergic/Nonallergic Rhinitis

  • Symptomatic relief of rhinorrhea
  • Adult: Nasal spray: 2 sprays per nostril 8-12 hours
  • Children under 6 years (nasal spray): Use not recommended
  • Children over 6 years (nasal spray): 2 sprays per nostril 8-12 hours

Seasonal Allergic Rhinitis

  • Adult: Nasal spray: 2 sprays per nostril every 6 hours
  • Children under 5 years (nasal spray): Use not recommended
  • Children over 5 years (nasal spray): 2 sprays per nostril every 6 hours

Acute Asthma Exacerbation (Off-label)

  • Adult, Inhaler: 8 actuations every 20 minutes as needed for 3 doses
  • Adult, Nebulizer: 500 mcg every 20 minutes for 3 doses, then as needed
  • NIH asthma guidelines, Pediatric
    • Children under 12 years (inhaler): 4-8 actuations every 20 minutes as needed for 3 doses
    • Children 12 years and older (inhaler): 8 actuations every 20 minutes as needed for 3 doses
    • Children under 12 years (nebulizer): 250-500 mcg every 20 minutes for 3 doses, then as needed
    • Children 12 years and older (nebulizer): 500 mcg every 20 minutes for 3 doses, then as needed

Administration

  • Prime before initial use by releasing 2 test sprays into air; repeat priming if unused for 3 days or more

Dosing Considerations

  • In treatment of acute asthma exacerbation with inhaler, short-acting beta agonist (SABA) must be coadministered
  • In treatment of allergic rhinitis, do not use for more than 3 weeks

What Are Side Effects Associated with Using Ipratropium?

Common side effects of ipratropium include:

Other side effects of ipratropium include:

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Ipratropium?

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Ipratropium has no known severe interactions with other drugs.

Serious interactions of ipratropium include:

  • pramlintide

Ipratropium has moderate interactions with at least 107 different drugs.

Mild interactions of ipratropium include:

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

What Are Warnings and Precautions for Ipratropium?

Warnings

This medication contains ipratropium. Do not take Atrovent or Atrovent HFA if you are allergic to ipratropium or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

Documented hypersensitivity to ipratropium, atropine, or derivatives

Effects of Drug Abuse

  • No information available

Short-Term Effects

  • See "What Are Side Effects Associated with Using Ipratropium?"

Long-Term Effects

  • See "What Are Side Effects Associated with Using Ipratropium?"

Cautions

  • Use for maintenance treatment only; should not be used as rescue therapy.
  • May cause life-threatening paradoxical bronchospasm or hypersensitivity reactions (skin rash, itching, angioedema, hives/giant hives, laryngospasm); discontinue immediately, and use alternative treatment.
  • May cause urinary retention; use with caution in patients with benign prostatic hyperplasia (BPH) or bladder-neck obstruction.
  • May worsen narrow-angle glaucoma.
  • Contact with eye can cause burning, stinging, dilated pupils (mydriasis), visual halos.

Pregnancy and Lactation

  • Ipratropium may be acceptable for use during pregnancy. Either animal studies show no risk but human studies are not available or animal studies showed minor risks and human studies were done and showed no risk.
  • It is unknown whether ipratropium is excreted in breast milk. Consult your doctor before breastfeeding.
Reviewed on 8/21/2017

Medscape. Ipratropium.
https://reference.medscape.com/drug/atrovent-atrovent-hfa-ipratropium-343416
RxList. Xgeva Side Effects Center.
https://www.rxlist.com/atrovent-nasal-spray-side-effects-drug-center.htm

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