Ipratropium Bromide

Ipratropium Bromide is a medication that opens up the medium and large airways in the lungs. It is used to treat the symptoms of chronic obstructive pulmonary disease and asthma. It is used by inhaler or nebulizer. Onset of action is typically within 15 to 30 minutes and lasts for three to five hours.

Common side effects include dry mouth, cough, and inflammation of the airways. Potentially serious side effects include urinary retention, worsening spasms of the airways, and a severe allergic reaction. It appears to be safe in pregnancy and breastfeeding. Ipratropium is an anticholinergic which works by causing smooth muscles to relax.

Ipratropium bromide was developed in Germany in 1976. It was approved for medical use in the United States in 1986. It is on the World Health Organization’s List of Essential Medicines, the most important medication needed in a basic health system. Ipratropium is available as a generic medication. The wholesale price is about 6.60 USD for a 200 dose inhaler. In the United States a month worth of medication is between 100 and 200 USD.

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).

Contraindications

There are no contraindications for inhaled ipratropium, apart from hypersensitivity to atropine and related substances. For oral administration, contraindications are similar to other anticholinergics; they include narrow angle glaucoma and obstructions in the gastrointestinal tract and urinary system.

Peanut allergy

Previously atrovent inhalers used chlorofluorocarbon (CFC) as a propellant and contained soy lecithin in the propellant ingredients. In 2008 all CFC inhalers were phased out and hydrofluoroalkane (HFA) inhalers replaced them. Allergy to peanuts was noted for the inhaler as a contraindication but now is not. It has never been a contraindication when administered as a nebulized solution.

Side effects

If ipratropium is inhaled, side effects resembling those of other anticholinergics are minimal. However, dry mouth and sedation have been reported. Also, effects such as skin flushing, tachycardia, acute angle-closure glaucoma, nausea, palpitations and headache have been observed. Inhaled ipratropium does not decrease mucociliary clearance. The inhalation itself can cause headache and irritation of the throat in a few percent of patients.

Urinary retention has been reported in patients receiving doses by nebulizer. As a result, caution may be warranted, especially by men with prostatic hypertrophy.