Ipratropium bromide

Ipratropium bromide Brand Name– Atrovent

What is Ipratropium bromide

Ipratropium bromide is used as a short-acting antimuscarinic agent and is a synthetic quaternary ammonium compound.

Ipratropium bromide is most commonly administered by inhalation (aerosol inhaler or nebulization) as a bronchodilator in adults for cholinergic-mediated bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.

A nasal spray of ipratropium is used for symptomatic relief of rhinorrhea associated with allergic and nonallergic perennial rhinitis in adults and pediatric patients 6 years and older.

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for COPD, ipratropium may be used for first-line therapy in patients with mild, stable COPD (Group A).

A systematic review of randomized controlled trials concluded that ipratropium monotherapy provided small benefits over short-acting beta-2 agonists (SABAs) regarding lung function, health status, and the requirement for oral steroids.

Ipratropium may be used in combination with other treatments in those with more severe disease (Groups B, C, and D); it may also be used with inhaled SABAs for the management of COPD exacerbations.

Ipratropium has been studied in the treatment of asthma. According to the Expert Panel of the National Asthma Education and Prevention Program (NAEPP), ipratropium may provide some additive benefit in treating severe acute asthma exacerbations when administered in multiple doses along with a short-acting beta-2 agonist (SABA).

Also, ipratropium is classified as a quick-relief medication by the Panel and is recommended as an alternative bronchodilator for acute bronchospasm in those who do not tolerate a SABA.

Limited studies suggest a lowered incidence of hospitalization if ipratropium is combined with beta-agonist treatments during severe, acute asthma exacerbations in children or adults.

However, maintenance treatment of asthma with ipratropium is not routinely recommended as an additive benefit to other controller medications has not been demonstrated.

Ipratropium is much less effective than a beta-2-adrenergic agonist as an agent to prevent exercise-induced bronchospasm (EIB), and the American Thoracic Society recommends use as a second line therapy controller agent if needed.

Ipratropium was initially approved by the FDA in 1986.

Indications

  1. acute bronchospasm
  2. allergic rhinitis
  3. chronic bronchitis
  4. chronic obstructive pulmonary disease (COPD)
  5. common cold
  6. emphysema
  7. exercise-induced bronchospasm prophylaxis
  8. perennial allergies
  9. rhinorrhea
  10. seasonal allergies

For the treatment of bronchospasm due to chronic obstructive pulmonary disease (COPD), including chronic bronchitis or emphysema

Side Effects

  1. anaphylactoid reactions
  2. angioedema
  3. arrhythmia exacerbation
  4. back pain
  5. blurred vision
  6. bronchospasm
  7. chest pain (unspecified)
  8. conjunctivitis
  9. constipation
  10. cough
  11. diarrhea
  12. dizziness
  13. dysgeusia
  14. dyspepsia
  15. dyspnea
  16. epistaxis
  17. headache
  18. hoarseness
  19. hypotension
  20. infection
  21. insomnia
  22. laryngospasm
  23. mydriasis
  24. nasal congestion
  25. nasal dryness
  26. nausea
  27. ocular irritation
  28. ocular pain
  29. oral ulceration
  30. palpitations
  31. paresthesias
  32. pharyngitis
  33. pruritus
  34. rash
  35. rhinitis
  36. sinus tachycardia
  37. sinusitis
  38. throat irritation
  39. tremor
  40. urinary retention
  41. urticaria
  42. visual impairment
  43. vomiting
  44. xerostomia

Monitoring Parameters

  • pulmonary function tests (PFTs)

Contraindications

  • acute bronchospasm
  • bladder obstruction
  • breast-feeding
  • bromide hypersensitivity
  • cardiac arrhythmias
  • closed-angle glaucoma
  • contact lenses
  • driving or operating machinery
  • geriatric
  • ocular exposure
  • ophthalmic administration
  • paradoxical bronchospasm
  • pregnancy
  • prostatic hypertrophy
  • urinary retention

Interactions

  • Aclidinium
  • Aclidinium; Formoterol
  • Anticholinergics
  • Atropine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benztropine
  • Chlordiazepoxide; Clidinium
  • Dicyclomine
  • Flavoxate
  • Glycopyrrolate
  • Glycopyrrolate; Formoterol
  • Glycopyrronium
  • Homatropine; Hydrocodone
  • Hyoscyamine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Indacaterol; Glycopyrrolate
  • Mepenzolate
  • Methacholine
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methscopolamine
  • Oxybutynin
  • Propantheline
  • Scopolamine
  • Trihexyphenidyl
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