Ipratropium Bromide

A to Z Drug Facts

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

 Indications

Bronchospasm: Maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and emphysema, used alone or in combination with other bronchodilators (especially beta-adrenergics). Rhinorrhea: Symptomatic relief of rhinorrhea associated with allergic and nonallergic rhinitis and symptomatic relief of rhinorrhea associated with the common cold in patients ³ 12 yr for aerosol and solution, ³ 6 yr for 0.03% nasal spray, and ³ 5 yr for 0.06% nasal spray.

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

 Route/Dosage

ADULTS: Aerosol/Inhalation: 2 inhalations (36 mcg) qid (max 12 inhalations/24 hr). Do not exceed 12 inhalations in 24 hours. Solution: 500 mcg (1 unit dose vial) administered 3 to 4 times a day by oral nebulization, with doses 6 to 8 hr apart. The solution can be mixed in the nebulizer with albuterol if used within 1 hr.

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).

 Interactions

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

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Palpitations; hypertension; aggravated hypertension. RESP: Cough; exacerbation of symptoms. CNS: Nervousness; dizziness; headache. EENT: Blurred vision; local irritation. For the 0.06 nasal spray formulation only: Epistaxis; nasal dryness; nasal congestion; taste perversion; nasal burning; conjunctivitis; hoarseness; pharyngitis. GI: Nausea; dry mouth; GI distress; constipation. DERM: Rash. OTHER: Arthritis.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy in children < 12 yr not established for aerosol and solution; < 6 yr for 0.03% nasal spray; < 5 yr for 0.06% nasal spray. Special risk patients: Use drug with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, 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 wtih COPD has not been demonstrated to be more efficacious than either drug alone.

 Administration/Storage

Inhalation

• Store at room temperature. Avoid excessive humidity.
• Allow 1 to 2 min between inhalations.
• Shake inhaler well before administration.
• If patient is also receiving an inhaled beta₂-agonist, give beta₂-agonist before administering ipratropium.
• Use spacing device (eg, Aerochamber) to facilitate intrapulmonary deposition.
• Have patient rinse mouth with water or mouthwash after each use.

Nasal spray

• Initial pump priming: 7 actuations of the pump. For regular use, no further priming is required. If not used for > 24 hours, 2 actuations are needed. If not used for > 7 days, 7 actuations are needed.
• Store tightly between 59° and 86°F. Avoid freezing.

Solution

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

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess respiratory status before initiation of therapy and monitor after inhalation of ipratropium. Therapeutic response is demonstrated by patient's ability to breathe adequately.
• If exacerbation of symptoms occurs, notify physician.
• Give patient frequent sips of water and sugarless hard candy or gum to relieve dry mouth.
• Since drug tolerance may develop with long-term therapy, dosage may need to be increased.

 Patient/Family Education

• Instruct patient on proper use of inhaler. Explain value of using spacing device.
• Instruct patient on proper sequencing and timing if using more than one 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 physician 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 physician 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.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts