BMA Concise Guide to Medicine & Drugs

Ipratropium Bromide

Brand names Atrovent, Respontin, Rinatec

Used in the following combined preparations Combivent, Duovent

QUICK REFERENCE

Drug group Bronchodilator

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Ipratropium bromide is an anticholinergic bronchodilator that relaxes the muscles surrounding the bronchioles (airways in the lungs). It is used primarily in the maintenance of reversible airway disorders, particularly chronic obstructive pulmonary disease (COPD). It is given only by inhaler or via a nebulizer for these conditions. The drug is also used in treating acute attacks of asthma alone, especially severe ones in hospital. In these cases, ipratropium bromide is usually used together with sympathomimetic bronchodilators, such as salbutamol. Ipratropium bromide is also prescribed as a nasal spray for the treatment of a continually runny nose due to allergy.

Unlike with other anticholinergic drugs, side effects are rare. Ipratropium bromide must be used with caution by people with glaucoma, but problems are unlikely at normal doses and if an inhaler or nebulizer is used correctly.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Inhaler, liquid for nebulizer, nasal spray.

Frequency and timing of doses 3–4 x daily (inhaler); 2 sprays into each nostril 2–3 x daily (nasal spray).

Adult dosage range 80–320mcg daily (inhaler); 400–2,000mcg daily (nebulizer); 1–2 puffs to the affected nostril 2–3 x daily (nasal spray).

Onset of effect 3–30 minutes.

Duration of action Up to 8 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children. Do not puncture or burn containers.

Missed dose Take as soon as you remember. If your next dose is due within 2 hours, take a single dose now and skip the next.

Stopping the drug Do not stop taking the drug without consulting your doctor; symptoms may recur.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Side effects are rare; the most common are dry mouth or throat, nausea, and headache. Constipation, difficulty in passing urine, and cough may also occur. If any of these symptoms are severe or if you experience palpitations or a fast heart rate, discuss with your doctor. If you develop a rash or facial swelling, stop taking the drug and consult your doctor. Rarely, eye pain or altered vision may occur, or wheezing or breathlessness may worsen immediately after inhaler use (paradoxical bronchospasm); if any of these symptoms occur, stop using the drug and contact your doctor immediately.

INTERACTIONS

Pasireotide may increase the risk of bradycardia (abnormally slow heart rate) when used with ipratropium bromide.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have glaucoma.

· You have prostate problems.

· You have difficulty in passing urine.

· You have cystic fibrosis.

· You are taking other medicines.

Pregnancy No evidence of risk, but discuss with your doctor before using in the first 3 months of pregnancy.

Breast-feeding No evidence of risk, but discuss with your doctor.

Infants and children Reduced dose necessary.

Over 60 No special problems.

Driving and hazardous work No special problems.

Alcohol No known problems.

PROLONGED USE

No special problems.