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ipratropium bromide

R01AX03

Forms & Strengths

Nasal spray: 0.03% (21 mcg/spray)
Nasal spray: 0.06% (42 mcg/spray)
Inhalation solution: 0.02% (0.25 mg/mL)
Metered dose inhaler: 17 mcg/actuation

Adult Dosing

Rhinorrhea (allergic/non-allergic): 0.03% nasal spray, 2 sprays per nostril 2-3 times daily
Rhinorrhea (common cold): 0.06% nasal spray, 2 sprays per nostril 3-4 times daily
COPD (inhalation solution): 500 mcg (one vial) 3-4 times daily via nebulizer
COPD (MDI): 2-4 inhalations (34-68 mcg) 4 times daily

Pediatric Dosing

Children <6 years: Safety and efficacy not established
Allergic rhinitis (children 6-11 years): 0.03% nasal spray, 2 sprays per nostril 2-3 times daily
Common cold (children 5-11 years): 0.06% nasal spray, 2 sprays per nostril 3 times daily
Bronchospasm/Asthma (children >=12 years): 250-500 mcg via nebulizer every 6-8 hours as needed

Indications

Symptomatic relief of rhinorrhea associated with allergic and non-allergic perennial rhinitis
Symptomatic relief of rhinorrhea associated with the common cold
Maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and emphysema

Mechanism of Action

Antagonizes acetylcholine at muscarinic receptors on bronchial smooth muscle
Inhibits vagally-mediated reflexes, leading to reduced secretions in the upper airways
Produces bronchodilation and decreased mucus hypersecretion

Contraindications

Hypersensitivity to ipratropium bromide, atropine, or its derivatives
History of hypersensitivity to soy lecithin (applies to certain MDI formulations)

Adverse Reactions

Epistaxis (nasal spray)
Nasal dryness and irritation
Headache
Dry mouth
Pharyngitis
Paradoxical bronchospasm
Angle-closure glaucoma (with inadvertent ocular exposure)

Drug Interactions

Anticholinergic agents: May potentiate additive anticholinergic adverse effects
Beta-2 adrenergic agonists: May enhance bronchodilating efficacy when used concurrently

Curated Content: Needs Vetting Before Put to Clinical Use