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RESPIRATORY SYSTEM › DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES › OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES, INHALANTS › Anticholinergics
ipratropium bromide
R03BB01
Forms & Strengths
- Inhalation aerosol: 17 mcg/actuation
- Nasal spray: 0.03% (31 mcg/spray), 0.06% (84 mcg/spray)
- Inhalation solution: 0.02% (0.25 mg/mL)
Adult Dosing
- COPD/Asthma (Inhalation): 500 mcg (one unit-dose vial) via nebulizer 3 to 4 times daily, or 2 inhalations (34 mcg) via MDI qid
- Rhinorrhea (Nasal 0.03%): 2 sprays (66 mcg) per nostril 2 to 3 times daily
- Rhinorrhea (Nasal 0.06%): 2 sprays (168 mcg) per nostril 3 to 4 times daily
Pediatric Dosing
- Children 6-12 years (Inhalation): 250-500 mcg via nebulizer q6-8h, or 1-2 inhalations via MDI tid-qid
- Children <6 years: Safety and efficacy not well established
- Allergic/Non-allergic rhinitis (Nasal 0.03%, ≥6 years): 2 sprays per nostril bid-tid
Indications
- Bronchospasm associated with COPD (chronic bronchitis and emphysema)
- Maintenance treatment of bronchospasm in asthma
- Rhinorrhea associated with allergic and non-allergic perennial rhinitis or common cold
Mechanism of Action
- Anticholinergic (parasympatholytic) agent
- Competitively inhibits muscarinic receptors on bronchial smooth muscle
- Blocks vagally mediated reflexes, reducing cyclic GMP and preventing bronchoconstriction
- Reduces serous and seromucous gland secretions when applied topically to nasal mucosa
Contraindications
- Hypersensitivity to ipratropium bromide, atropine, or its derivatives
- History of hypersensitivity to soy lecithin (for specific MDI formulations)
Adverse Reactions
- Dry mouth
- Upper respiratory tract infection
- Cough
- Pharyngitis
- Headache
- Nausea
- Glaucoma precipitation or worsening (with inadvertent ocular exposure)
- Urinary retention
Drug Interactions
- Anticholinergics (additive anticholinergic adverse effects)
- Beta-2 adrenergic agonists (synergistic bronchodilation, commonly co-formulated)
Curated Content: Needs Vetting Before Put to Clinical Use