Generic Name: ipratropium

Brand Names: Atrovent, Atrovent HFA, Atrovent Nasal Spray

Drug Class: Anticholinergics, Respiratory; allergy, Intranasal

What is ipratropium, and what is it used for?

Ipratropium is a medication used to relieve runny nose and nasal inflammation (rhinitis) caused by colds and allergies, and as a bronchodilator to relieve bronchospasm and ease breathing in chronic obstructive pulmonary diseases (COPD), including chronic bronchitis and emphysema.

Ipratropium oral inhalations are used as maintenance treatment for COPD, while nasal sprays are used to relieve runny nose from allergic and nonallergic rhinitis.

Ipratropium is a respiratory anticholinergic medication that works by blocking the activity of acetylcholine in the respiratory tract. Acetylcholine is a chemical (neurotransmitter) that nerve cells release in neuromuscular junctions to make muscles contract. Acetylcholine also dilates blood vessels, increases secretion of body fluids, and slows heart rate. Acetylcholine works by stimulating molecules known as cholinergic receptors in various tissues.

Ipratropium nasal spray blocks the activity of acetylcholine on the cholinergic receptors in the nasal passage, reducing secretions by the serous and seromucous glands in the nasal mucous membrane. Ipratropium oral inhalation blocks acetylcholine activity in the bronchial smooth muscles, which relaxes the respiratory muscles and dilates the airway, making breathing easier.

Warnings

• Do not use ipratropium to treat patients with a history of hypersensitivity to atropine or its derivatives, ipratropium or any of the components in the formulation.
• If hypersensitive reactions occur, immediately discontinue ipratropium.
• Inhalation and nebulizers should be used only for maintenance treatment of COPD, not for initial treatment or acute bronchospasm episodes that require rescue therapy.
• Ipratropium can cause urinary retention, use with caution in patients with enlarged prostate (benign prostatic hyperplasia), bladder-neck obstruction or impaired kidney function.
• Inhaled bronchodilators including ipratropium may cause life-threatening paradoxical bronchospasm that should be differentiated from inadequate response.
• Use with caution in patients with narrow-angle glaucoma, a progressive disease with high intraocular pressure that damages the optic nerve. Ipratropium may further increase intraocular pressure.
• Use with caution in myasthenia gravis, a neuromuscular disease. Ipratropium may worsen symptoms.
• Ipratropium may cause dizziness, blurred vision, pupil dilation (mydriasis) and focusing difficulties (accommodation disorder). Advise patients appropriately.

Allergies can best be described as:
See Answer

What are the side effects of ipratropium?

Common side effects of ipratropium include:

Intranasal

• Headache
• Upper respiratory tract infection (URI)
• Nasal bleeding (epistaxis)
• Throat inflammation (pharyngitis)
• Nasal dryness or irritation
• Nasal congestion
• Taste perversion
• Dry mouth (xerostomia)
• Increased thirst
• Nausea
• Diarrhea

Oral inhalation

• Bronchial inflammation (bronchitis)
• Exacerbation of COPD
• Sinus inflammation (sinusitis)
• Shortness of breath (dyspnea)
• Cough
• Flulike symptoms
• Back pain
• Headache
• Dizziness
• Urinary tract infection (UTI)
• Nausea
• Indigestion (dyspepsia)
• Dry mouth

Less common side effects of ipratropium include:

• Cough
• Dry and irritated throat
• Hoarseness
• Voice box spasm (laryngospasm)
• Burning sensation of the nose
• Nasal inflammation (rhinitis)
• Inflammation in the mouth (stomatitis)
• Blurred vision
• Inflammation of conjunctiva, the membrane over the eye whites and inner eyelid surfaces (conjunctivitis)
• Swelling of cornea (corneal edema)
• Eye irritation and red eye
• Eye focusing difficulty (accommodation disorder)
• Acute eye pain
• Increased intraocular pressure
• Glaucoma
• Dilation of pupils (mydriasis)
• Visual halos around lights
• Ringing in the ears (tinnitus)
• Low blood pressure (hypotension)
• Palpitations
• Rapid heart rate
• Reduced gastrointestinal motility
• Constipation
• Vomiting
• Urinary retention
• Skin rash
• Hives (urticaria)
• Itching (pruritus)
• Swelling in the tissue under the skin and mucous membranes (angioedema)
• Mouth edema
• Throat (pharyngeal) edema
• Severe allergic reaction (anaphylaxis)

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.

Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

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What are the dosages of ipratropium?

Metered-Dose Inhaler

• 17 mcg/actuation

Nebulized Solution

• 0.02%

Nasal Spray

• 0.03%
• 0.06%

Adult:

Chronic Obstructive Pulmonary Disease

• Maintenance treatment of bronchospasm, including chronic bronchitis and emphysema
• Inhaler: 2 actuations (34 mcg) every 6 hours, then additional actuations as needed; not to exceed 12 actuations/day (408 mcg/day)
• Nebulizer: 2.5 mL (500 mcg) every 6-8 hours

Acute Asthma Exacerbation (Off-label)

• Inhaler: 8 actuations (136 mcg) every 20 minutes as needed for 3 hours
• Nebulizer: 500 mcg every 20 minutes for 3 doses, then as needed

Administration

• Prime before initial use by releasing 2 test sprays into air; repeat priming if unused for 3 days or longer

Dosing Considerations

• In treatment of acute asthma exacerbation with inhaler, short-acting beta agonist (SABA) must be coadministered

Perennial Allergic/Nonallergic Rhinitis

• Nasal spray (0.03%): 2 sprays (21 mcg/spray) per nostril every 8-12 hours; not to exceed 168-252 mcg/day
• Seasonal allergic rhinitis: 2 sprays (0.06%) per nostril every 6 hours

Symptomatic relief of rhinorrhea (Common Cold)

• Nasal spray (0.06%): 2 sprays (0.42 mcg/spray) per nostril every 6 hours; not to exceed 672 mcg/day

Seasonal Allergic Rhinitis

• Nasal spray (0.06%): 2 sprays (0.42 mcg/spray) per nostril every 6 hours; not to exceed 672 mcg/day

Dosing Considerations

• In the treatment of allergic rhinitis, do not use for longer than 3 weeks

Pediatric:

Acute Asthma Exacerbation (Off-label)

NIH asthma guidelines

• Children younger than 5 years (inhaler): 2 inhalations every 20 minutes for 1 hour if necessary
• Children 5-12 years (inhaler): 4-8 actuations every 20 minutes as needed for up to 3 hours
• Children 12 years or older (inhaler): 8 actuations every 20 minutes as needed for up to 3 hours
• Children younger than 5 years (nebulizer): 0.25 mg (250 mcg) every 20 minutes for 1 hour if necessary
• Children 5-12 years (nebulizer): 250-500 mcg every 20 minutes for 3 doses, then as needed
• Children 12 years or older (nebulizer): 500 mcg every 20 minutes for 3 doses, then as needed

Symptomatic Relief of Rhinorrhea (Colds)

• Children younger than 5 years: Safety and efficacy not established
• Children 5-12 years: 2 sprays (0.06%) in each nostril every 8 hours
• Children older than 12 years: 2 sprays (0.06%) in each nostril every 6-8 hours

Allergic/Nonallergic Rhinitis

• Children younger than 6 years: Safety and efficacy not established
• Children older than 6 years: 2 sprays (0.03%) per nostril every 8-12 hours

Seasonal Allergic Rhinitis

• Children younger than 5 years: Safety and efficacy not established
• Children older than 5 years: 2 sprays (0.06%) per nostril every 6 hours

Overdose

• Overdosage of ipratropium nasal spray or oral inhalation is unlikely because it is not systemically well absorbed. 

What drugs interact with ipratropium?

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

Ipratropium has no known severe interactions with other drugs.

• Serious interactions of ipratropium include:
  • glucagon
  • glucagon intranasal
  • macimorelin
  • pramlintide
  • revefenacin
  • umeclidinium bromide/vilanterol inhaled
• Ipratropium has moderate interactions with at least 94 different drugs.
• Mild interactions of ipratropium include:
  • dimenhydrinate
  • donepezil
  • galantamine
  • levodopa

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

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Pregnancy and breastfeeding

• Ipratropium use may be acceptable during pregnancy because ipratropium oral inhalation and nasal spray are poorly absorbed systemically. There are no adequate and well-controlled studies of ipratropium use during pregnancy, however, animal reproductive studies revealed no evidence of fetal risk.
• It is not known if ipratropium is excreted in breast milk, however, because many drugs are excreted in breast milk, use with caution in nursing mothers.

What else should I know about ipratropium?

• Use ipratropium exactly as directed.
• Ipratropium is only for maintenance treatment in COPD. Seek medical help if you have an acute episode of bronchospasm.
• Do not use ipratropium nasal spray for longer than four days for your cold or three weeks for seasonal allergic rhinitis unless instructed by your physician.
• Avoid contact with eyes. In case of accidental contact, wash the eye with plenty of cool water for several minutes. If eye pain or blurry vision persists after a few hours, consult with your physician.
• Ipratropium may cause dizziness and blurry vision. Avoid hazardous tasks such as driving and operating heavy machinery.