Ipratropium bromide

Generic Medicine Info
Indications and Dosage
Asthma, Chronic obstructive pulmonary disease
Adult: As metered-dose aerosol: 20-40 mcg 3-4 times daily; single doses of up to 80 mcg may be required in some patients. As soln for nebulisation: 250-500 mcg 3-4 times daily.
Child: As metered-dose aerosol: <6 yr 20 mcg tid; 6-12 yr 20-40 mcg tid. As soln for nebulisation: <6 yr For acute asthma: 125-250 mcg, given no more often than 6 hrly up to a total dose of 1 mg. 6-12 yr For acute and chronic asthma: 250 mcg, repeated as necessary up to a total dose of 1 mg.

Rhinorrhoea associated with rhinitis
Adult: As metered-dose nasal spray: 42 mcg into each nostril 2-3 times daily, up to 84 mcg into each nostril 3-4 times daily for up to 4 days when rhinorrhoea is associated w/ common cold or up to 3 wk when associated w/ seasonal allergic rhinitis.
Child: As metered-dose nasal spray: ≥12 yr 42 mcg into each nostril 2-3 times daily.
Hypersensitivity to ipratropium, atropine, or its derivatives.
Special Precautions
Patient w/ prostatic hyperplasia/bladder neck obstruction, myasthenia gravis, narrow-angle glaucoma, cystic fibrosis. Pregnancy and lactation.
Adverse Reactions
Dry mouth, constipation, tachycardia, palpitations, arrhythmias, nausea and vomiting, dyspepsia, headaches, dizziness, ocular complications (e.g. mydriasis, narrow-angle glaucoma). Rarely, urinary retention, hypersensitivity reactions (e.g. urticaria, angioedema, rash); nasal dryness, irritation and epistaxis.
Potentially Fatal: Paradoxical bronchospasm, anaphylaxis.
Inhalation/Respiratory/Nasal: B
Patient Counseling Information
This drug may cause dizziness, accommodation disorder, mydriasis and blurred vision, if affected, do not drive or operate machinery.
Drug Interactions
Additive bronchodilatory effect w/ β-adrenergic drugs and xanthine preparations.
Description: Ipratropium bromide causes bronchodilation by blocking the action of acetylcholine at parasympathetic site in bronchial smooth muscle. It also inhibits serous and seromucous gland secretions by nasal application.
Onset: Bronchodilation: W/in 15 min.
Duration: 2-5 hr (oral inhalation).
Absorption: 10-30% of a dose is deposited in the lungs while only a small amount reaches systemic circulation. Poorly absorbed from the GI tract. Bioavailability: 2% (oral inhalation); 7-28% (nasal).
Distribution: Plasma protein binding: ≤9% (oral inhalation); <20% (nasal).
Metabolism: Metabolised via ester hydrolysis (41%) and conjugation (36%).
Excretion: Via urine and faeces. Elimination half-life: 2 hr (oral inhalation); 1.6 hr (nasal).
Chemical Structure

Chemical Structure Image
Ipratropium bromide

Source: National Center for Biotechnology Information. PubChem Database. Ipratropium bromide, CID=657308, https://pubchem.ncbi.nlm.nih.gov/compound/Ipratropium-bromide (accessed on Jan. 21, 2020)

Aerosol/nasal spray: Store at 25°C. Protect from light or heat. Soln for nebulisation: Store between 15-30°C. Protect from light.
MIMS Class
Antiasthmatic & COPD Preparations / Nasal Decongestants & Other Nasal Preparations
ATC Classification
R03BB01 - ipratropium bromide ; Belongs to the class of other inhalants used in the treatment of obstructive airway diseases, anticholinergics.
R01AX03 - ipratropium bromide ; Belongs to the class of other nasal preparations for topical use.
Anon. Ipratropium (Nasal). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 07/07/2015.

Anon. Ipratropium (Oral Inhalation). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 07/07/2015.

Buckingham R (ed). Ipratropium Bromide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/07/2015.

Ipratropium Bromide Solution (Mylan Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 07/07/2015.

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