II. Indications
-
Chronic Obstructive Pulmonary Disease (COPD)
- Longer acting Anticholinergic Agents are preferred in COPD
- See Long-acting Anticholinergic Bronchodilator
- Acute Asthma Exacerbation
- Used in combination with Albuterol (duoneb)
III. Mechanism
- Ipratropium (Atrovent) is a Short-Acting Anticholinergic Bronchodilator
- Acts as a Muscarinic Antagonist, reducing Acetylcholine induced bronchospasm
IV. Preparations: Ipratropium Bromide
- Atrovent MDI
- Inhale 2-3 puffs three to four times daily as needed (maximum 12 puffs/day)
- Atrovent Nebulization (0.02%, 500 mcg/ampule)
- Nebulize 1 ampule of Ipratropium solution every 6 to 8 hours as needed
V. Preparations: Combination Ipratropium with Albuterol (Combivent)
- Combivent (older CFC version)
- Will be phased out in 2013 due to CFC
- Dose: 2 puffs up to every 6 hours
- Contraindicated in soybean or peanut allergy
- Combivent Respimat
- Dose: 1 puff every 6 hours
- Does not carry the Food Allergy related contraindications of the older Combivent
VI. Adverse Effects
- Serious adverse effects
- Anaphylaxis, Angioedema or other Hypersensitivity Reaction
- Paradoxical bronchospasm or Laryngospasm
- Exacerbation of Glaucoma
- Increased cardiovascular events
- Avoid short acting Anticholinergics (Ipratropium) in comorbid cardiovascular disease
- Ogale (2010) Chest 137(1): 13-19 [PubMed]
- Singh (2008) JAMA 300(12): 1439-50 [PubMed]
- Common adverse effects
- Allergy
- Original Atrovent MDI (non-HFA) was contraindicated with soy or peanut allergy
VII. Safety
- Pregnancy Category B
- Unknown safety in Lactation
VIII. Reources
- Ipratropium Bromide Nebulizer Solution (DailyMed)
- Ipratropium Bromide and Albuterol Nebulizer Solution (Duoneb, DailyMed)
- Ipratropium HFA MDI (DailyMed)
Images: Related links to external sites (from Bing)
Related Studies
| ipratropium (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| IPRATROPIUM 0.03% SPRAY | Generic | $0.80 per ml |
| IPRATROPIUM 0.06% SPRAY | Generic | $1.52 per ml |
| IPRATROPIUM BR 0.02% SOLN | Generic | $0.06 per ml |
| IPRATROPIUM-ALBUTEROL 0.5-3(2.5) MG/3 ML | Generic | $0.07 per ml |
| atrovent (on 1/1/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ATROVENT 17 MCG HFA INHALER | $34.02 per gram | |
| combivent (on 1/1/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| COMBIVENT RESPIMAT 20-100 MCG | $113.86 per gram | |
Ontology: Ipratropium (C0027235)
| Definition (NCI) | A synthetic derivative of the alkaloid atropine with anticholinergic properties. Ipratropium antagonizes the actions of acetylcholine at parasympathetic postganglionic effector cell junctions. When inhaled, ipratropium binds competitively to cholinergic receptors in the bronchial smooth muscle thereby blocking the bronchoconstrictor actions of the acetylcholine (Ach) mediated vagal impulses. Inhibition of the vagal tone leads to dilation of the large central airways resulting in bronchodilation. |
| Definition (MSH) | A muscarinic antagonist structurally related to ATROPINE but often considered safer and more effective for inhalation use. It is used for various bronchial disorders, in rhinitis, and as an antiarrhythmic. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D009241 |
| SnomedCT | 349952008, 108624006, 372518007 |
| LNC | LP171404-9 |
| English | Ipratropium, N Isopropylatropine, N-Isopropylatropine, (endo,syn)-(+-)-3-(3-Hydroxy-1-oxo-2-phenylpropoxy)-8-methyl-8-(1-methylethyl)-8-azoniabicyclo(3.2.1)octane, 8-Azoniabicyclo(3.2.1)octane, 3-(3-hydroxy-1-oxo-2-phenylpropoxy)-8-methyl-8-(1-methylethyl)-, (endo,syn)-(+-)-, ISOPROPYLATROPINE N, (3-endo,8-syn)-3-(3-Hydroxy-1-oxo-2-phenylpropoxy)-8-methyl-8-(1-methylethyl)-8-azoniabicyclo(3.2.1)octane, Ipratropium [Chemical/Ingredient], IPRATROPIUM, ipratropium, Ipratropium (product), Ipratropium (substance) |
| Swedish | Ipratropium |
| Czech | ipratropium, ipratropiumbromid, N-isopropylatropin |
| Finnish | Ipratropium |
| Russian | IPRATROPII, N-IZOPROPILATROPIN, N-ИЗОПРОПИЛАТРОПИН, ИПРАТРОПИЙ |
| Japanese | イプラトロピウム, N-イソプロピルアトロピン, 臭化イプラトロピウム, イソプロピルアトロピン |
| German | ISOPROPYLATROPIN N, Ipratropium, N-Isopropylatropin |
| French | Ipratropium |
| Polish | Ipratropium, N-izopropyloatropina, Bromek ipratropium |
| Spanish | ipratropio (producto), ipratropio (sustancia), ipratropio, Ipratropio, N-Isopropilatropina |
| Italian | Ipratropio |
| Portuguese | Ipratropio, N-Isopropilatropina |
Ontology: Atrovent (C0591130)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D009241 |
| English | atrovent, Atrovent |
Ontology: Combivent (C0591282)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C116388 |
| English | Combivent, combivent |
