Short-Acting Anticholinergic Bronchodilator

Aka: Short-Acting Anticholinergic Bronchodilator, Short-Acting Muscarinic Antagonist, Ipratropium, Ipratropium Bromide, Atrovent, Combivent, Combivent Respimat

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II. Indications

  1. Chronic Obstructive Pulmonary Disease (COPD)
    1. Longer acting Anticholinergic Agents are preferred in COPD
    2. See Long-acting Anticholinergic Bronchodilator
  2. Acute Asthma Exacerbation
    1. Used in combination with Albuterol (duoneb)

III. Mechanism

  1. Ipratropium (Atrovent) is a Short-Acting Anticholinergic Bronchodilator
  2. Acts as a Muscarinic Antagonist, reducing Acetylcholine induced bronchospasm

IV. Preparations: Ipratropium Bromide

  1. Atrovent MDI
    1. Inhale 2-3 puffs three to four times daily as needed (maximum 12 puffs/day)
  2. Atrovent Nebulization (0.02%, 500 mcg/ampule)
    1. Nebulize 1 ampule of Ipratropium solution every 6 to 8 hours as needed

V. Preparations: Combination Ipratropium with Albuterol (Combivent)

  1. Combivent (older CFC version)
    1. Will be phased out in 2013 due to CFC
    2. Dose: 2 puffs up to every 6 hours
    3. Contraindicated in soybean or peanut allergy
  2. Combivent Respimat
    1. Dose: 1 puff every 6 hours
    2. Does not carry the Food Allergy related contraindications of the older Combivent

VI. Adverse Effects

  1. Serious adverse effects
    1. Anaphylaxis, Angioedema or other Hypersensitivity Reaction
    2. Paradoxical bronchospasm or Laryngospasm
    3. Exacerbation of Glaucoma
    4. Increased cardiovascular events
      1. Avoid short acting Anticholinergics (Ipratropium) in comorbid cardiovascular disease
      2. Ogale (2010) Chest 137(1): 13-19 [PubMed]
      3. Singh (2008) JAMA 300(12): 1439-50 [PubMed]
  2. Common adverse effects
    1. Cough
    2. Dry Mouth or oral irritation
    3. Gastrointestinal upset such as Nausea
    4. Urticaria or other rash
    5. Headache
    6. Nervous Sensation
    7. Urinary Retention
  3. Allergy
    1. Original Atrovent MDI (non-HFA) was contraindicated with soy or peanut allergy

VII. Safety

  1. Pregnancy Category B
  2. Unknown safety in Lactation

VIII. Reources

  1. Ipratropium Bromide Nebulizer Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f625d3e3-c175-4d9a-99ea-dab410b262f1
  2. Ipratropium Bromide and Albuterol Nebulizer Solution (Duoneb, DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8bcc115b-88da-4ff0-b4e1-ef10d5287e54
  3. Ipratropium HFA MDI (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884

IX. References

  1. (2022) Inhaled Medications for COPD, Presc Lett, #381116
  2. (2020) Drugs for COPD, Med Lett Drug Ther 62: 137-44

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Related Studies

Cost: Medications

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
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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