Ipratropium Bromide

Ipratropium Bromide is a quaternary ammonium compound with anticholinergic properties. It appears to inhibit vagal reflexes by antagonising the action of acetylcholine on bronchial smooth muscle. It causes bronchodilation by blocking the action of acetylcholine at parasympathetic sites in bronchial smooth muscle. It is used in inhalation form to relieve bronchial airway obstruction.

• Chronic obstructive pulmonary disease (COPD)
• Asthma (acute and chronic)

Adult Dose (Inhalation):

• Inhaler (MDI): 1-2 puffs (20 mcg/puff) 3-4 times daily; up to 80 mcg may be required
• Nebulizer solution: 250-500 mcg 3-4 times daily; acute bronchospasm: 500 mcg/2 mL
• Maximum 12 puffs in 24 hours

Child Dose (Inhalation):

• MDI (<6 years): 20 mcg tid; (6-12 years): 20-40 mcg tid
• Nebulizer (<6 years, acute asthma): 125-250 mcg, no more often than 6 hourly; (6-12 years): 250 mcg as needed

Common Side Effects:

• Dryness in mouth
• Dry nose
• Headache
• Cough
• Throat irritation
• Dizziness

Uncommon: Urticaria, Tachycardia, Skin rash, Pruritus, Vomiting, Anaphylactic reaction, Eye pain, Mydriasis, Increased intraocular pressure, Palpitations, Atrial fibrillation, Nausea

Precautions:

• Ipratropium Bromide does not usually affect your ability to drive
• For inhalation only; do not swallow capsules
• Do not use to relieve sudden breathing problems (use rescue inhaler)
• Take first dose under medical supervision (may cause bronchospasm)
• Caution in narrow-angle glaucoma, prostatic hyperplasia, bladder-outflow obstruction or cystic fibrosis
• Care must be taken not to allow solution or mist to enter eyes during nebulizer therapy

Contraindications:

• Known hypersensitivity to atropine or its derivatives
• History of hypersensitivity to soya lecithin, soybean or peanut (inhaler)

Drug Interactions:

• Increased toxicity with other anticholinergic drugs
• Can be used with sympathomimetic bronchodilators, methylxanthines, steroids and cromolyn sodium

Food Interactions: It is not known whether it is safe to consume alcohol with Ipratropium Bromide; consult your doctor.

Use in Pregnancy: Generally considered safe; animal studies show low or no adverse effects; limited human studies; benefits must be weighed against possible hazards to fetus.

Use in Lactation: Probably safe; limited human data suggests drug does not represent significant risk to baby; it is not known whether ipratropium bromide is excreted into breast milk; caution required.

Pediatric Use: 6-12 years: 20-40 mcg tid; <6 years: 20 mcg tid; nebulizer doses provided above.

Overdose: Acute overdosage by inhalation is unlikely (poor systemic absorption); 5 mg inhaled dose causes increased heart rate and palpitation; 30 mg oral dose caused anticholinergic side effects but not severe enough to require specific reversal.