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Ipratropium bromide is a quaternary ammonium compound. It has anticholinergic properties. It inhibits vagal nerve reflexes, being a competitive antagonist of the neurotransmitter acetylcholine. Blocks muscarinic receptors in the smooth muscles of the tracheobronchial tree and suppresses reflex bronchoconstriction. The expansion of the bronchi with inhalation administration is mainly due to the local, rather than the systemic, anticholinergic effect of the drug. It effectively prevents the narrowing of the bronchi, resulting from inhalation of cigarette smoke, cold air, the action of various bronchospasm substances, and also inhibits bronchospasm associated with the influence of the vagus nerves. With inhalation use, it has almost no resorptive effect - for the development of tachycardia, it is necessary to inhale about 500 doses, while only 10% reaches the small bronchi and alveoli, and the rest settles in the pharynx or oral cavity and is swallowed.
In patients with bronchospasm associated with chronic obstructive pulmonary disease (chronic bronchitis and pulmonary emphysema), a significant improvement in lung function (increase in forced expiratory volume in 1 s - FEV1 and an average forced expiratory flow rate of 25-75% increased by 15% or more) is noted after 15 minutes, the maximum effect is achieved in 1-2 hours and lasts up to 6 hours in most patients.
In patients with bronchospasm associated with bronchial asthma, a significant improvement in lung function (increased FEV1 15% or more) is observed in 40% of patients.
Chronic obstructive pulmonary disease (chronic obstructive bronchitis, pulmonary emphysema).
Bronchial asthma (moderate and mild), especially with concomitant diseases of the cardiovascular system.
1 dose contains:
Active substance: ipratropium bromide - 0.021 mg, (which corresponds to 0.02 mg ipratropium anhydrous bromide).
Propellant: 1,1,1,2-tetrafluoroethane (HFA 134a).
Excipients: anhydrous citric acid; distilled water; ethanol
Ipratropium bromide is marketed under different brands and generic names, and comes in different dosage forms:
|Brand name||Manufacturer||Country||Dosage form|
|Atrovent N||Boehringer Ingelheim||Austria||spray can|
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Dosage and Administration
Inhalation aerosol dosed: adults and children over 6 years old - 2 doses of aerosol 4 times a day, if necessary, the dose can be increased to 12 inhalations per day.
The most frequent undesirable effects are headache, nausea, dry mouth.
Due to low systemic absorption of the drug, side effects associated with systemic anticholinergic effects, such as tachycardia, palpitations, accommodation disturbances, decreased secretion of sweat glands, impaired gastrointestinal motility, urinary retention, are rare and are reversible. However, in patients with obstructive lesions of the urinary tract, the risk of urinary retention increases.
As with other inhalation therapy, incl. bronchodilators, sometimes there is a cough, less often - paradoxical bronchospasm.
In rare cases, allergic reactions may develop, incl. urticaria, angioedema, rash, oropharyngeal edema and anaphylaxis.
There are separate reports of the occurrence of eye complications (dilated pupil, increased intraocular pressure, angle-closure glaucoma, pain in the eye) when an ipratropium bromide aerosol or an ipratropium bromide aerosol combined with beta-agonists in the eye occurs. Patients should be able to properly use metered aerosol.
- Hypersensitivity to atropine and its derivatives, and other components of the drug.
- Pregnancy (I trimester).
- Children's age up to 6 years.
Potentiates the bronchodilator effect of beta-adrenergic agonists and xanthine derivatives. Strengthens anticholinergic effect of other drugs.
Pregnancy and Lactation
Contraindicated in the first trimester of pregnancy, the appointment of the drug is possible in the II-III trimester of pregnancy and during breastfeeding only if the expected effect of therapy outweighs the potential risk to the fetus or child.
It is not recommended for emergency relief of asthma attack (the bronchodilator effect develops later than that of beta-adrenergic stimulants).
Patients with cystic fibrosis have an increased likelihood of slowing gastrointestinal motility.
Patients should be able to properly use Atrovent H metered-dose aerosol for inhalation.
When first using the freon-free metered-dose aerosol form, patients may note that the taste of the new drug is somewhat different from the previous dosage form of the drug containing freon. When switching from one form of the drug to another, patients should be warned about a possible change in the taste of the drug. It should be reported that these drugs are interchangeable, and that the taste properties are not related to the safety and effectiveness of the new drug.
0.025% solution for inhalation contains the preservative benzalkonium chloride and the stabilizer ethylenediaminetetraacetic acid. There are reports that these substances, when administered in high doses, can cause bronchospasm in some patients.
It is not recommended to exceed the set daily dose, both with short-term and long-term use of the drug.
The drug should be used with caution in patients with angle-closure glaucoma and urination disorders due to benign prostatic hyperplasia.
In case of accidental contact with the patient with closed angle glaucoma, the intraocular pressure may increase.
Eye pain or discomfort, blurred vision, the appearance of halo and colored spots before the eyes, in combination with conjunctival and corneal hyperemia, can be symptoms of an attack of narrow-angle glaucoma. If any of these symptoms appear, drops should be prescribed that cause pupil constriction and immediately consult an ophthalmologist.
If the patient’s condition worsens or there is no significant improvement, consult a doctor to determine a plan for further treatment. In the case of sudden and rapid increase in shortness of breath (difficulty breathing), you should immediately consult a doctor.
Children dosed aerosol Atrovent N should be prescribed only after the recommendation of a doctor and under the supervision of adults.
Symptoms: no specific overdose symptoms have been identified. There may be minor manifestations of systemic anticholinergic effects, such as dry mouth, disturbed accommodation, an increase in heart rate.
- Brand name: Atrovent N
- Active ingredient: Ipratropium bromide
- Dosage form: Spray can.
- Manufacturer: Boehringer Ingelheim
- Country of Origin: Austria
- Effect of ipratropium bromide on bronchospasm induced by inhalation of hypotonic solutions
- Ipratropium bromide spray as treatment for sialorrhea in Parkinson's disease
- The Protective Effects of Ipratropium Bromide and Terbutaline on Distilled Water-induced Bronchoconstriction
- A comparison of the bronchodilating effects of salmeterol, salbutamol and Ipratropium bromide in patients with chronic obstructive pulmonary disease
- Physicochemical and in vitro deposition properties of salbutamol sulphate/ipratropium bromide and salbutamol sulphate/excipient spray dried mixtures for use in dry powder inhalers
- Radioreceptor assays of ipratropium bromide in plasma and urine
- High-performance liquid chromatographic assay for the simultaneous determination of ipratropium bromide, fenoterol, salbutamol and terbutaline in nebulizer solution
- Development and validation of a stability indicating RP-HPLC method for the simultaneous determination of related substances of albuterol sulfate and ipratropium bromide in nasal solution
- Supercritical fluid-micronized ipratropium bromide for pulmonary drug delivery
- Ipratropium Bromide in Emergency Management of Acute Asthma Exacerbation
- Decreased duration of emergency department treatment of chronic obstructive pulmonary disease exacerbations with the addition of ipratropium bromide to β-agonist therapy
- Comparison of the anticholinergic bronchodilator ipratropium bromide with metaproterenol in chronic obstructive pulmonary disease: Tashkin DP, Ashutosh K, Bleecker ER, et al Am J Med 81 (suppl 5A):81–90 Nov 1986
- Should ipratropium bromide be added to beta-agonists in treatment of acute severe asthma?: Higgins RM, Stradling JR, Lane DJ Chest 94:718–722 Aug 1988
- Adjunctive use of ipratropium bromide in the emergency management of acute asthma
- Acute Angle-Closure Glaucoma as a Complication of Combined β-Agonist and Ipratropium Bromide Therapy in the Emergency Department
- For COPD a combination of ipratropium bromide and albuterol sulfate is more effective than albuterol base: Campbell S Arch Intern Med 159:156–160 January 1999
- The separation of ipratropium bromide and its related compounds
- Determination of ipratropium bromide in vials using kinetic and first-derivative spectrophotometric methods
- A time-dose study of the effect of topical ipratropium bromide on methacholine-induced rhinorrhoea in patients with perennial non-allergic rhinitis
- Standard dose of inhaled albuterol significantly increases QT dispersion compared to low dose of albuterol plus ipratropium bromide therapy in moderate to severe acute asthma attacks in children
- Efficacy and safety of ipratropium bromide plus fenoterol inhaled via Respimat® Soft Mist™ Inhaler vs. a conventional metered dose inhaler plus spacer in children with asthma
- Bronchodilatory effects of salbutamol, ipratropium bromide, and their combination: Double-blind, placebo-controlled crossover study in cystic fibrosis
- The bronchodilator effect of a fixed-combination metered aerosol (fenoterol and ipratropium bromide)
- Bronchodilator effect of fenoterol and ipratropium bromide in infants with acute wheezing: Use of MDI with a spacer device