Classes
DEA Class; Rx
Common Brand Names; Atrovent, Atrovent HFA
- Anticholinergics, Respiratory
Description
Tertiary amine antimuscarinic; one of the isomers of atropine; used for hypermotility disorders of the lower urinary tract or to control excessive salivary or respiratory secretions.
Indications
Indicated for Maintenance treatment of bronchospasm, including chronic bronchitis and emphysema
For the management of rhinorrhea due to the common cold, seasonal allergies, or perennial allergies, including nonallergic and allergic rhinitis.
For exercise-induced bronchospasm prophylaxis
Contraindications
Documented hypersensitivity to ipratropium, atropine, or derivatives
Adverse Effects
- Bronchitis (10-23%)
- Chronic obstructive pulmonary disease (COPD) exacerbation (8-23%)
- Sinusitis (1-14%)
- Dyspnea (4-10%)
- Urinary tract infection (UTI) (2-10%)
- Headache (5-9%)
- Flulike symptoms (2-8%)
- Back pain (2-7%)
- Cough (5.9%)
- Dyspepsia (1-5%)
- Dry mouth (2-4%)
- Dizziness (1-3%)
- Nausea (2.8%)
- Cardiovascular: Hypotension, palpitations, tachycardia
- General: Dry throat, throat irritation
- Gastrointestinal (GI): Constipation, stomatitis, mouth edema
- Sensory: Narrow-angle glaucoma, glaucoma, halo vision, conjunctival hyperemia, corneal edema, mydriasis, acute eye pain, blurry vision
- Respiratory: Bronchospasm, including paradoxical bronchospasm
- Renal: Urinary retention
Warnings
Use for maintenance treatment only; should not be used as rescue therapy
Inhaled bronchodilating agents may cause life-threatening paradoxical bronchospasm that should be differentiated from inadequate response
Hypersensitivity reactions (skin rash, pruritus, angioedema, urticaria/giant urticaria, laryngospasm) reported; discontinue immediately, and use alternative treatment
May cause urinary retention; use with caution in patients with benign prostatic hyperplasia (BPH) or bladder-neck obstruction
Use caution in patients with myasthenia gravis
May worsen narrow-angle glaucoma
Inhalation/nebulizer not indicated for initial treatment of acute episodes of bronchospasm; rescue therapy required
Pregnancy and Lactation
Ipratropium is negligibly absorbed systemically following oral inhalation; therefore, maternal use is not expected to result in fetal exposure to the drug
There are no data on presence of drug in either human or animal milk, effects on breastfed infant, or on milk production; although lipid- insoluble quaternary cations pass into breast milk
Maximum Dosage
672 mcg/day intranasally; FDA-approved labeling for inhaler recommends not exceeding 12 puffs/day (204 mcg/day); FDA-approved labeling for nebulizer solution for oral inhalation recommends not exceeding 4 doses/day or 2,000 mcg/day (0.02% nebulizer solution). While higher doses have been reported in trials, no advantage of nebulized doses greater than 2,000 mcg/day in adults has been noted.
672 mcg/day intranasally; FDA-approved labeling for inhaler recommends not exceeding 12 puffs/day (204 mcg/day); FDA-approved labeling for nebulizer solution for oral inhalation recommends not exceeding 4 doses/day or 2,000 mcg/day (0.02% nebulizer solution). While higher doses have been reported in trials, no advantage of nebulized doses greater than 2,000 mcg/day in adults has been noted.
672 mcg/day intranasally. In general, a maximum of 12 puffs/day for HFA inhaler has been reported; FDA-approved labeling for nebulizer solution for oral inhalation recommends not exceeding 4 doses/day or 2,000 mcg/day (0.02% nebulizer solution). Higher maximum dosages for inhalation products have been recommended in NAEPP guidelines for acute exacerbations of asthma in the emergency care setting.
12 years: 672 mcg/day intranasally. In general, a maximum of 12 puffs/day for HFA inhaler has been reported; FDA-approved labeling for nebulizer solution for oral inhalation recommends not exceeding 4 doses/day or 2,000 mcg/day (0.02% nebulizer solution). Higher maximum dosages for inhalation products have been recommended in NAEPP guidelines for acute exacerbations of asthma in the emergency care setting.
5 to 11 years: 504 mcg/day intranasally. Safety and efficacy of orally inhaled formulations have not been established; oral inhalation maximum dependent on patient response and formulation used.
1 to 4 years: Safety and efficacy have not been established; oral inhalation maximum dependent on patient response and formulation used.
Safety and efficacy have not been established; oral inhalation maximum dependent on patient response and formulation used.
Safety and efficacy have not been established; oral inhalation maximum dependent on patient response and formulation used.