| IPRATROPIUM BROMIDE
Atrovent, Atrovent HFA
Classifications: anticholinergic; antimuscarinic; bronchodilator; Therapeutic: bronchodilator
Pregnancy Category: B
0.02% solution for inhalation; 18 mcg inhaler; 0.03%, 0.06% nasal spray
Results in bronchodilation by inhibiting acetylcholine at its receptor sites, thereby blocking cholinergic bronchomotor
tone (bronchoconstriction); also abolishes vagally mediated reflex bronchospasm triggered by such nonspecific agents as cigarette
smoke, inert dusts, cold air, and a range of inflammatory mediators (e.g., histamine).
Produces local, site-specific effects on the larger central airways including bronchodilation and prevention of bronchospasms.
Maintenance therapy in COPD including chronic bronchitis and emphysema; nasal spray for perennial rhinitis and symptomatic
relief of rhinorrhea associated with the common cold.
Perennial nonallergic rhinitis.
Use as primary treatment for acute episodes; hypersensitivity to atropine, bromides, peanut oils, soy lecithin. Safe use
in children ≤3 y (inhalation) or ≤5
y (intranasal) is not established.
Pregnancy (category B), narrow-angle glaucoma; prostatic hypertrophy, bladder neck obstruction.
Route & Dosage
Adult: Inhalation 2 inhalations of MDI q.i.d. at no less than 4 h intervals (max: 12 inhalations in 24 h) Nebulizer 500 mcg (1 unit dose vial) q68h
Child (312 y): Inhalation 12 inhalations t.i.d. (max: 6/d) Nebulizer 125250 mcg t.i.d.
Adult (≥5 y): Intranasal 2 sprays of 0.03% each nostril b.i.d. or t.i.d.
Adult: Intranasal 2 sprays of 0.06% each nostril t.i.d. or q.i.d. up to 4 d
- Demonstrate aerosol use and check return demonstration.
- Wait 3 min between inhalations if more than one inhalation per dose is ordered.
- Avoid contact with eyes.
Adverse Effects (≥1%)Special Senses:
Blurred vision (especially if sprayed into eye), difficulty in accommodation, acute eye pain, worsening of narrow-angle
Bitter taste, dry oropharyngeal
membranes. With higher doses: nausea, constipation
. Respiratory: Cough,
hoarseness, exacerbation of symptoms
, drying of bronchial secretions, mucosal ulcers, epistaxis, nasal dryness. Skin:
Rash, hives. Urogenital:
Urinary retention. CNS:
10% of inhaled dose reaches lower airway; approximately 0.5% of dose is systemically absorbed. Peak:
1.52 h. Duration:
46 h. Elimination:
48% of dose excreted in feces; <5% excreted in urine. Half-Life:
Assessment & Drug Effects
- Monitor respiratory status; auscultate lungs before and after inhalation.
- Report treatment failure (exacerbation of respiratory symptoms) to physician.
Patient & Family Education
- Note: This medication is not an emergency agent because of its delayed onset and the time required to reach peak bronchodilation.
- Review patient information sheet on proper use of nasal spray.
- Allow 3060 sec between puffs for optimum results. Do not let medication contact your eyes.
- Wait 5 min between this and other inhaled medications. Check with physician about sequence of administration.
- Take medication only as directed, noting some leniency in number of puffs within 24 h. Supervise child's administration
until certain all of dose is being administered.
- Rinse mouth after medication puffs to reduce bitter taste.
- Discuss changes in normal urinary pattern with the physician (more common in older adults).
- Call physician if you note changes in sputum color or amount, ankle edema, or significant weight gain.