(i pra TROE pee um)
Chronic obstructive pulmonary disease: Maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema
Hypersensitivity to ipratropium, atropine (and its derivatives), or any component of the formulation
COPD: Oral inhalation:
Nebulization: 500 mcg every 6 to 8 hours
Metered-dose inhaler (MDI): 2 inhalations 4 times daily; maximum dose: 12 inhalations in 24 hours
Acute asthma (exacerbations) (off-label use): Moderate to severe exacerbations:
Oral inhalation: Note: Should be given in combination with a short-acting beta-adrenergic agonist.
Nebulization: 0.5 mg (500 mcg) every 20 minutes for 3 doses, then as needed (NAEPP 2007)
MDI: 8 inhalations every 20 minutes as needed for up to 3 hours (NAEPP 2007)
Refer to adult dosing.
COPD: Oral inhalation: Nebulization: Children ≥12 years and Adolescents: Refer to adult dosing
Acute asthma (exacerbations) (off-label use): Moderate to severe exacerbations and poor response to SABA:
Oral Inhalation: Note: Should be given in combination with a short-acting beta-adrenergic agonist
Children ≤5 years:
Nebulization: 0.25 mg (250 mcg) every 20 minutes if needed for 1 hour (GINA 2016)
MDI: 2 inhalations every 20 minutes if needed for 1 hour (GINA 2016)
Children ≤12 years:
Nebulization: 0.25 to 0.5 mg (250 to 500 mcg) every 20 minutes for 3 doses, then as needed (NAEPP 2007)
MDI: 4 to 8 inhalations every 20 minutes as needed for up to 3 hours (NAEPP 2007)
Adolescents ≥13 years: Refer to adult dosing.
There are no dosage adjustments provided in the manufacturer 's labeling (has not been studied).
There are no dosage adjustments provided in the manufacturer 's labeling (has not been studied).
Avoid spraying into the eyes.
Atrovent HFA: Prior to initial use, prime inhaler by releasing 2 test sprays into the air. If the inhaler has not been used for >3 days, reprime.
Aerosol: Store at controlled room temperature of 25 ‚ °C (77 ‚ °F). Do not store near heat or open flame.
Solution: Store at 15 ‚ °C to 30 ‚ °C (59 ‚ °F to 86 ‚ °F). Protect from light.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Aerosol Solution, Inhalation, as bromide:
Atrovent HFA: 17 mcg/actuation (12.9 g) [contains alcohol, usp]
Solution, Inhalation, as bromide:
Generic: 0.02% (2.5 mL)
Solution, Inhalation, as bromide [preservative free]:
Generic: 0.02% (2.5 mL)
Compatible for 1 hour when mixed with albuterol or metaproterenol in a nebulizer.
AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Monitor therapy
Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy
Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
Analgesics (Opioid): Anticholinergic Agents may enhance the adverse/toxic effect of Analgesics (Opioid). Specifically, the risk for constipation and urinary retention may be increased with this combination. Monitor therapy
Anticholinergic Agents: Ipratropium (Oral Inhalation) may enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol. Monitor therapy
Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination
Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination
Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy
Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Avoid combination
Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination
Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy
Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination
Loxapine: Agents to Treat Airway Disease may enhance the adverse/toxic effect of Loxapine. More specifically, the use of Agents to Treat Airway Disease is likely a marker of patients who are likely at a greater risk for experiencing significant bronchospasm from use of inhaled loxapine. Management: This is specific to the Adasuve brand of loxapine, which is an inhaled formulation. This does not apply to non-inhaled formulations of loxapine. Avoid combination
Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy
Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Monitor therapy
OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy
Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination
Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Consider therapy modification
Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy
RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Monitor therapy
Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid using drugs with substantial anticholinergic effects in patients receiving secretin whenever possible. If such agents must be used in combination, monitor closely for a diminished response to secretin. Consider therapy modification
Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy
Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination
Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy
Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
>10%: Respiratory: Bronchitis (10% to 23%), exacerbation of chronic obstructive pulmonary disease (8% to 23%), sinusitis (1% to 11%)
1% to 10%:
Central nervous system: Headache (6% to 7%), dizziness (3%)
Gastrointestinal: Dyspepsia (1% to 5%), nausea (4%), xerostomia (2% to 4%), dysgeusia (1%)
Genitourinary: Urinary tract infection (2% to 10%)
Neuromuscular & skeletal: Back pain (2% to 7%)
Respiratory: Dyspnea (7% to 8%), flu-like symptoms (4% to 8%), cough (>3%), rhinitis (>3%), upper respiratory tract infection (>3%)
<1% (Limited to important or life-threatening): Accommodation disturbance, acute eye pain, anaphylaxis, angioedema, bronchospasm, corneal edema, glaucoma, hypersensitivity reaction, hypotension, increased intraocular pressure, laryngospasm, palpitations, stomatitis, tachycardia, urinary retention
Concerns related to adverse effects:
- Bronchospasm: Rarely, paradoxical bronchospasm may occur with use of inhaled bronchodilating agents; this should be distinguished from inadequate response.
- Hypersensitivity reactions: Immediate hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm) have been reported.
Disease-related concerns:
- Glaucoma: Use with caution in patients with narrow-angle glaucoma.
- Myasthenia gravis: Use with caution in patients with myasthenia gravis.
- Prostatic hyperplasia/bladder neck obstruction: Use with caution in patients with prostatic hyperplasia or bladder neck obstruction.
Other warnings/precautions:
- Appropriate use: Inhalation/nebulizer not indicated for the initial treatment of acute episodes of bronchospasm where rescue therapy is required for rapid response. Should only be used in acute exacerbations of asthma in conjunction with short-acting beta-adrenergic agonists for acute episodes (NAEPP 2007).
B
Teratogenic effects were not observed in animal studies. Inhaled ipratropium is recommended for use as additional therapy for pregnant women with severe asthma exacerbations.
Blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation; local application to nasal mucosa inhibits serous and seromucous gland secretions.
Not readily absorbed into the systemic circulation from the surface of the lung or from the GI tract; ~7% absorbed after nebulization of a 2 mg dose
15% of dose reaches the lower airways
Partially metabolized to inactive ester hydrolysis products
Urine (50%)
Bronchodilation: Within 15 minutes; Peak effect: 1-2 hours
Oral inhalation: 2-4 hours; Nebulization: 4-5 hours, up to 7-8 hours in some patients
2 hours
≤9%
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience back pain, headache, flu-like symptoms, nasal irritation, pharyngitis, or rhinitis. Have patient report immediately to prescriber vision changes, eye pain, severe eye irritation, urinary retention, painful urination, polyuria, severe dizziness, passing out, tachycardia, arrhythmia, mouth sores, difficulty breathing, wheezing, or cough (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.