ipratropium bromide

(i pra troe' pee um)

Alti-Ipratropium (CAN), Apo-Ipravent (CAN), Atrovent, Novo-Ipramide (CAN)

Pregnancy Category B

Drug classes
Anticholinergic
Antimuscarinic agent
Parasympatholytic

Therapeutic actions
Anticholinergic, chemically related to atropine, which blocks vagally mediated reflexes
by antagonizing the action of acetylcholine. Causes bronchodilation and inhibits secretion
from serous and seromucous glands lining the nasal mucosa.

Indications
• Bronchodilator for maintenance treatment of bronchospasm associated with
COPD (solution, aerosol), chronic bronchitis, and emphysema
• Nasal spray: Symptomatic relief of rhinorrhea associated with perennial rhinitis,
common cold

Contraindications and cautions

• Contraindicated with hypersensitivity to atropine or its derivatives, soy bean or
peanut allergies (aerosol).
• Use cautiously with narrow-angle glaucoma, prostatic hypertrophy, bladder neck
obstruction, pregnancy, lactation.

Available forms
Aerosol—18 mcg/actuation; solution for inhalation—0.02%; solution—500 mcg/vial;
nasal spray—0.03% (21 mcg/spray), 0.06% (42 mcg/spray)

Dosages
ADULTS
Inhalation
The usual dosage is 2 inhalations (36 mcg) qid. Patients may take additional inhalations
as required. Do not exceed 12 inhalations/24 hr.
Solution for inhalation
500 mcg tid to qid with doses 6–8 hr apart.
Nasal spray
2 sprays 0.03% per nostril bid to tid or 2 sprays 0.06% per nostril tid–qid for relief with
common cold.
PEDIATRIC PATIENTS
Safety and efficacy not established for children < 12 yr.

Pharmacokinetics
Route Onset Peak Duration
Inhalation 15 min 1–2 hr 3–4 hr

Adverse effects
• CNS: Nervousness, dizziness, headache, fatigue, insomnia, blurred vision
• GI: Nausea, GI distress, dry mouth
• Respiratory: Dyspnea, bronchitis, bronchospasms, upper respiratory tract
infection, cough, exacerbation of symptoms, hoarseness
• Other: Back pain, chest pain, allergic-type reactions, palpitations, rash

Nursing considerations
Assessment
• History: Hypersensitivity to atropine, soy beans, peanuts (aerosol preparation);
acute bronchospasm, narrow-angle glaucoma, prostatic hypertrophy, bladder neck
obstruction, pregnancy, lactation
• Physical: Skin color, lesions, texture; T; orientation, reflexes, bilateral grip
strength; affect; ophthalmic exam; P, BP; R, adventitious sounds; bowel sounds,
normal output; normal urinary output, prostate palpation

Interventions
• Protect solution for inhalation from light. Store unused vials in foil pouch.
• Use nebulizer mouthpiece instead of face mask to avoid blurred vision or
aggravation of narrow-angle glaucoma.
• Can mix albuterol in nebulizer for up to 1 hr.
• Ensure adequate hydration, control environmental temperature to prevent
hyperpyrexia.
• Have patient void before taking medication to avoid urinary retention.
• Teach patient proper use of inhalator.

Teaching points
• Use this drug as an inhalation product. Review the proper use of inhalator; for
nasal spray, initiation of pump requires 7 actuations; if not used for 24 hr, 2
actuations will be needed before use. Protect from light; do not freeze.
• These side effects may occur: Dizziness, headache, blurred vision (avoid driving
or performing hazardous tasks); nausea, vomiting, GI upset (proper nutrition is
important; consult with your dietitian to maintain nutrition); cough.
• Report rash, eye pain, difficulty voiding, palpitations, vision changes.

Adverse effects in Italic are most common; those in Bold are life-threatening.