Ipratropium

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Contents 1 Introduction 2 Indications 3 Contraindications 4 Pharmacokinetics 5 Adverse-effects 6 Mechanism-of-action 7 More General Terms 8 Internet Database 9 References

Introduction

• Tradename: Atrovent.

Indications

• chronic bronchitis
• asthmatic bronchitis
• not useful in patients with pure emphysema
• useful used concurrently with beta2 agonists

Contraindications

• allergy to soy or peanuts ( soy lecithin* used as suspension agent <Atrovent CFC metered dose inhaler ONLY>) [5,7] <Atrovent HFA inhaler DOESN'T have soy, neither does ipratropium nasal spray or inhalation solution>
• maintenance therapy; NOT for acute exacerbations
• combined use with long-acting anticholinergic agent ( tiotropium) [6,8]
  

• * soy lecithin can contain small amounts of soy protein, which can cause a reaction in a small number of people with peanut allergy
  
• Caution:

• temporary blurred vision may occur if sprayed into eyes Inhaler:
• 2 puffs QID or 1 vial nebulized every 6-8 hours
• max: 12 puffs/24 hours.

• Aerosol: 18 ug/metered dose (14 g) Solution for inhalation: 0.02% (2.5 mL) (box of 25)
  
• pregnancy category = b
• safety in lactation = ?

Pharmacokinetics

• onset of action is within 3 minutes
• maximal effect within 1.5-2 hours
• duration of action 3-6 hours [6]
  

• elimination via lung

Adverse-effects

• common (> 10%)

• cough, dry mouth, headache, dizziness, nausea, gastrointestinal upset

• less common (1-10%)

• blurred vision, insomnia, hypotension, nasal congestion, palpitations, urinary retention, trembling

• uncommon (< 1%)

• rash, stomatitis, hives

• other

• nervousness
• may aggravate:

• narrow-angle glaucoma
• prostatic hypertrophy
• bladder neck obstruction

• increased cardiovascular risk of inhaled anticholinergics (see inhaled anticholinergic agents)

• nasal spray:

• not common (1-10%)

• epistaxis, nasal dryness

• uncommon (< 1%)

• nasal burning, coughing, dizziness, palpitations, thirst, tinnitus, blurred vision
  

• drug adverse effects of parasympatholytics

Mechanism-of-action

• short-actinb anticholinergic agent causing relaxation of the bronchial smooth muscle, especially in the upper bronchial tree
• inhibits vagally-mediated reflexes
• prevents increase in cGMP caused by stimulation of muscarinic receptors in bronchial smooth muscle

• Ipatropium does not:

• prevent bronchoconstriction induced by:

• tobacco smoke
• citric acid
• sulfur dioxide
• carbon dust

• affect mucous production or transport or ciliary action

• Allergen-induced bronchoconstriction responds poorly to ipratropium.

More General Terms

• antiasthmatic agent
• parasympatholytic (anticholinergic, antimuscarinic agent)

Internet Database

PubChem: 3746
PubChem: 43232
PubChem: 657309
PubChem: 441337
PubChem: 31098
PubChem: 592261
PubChem: 657308

References

1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 742
4. Kaiser Permanente Northern California Regional Drug Formulary, 1998
5. Prescriber's Letter 10(3):13 2003
6. Prescriber's Letter 15(1): 2008 Combined Use of Tiotropium (Spiriva) and Ipratropium (Atrovent) Detail-Document#: [1] (subscription needed) [2]
7. Prescriber's Letter 16(6): 2009 Drug Therapy Considerations for Patients with Peanut Allergy Detail-Document#: [3] (subscription needed) [4]
8. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006

ipratropium (Atrovent)