Ipratropium

Ipratropium is available in multiple forms, each approved for specific uses.

• Atrovent HFA inhaler and Ipratropium Bromide Inhalation aerosol: maintenance treatment of bronchospasm (airway narrowing) in COPD, including chronic bronchitis and emphysema
• Ipratropium Bromide inhalation solution (nebulizer): maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and emphysema — can be used alone or with other bronchodilators
• Ipratropium Bromide nasal spray: relief of runny nose (rhinorrhea) from the common cold in adults and children age 5 and older
• Ipratropium Bromide nasal spray: relief of runny nose from seasonal allergic rhinitis in adults and children age 5 and older
• The nasal spray does not treat nasal congestion or sneezing from colds or allergies

Ipratropium is an anticholinergic (parasympatholytic) agent — it works by blocking acetylcholine, a chemical messenger your nervous system uses to trigger muscle contractions and gland secretions. In the lungs, blocking acetylcholine relaxes the muscles around the airways, opening them up and making it easier to breathe. In the nose, it reduces secretions from the glands lining the nasal passages, cutting down the flow of a runny nose.

Ipratropium is a quaternary amine, which means it is poorly absorbed across nasal and gut membranes and does not easily cross into the brain. This keeps its action mostly local — in the lungs or nose — and reduces body-wide anticholinergic side effects compared to similar drugs that enter the bloodstream more readily.

How ipratropium is taken depends on the form prescribed. The inhaler (Atrovent HFA or Ipratropium Bromide Inhalation aerosol) and the nebulizer solution are taken by mouth inhalation several times per day as directed — do not exceed the maximum number of doses your prescriber or label specifies in 24 hours. The nasal spray is used in each nostril several times a day; for the common cold it should not be used for more than 4 days, and for seasonal allergic rhinitis no more than 3 weeks. Always follow your prescriber's specific instructions.

• Inhaler products must be primed before first use and re-primed after extended periods without use
• Nebulizer solution doses should be spaced several hours apart
• Nasal spray must be primed before first use
• Do not spray any form into your eyes

The most common side effects reported with ipratropium include:

• Dry mouth or throat irritation
• Headache
• Bronchitis or worsening COPD symptoms
• Shortness of breath (dyspnea)
• Nausea
• Dizziness
• Bitter taste
• Upset stomach (dyspepsia)

More serious reactions that need prompt medical attention include sudden worsening of breathing (paradoxical bronchospasm), signs of an allergic reaction (hives, swelling, difficulty breathing, anaphylaxis), eye pain or blurred vision suggesting raised eye pressure, and difficulty urinating. Stop the medication and get help right away if any of these occur.

• Not for acute attacks: The inhaled forms are for everyday maintenance only — not to treat a sudden breathing crisis. Use a rescue inhaler for that.
• Paradoxical bronchospasm: In rare cases, ipratropium can make breathing worse right after use. Stop immediately and seek emergency care.
• Serious allergic reactions: Anaphylaxis, angioedema (swelling of the tongue, lips, or face), and severe skin reactions have been reported. Discontinue and seek emergency help if these occur.
• Eye pressure (narrow-angle glaucoma): Ipratropium can raise pressure inside the eye. People with narrow-angle glaucoma must use it with caution. Never spray it into your eyes — accidental eye contact can cause pain, blurred vision, and changes in eye pressure.
• Urinary retention: Ipratropium may make it hard to urinate, especially in men with an enlarged prostate (prostatic hyperplasia) or bladder-neck obstruction. Tell your doctor right away if this happens.
• Heart rhythm: Post-marketing data have noted cases of atrial fibrillation and fast heart rate (supraventricular tachycardia) in COPD patients using ipratropium products.

Ipratropium has one well-established drug interaction category to be aware of:

• Other anticholinergic drugs: Taking ipratropium alongside other medications that also block acetylcholine (anticholinergics) can increase the risk of side effects like dry mouth, difficulty urinating, raised eye pressure, and constipation — avoid combining them unless directed by your prescriber.

This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.

• Do not use ipratropium if you are allergic to ipratropium bromide, atropine, or any of atropine's derivatives
• Tell your doctor if you have narrow-angle glaucoma — ipratropium can raise eye pressure and make this condition worse
• Tell your doctor if you have an enlarged prostate or any bladder-neck obstruction — ipratropium can cause urinary retention
• The inhaler and nebulizer forms have not been established as safe and effective in children; the nasal spray is approved for children age 5 and older
• Pregnancy: Inhaled ipratropium is negligibly absorbed into the bloodstream, so fetal exposure is expected to be very low; still, discuss use during pregnancy with your doctor
• Breastfeeding: Levels in breast milk are expected to be low given minimal systemic absorption from inhalation, but discuss with your doctor
• Older adults (65+): No differences in safety or effectiveness have been found compared to younger adults for the inhaled forms
• Kidney or liver impairment: The pharmacokinetics of ipratropium have not been formally studied in these populations — inform your prescriber

Overdose from the nasal spray is unlikely because ipratropium is poorly absorbed through the nasal lining or gut. In a study where volunteers took a very large oral dose, no significant changes in heart rate or blood pressure were observed. If you are concerned about taking too much, contact Poison Control or seek medical attention.

In clinical studies, ipratropium at nasal doses did not significantly affect pupil size, heart rate, or blood pressure, and did not interfere with normal nasal functions such as sense of smell, the ability of nasal tissues to move mucus (mucociliary clearance), or the nose's ability to warm and humidify air. For the runny nose indication, a meaningful reduction in nasal discharge was seen within one hour of dosing. The drug had no effect on nasal congestion or sneezing.

Ipratropium bromide is poorly absorbed from the nasal mucosa — less than 20% of a nasal dose enters the bloodstream — and even less is absorbed after oral ingestion (2–3%). It binds minimally to proteins in the blood and does not cross the blood-brain barrier. The drug is partially broken down (metabolized) in the body into inactive byproducts, and about half of an intravenous dose is excreted unchanged in the urine within 24 hours. The half-life (the time for the body to clear half the drug) is approximately 1.6 hours following intravenous administration.

Store tightly closed at 20° to 25°C (68° to 77°F) . Avoid freezing. Keep out of reach of children.