ipratropium bromide

Drug Name

Generic Name :  ipratropium bromide

Brand Name:  Apo-Ipravent (CAN), Atrovent, Atrovent HFA, Novo-Ipramide (CAN), ratio-Ipratropium (CAN)

Classification:
Anticholinergic, Antimuscarinic, Parasympatholytic

Pregnancy Category B 

Dosage & Route

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

Aerosol
ADULTS AND PEDIATRIC PATIENTS > 12 YR

  • 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
ADULTS AND PEDIATRIC PATIENTS > 12 YR

  • 500 mcg tid–qid with doses 6–8 hr apart.

Nasal spray
ADULTS AND PEDIATRIC PATIENTS > 12 YR

  • 2 sprays 0.06% per nostril tid–qid for relief with common cold

ADULTS AND PEDIATRIC PATIENTS > 6 YR

  • 2 sprays 0.03% per nostril bid-tid for rhinitis.

PEDIATRIC PATIENTS 5-11 YR

  • 2 sprays 0.06% per nostril tid for relief with common cold.
Therapeutic actions
  • Ipratropium bromide blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation.
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
Adverse effects
  • Dry mouth, urinary retention, buccal ulceration, paralytic ileus, headache, nausea, constipation, paradoxical bronchospasm, immediate hypersensitivity reactions (urticaria, angioedema), acute angle-closure glaucoma, nasal dryness and epistaxis (nasal spray).
  • Potentially Fatal: Anaphylactic reactions, atrial fibrillation, supraventricular tachycardia.
Contraindications
  • 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.
Nursing considerations
Assessment
  • History: Hypersensitivity to atropine, soybeans, 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 examination; 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 inhaler.
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 hours, 2 actuations will be needed before use. Protect from light; do not freeze.
  • You may experience these side effects: 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.