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ipratropium bromide
Atrovent

Pregnancy Risk Category B

How supplied
Inhaler:
each metered dose supplies 18 mcg
Solution (for inhalation):
0.02% (500 mcg/vial)
Solution (for nebulizer):
0.025% (250 mcg/ml)‡
Nasal spray:
0.03% (each metered dose supplies 21 mcg), 0.06% (each metered dose supplies 42 mcg)

Action
Inhibits vagally mediated reflexes by antagonizing acetylcholine at muscarinic receptors on bronchial smooth muscle.

Indications & dosage
Bronchospasm associated with COPD--

Adults and children over age 12:
1 to 2 inhalations q.i.d. Additional inhalations may be needed. However, total inhalations shouldn't exceed 12 in 24 hours. Or, use inhalation solution. Give 500 mcg dissolved in normal saline and administer by nebulizer q 6 to 8 hours.
Children ages 5 to 12:
give 125 to 250 mcg nebulizer solution dissolved in normal saline and administer by nebulizer q 4 to 6 hours.
Perennial rhinitis--

Adults and children ages 6 and older:
usual dosage of 0.03% nasal spray is 2 sprays (42 mcg) per nostril b.i.d. or t.i.d. (total dose 168 to 252 mcg/day).
Common cold-induced rhinorrhea--

Adults and children over age 12:
usual dosage of 0.06% nasal spray is 2 sprays (84 mcg) per nostril t.i.d. or q.i.d.
Infants and children:
nebulization 25 mcg/kg t.i.d.
NEW INDICATION:
Symptomatic relief of rhinorrhea associated with the common cold--
Children ages 5 to 11:
2 sprays of the 0.06% nasal spray (84 mcg) per nostril three times daily.

Adverse reactions
CNS:
dizziness, pain, headache, nervousness.
CV:
palpitations, hypertension, chest pain.
EENT:
blurred vision, rhinitis, pharyngitis, sinusitis, epistaxis.
GI:
nausea, GI distress, dry mouth.
Musculoskeletal:
back pain.
Respiratory:
upper respiratory tract infection, bronchitis, cough, dyspnea, bronchospasm, increased sputum.
Skin:
rash.
Other:
flulike symptoms, hypersensitivity reactions.

Interactions
Drug-drug.
Anticholinergics: increased anticholinergic effects. Avoid concomitant use.
Drug-herb.
Jaborandi tree: effects of ipratropium may be decreased with concurrent administration. Monitor closely.
Pill-bearing spurge:
choline, a chemical component of the herb, may decrease effect of ipratropium. Use together cautiously.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to drug, atropine, or its derivatives and in those with history of hypersensitivity to soy lecithin or related food products, such as soybeans and peanuts.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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