Bronchospasm associated with chronic bronchitis and emphysema.
Antimuscarinic; Antiasth matic
Ipratropium Bromide is a quaternary ammonium compound with anticholinergic properties. It appears to inhibit vagal reflexes by antagonising the action of acetylcholine (the transmitter agent released from the vagus nerve). Anticholinergics prevent the increase in intracellular concentration of cyclic guanosine monophosphate (cyclic GMP) caused by interaction of acetylcholine with the muscarinic receptor on bronchial smooth muscle.
NASAL Seasonal allergic rhinitis; Rhinorrhoea associated w/ rhinitis: Adult: As metered-dose nasal spray (0.06%): 42 mcg into each nostril bid/tid. up to 84 mcg into each nostril 3-4 times daily for up to 4 days when rhinorrfloea is associated w/ common cold or up to 3 wk in seasonal allergic cases. Child: As metered-dose nasal spray: 6 yr: 42 mcg into each nostril bid/tid. INHALATION Chronic obstructive pulmonary disease: Adult: As metered-dose aerosol: 20 or 40 mcg 3 or 4 times daily. Max: 12 inhalations daily. As dry powder: 40 mcg 3 or 4 times daily. Max: 320 mcg daily. As nebulised solution: 500 mcg (1 u dose vial) 3-4 times daily. Child: As metered- dose aerosol: <6 yr: 20 mcg tid; 6-12 yr: 20 or 40 mcg tid. As nebulised solution: <6 yr: 125-250 mcg; 6-12 yr: 250 mcg at intervals of at least 6 hr up to 1 mg daily.
Ipratropium has been used concomitantly with other drugs, including sympathomimetic bronchodilators, methylxanthines, steroids and cromolyn sodium, commonly used in the treatment of chronic obstructive pulmonary disease, without adverse drug reactions. There are no studies fully evaluating the interaction effects of Ipratropium and these drugs with respect to effectiveness.
Bladder neck obstruction, narrowangle glaucoma or patients susceptible to glaucoma, prostatic hyperplasia. Protect patient’s eyes from nebulised drug. Renal & hepatic impairment. Pregnancy, lactation, children, elderly.
Dry mouth, urinary retention, buccal ulceration, paralytic ileus, headache, nausea, constipation, paradoxical bronchospasm, immediate hypersensitivity reactions (urticaria, angioedema), acute angle-closure glaucoma, nasal dryness & epistaxis (nasal spray). Anaphylactic reactions, atrial fibrillation, supraventricular tachycardia.
Use is recommended only if clearly needed and the benefit outweighs the risk in pregnancy. Caution is recommended for breastfeeding.
Acute overdosage by inhalation is unlikely since Ipratropium bromide is not well absorbed systematically after aerosol administration. Inhaled dosage of 5 mg produces an increase in heart rate and palpitation. Single doses of Ipratropium bromide 30 mg by mouth caused anticholinergic side effects but which were not considered severe enough to require specifc reversal.
As the product contains no preservative, a fresh ampoule should be used for each dose and the ampoule should be opened immediately before administration. Any solution left in the ampoule should be discarded. Do not store above 25°C. Keep the ampoule in the outer carton.
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