III. Mechanism

  1. Short-acting Anticholinergic Bronchodilator

IV. Preparations: Ipratropium Bromide

  1. Atrovent MDI: 2-3 puffs three to four times daily
  2. Atrovent Nebulization: 1 ampule in nebulization solution every 6 hours prn

V. Preparations: Combination Ipratropium with Albuterol (Combivent)

  1. Combivent (older CFC version)
    1. Will be phased out in 2013 due to CFC
    2. Dose: 2 puffs up to every 6 hours
    3. Contraindicated in soybean or peanut allergy
  2. Combivent Respimat
    1. Dose: 1 puff every 6 hours
    2. Does not carry the Food Allergy related contraindications of the older Combivent

VI. Adverse Effects

  1. Serious adverse effects
    1. Anaphylaxis, Angioedema or other Hypersensitivity Reaction
    2. Paradoxical bronchospasm or Laryngospasm
    3. Exacerbation of Glaucoma
    4. Increased cardiovascular events
      1. Avoid short acting Anticholinergics (Ipratropium) in comorbid cardiovascular disease
      2. Ogale (2010) Chest 137(1): 13-19 [PubMed]
      3. Singh (2008) JAMA 300(12): 1439-50 [PubMed]
  2. Common adverse effects
    1. Cough
    2. Dry Mouth or oral irritation
    3. Gastrointestinal upset such as Nausea
    4. Urticaria or other rash
    5. Headache
    6. Nervous sensation

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Cost: Medications

IPRATROPIUM NEB (on 2/19/2015 at Target.com)
IPRATROPIUM NEB 0.2 MG/ML* Solution #90 for $10.00 $0.11 each
ipratropium (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
IPRATROPIUM 0.03% SPRAY Generic $0.66 per ml
IPRATROPIUM 0.06% SPRAY Generic $1.35 per ml
IPRATROPIUM BR 0.02% SOLN Generic $0.06 per ml
IPRATROPIUM-ALBUTEROL 0.5-3(2.5) MG/3 ML Generic $0.07 per ml
atrovent (on 7/13/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
ATROVENT HFA INHALER $23.49 per gram
combivent (on 4/1/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
COMBIVENT RESPIMAT INHAL SPRAY $77.11 per gram

Ontology: Ipratropium (C0027235)

Definition (NCI) A synthetic derivative of the alkaloid atropine with anticholinergic properties. Ipratropium antagonizes the actions of acetylcholine at parasympathetic postganglionic effector cell junctions. When inhaled, ipratropium binds competitively to cholinergic receptors in the bronchial smooth muscle thereby blocking the bronchoconstrictor actions of the acetylcholine (Ach) mediated vagal impulses. Inhibition of the vagal tone leads to dilation of the large central airways resulting in bronchodilation.
Definition (MSH) A muscarinic antagonist structurally related to ATROPINE but often considered safer and more effective for inhalation use. It is used for various bronchial disorders, in rhinitis, and as an antiarrhythmic.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D009241
SnomedCT 349952008, 108624006, 372518007
LNC LP171404-9
English Ipratropium, N Isopropylatropine, N-Isopropylatropine, (endo,syn)-(+-)-3-(3-Hydroxy-1-oxo-2-phenylpropoxy)-8-methyl-8-(1-methylethyl)-8-azoniabicyclo(3.2.1)octane, 8-Azoniabicyclo(3.2.1)octane, 3-(3-hydroxy-1-oxo-2-phenylpropoxy)-8-methyl-8-(1-methylethyl)-, (endo,syn)-(+-)-, ISOPROPYLATROPINE N, (3-endo,8-syn)-3-(3-Hydroxy-1-oxo-2-phenylpropoxy)-8-methyl-8-(1-methylethyl)-8-azoniabicyclo(3.2.1)octane, Ipratropium [Chemical/Ingredient], IPRATROPIUM, ipratropium, Ipratropium (product), Ipratropium (substance)
Swedish Ipratropium
Czech ipratropium, ipratropiumbromid, N-isopropylatropin
Finnish Ipratropium
Russian IPRATROPII, N-IZOPROPILATROPIN, N-ИЗОПРОПИЛАТРОПИН, ИПРАТРОПИЙ
Japanese イプラトロピウム, N-イソプロピルアトロピン, 臭化イプラトロピウム, イソプロピルアトロピン
German ISOPROPYLATROPIN N, Ipratropium, N-Isopropylatropin
French Ipratropium
Polish Ipratropium, N-izopropyloatropina, Bromek ipratropium
Spanish ipratropio (producto), ipratropio (sustancia), ipratropio, Ipratropio, N-Isopropilatropina
Italian Ipratropio
Portuguese Ipratropio, N-Isopropilatropina

Ontology: Atrovent (C0591130)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D009241
English atrovent, Atrovent

Ontology: Combivent (C0591282)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C116388
English Combivent, combivent