II. Indications

III. Mechanism

  1. Ipratropium (Atrovent) is a Short-Acting Anticholinergic Bronchodilator
  2. Acts as a Muscarinic Antagonist, reducing Acetylcholine induced bronchospasm

IV. Preparations: Ipratropium Bromide

  1. Atrovent MDI
    1. Inhale 2-3 puffs three to four times daily as needed (maximum 12 puffs/day)
  2. Atrovent Nebulization (0.02%, 500 mcg/ampule)
    1. Nebulize 1 ampule of Ipratropium solution every 6 to 8 hours as needed

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
    7. Urinary Retention
  3. Allergy
    1. Original Atrovent MDI (non-HFA) was contraindicated with soy or peanut allergy

VII. Safety

  1. Pregnancy Category B
  2. Unknown safety in Lactation

IX. References

  1. (2022) Inhaled Medications for COPD, Presc Lett, #381116
  2. (2020) Drugs for COPD, Med Lett Drug Ther 62: 137-44

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Related Studies

Cost: Medications

ipratropium (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
IPRATROPIUM 0.03% SPRAY Generic $0.80 per ml
IPRATROPIUM 0.06% SPRAY Generic $1.52 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 1/1/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
ATROVENT 17 MCG HFA INHALER $34.02 per gram
combivent (on 1/1/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
COMBIVENT RESPIMAT 20-100 MCG $113.86 per gram