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ipratropium (Atrovent)

Tradename: Atrovent. Indications: - chronic bronchitis - asthmatic bronchitis - not useful in patients with pure pulmonary emphysema - useful used concurrently with beta2 agonists Contraindications: 1) allergy to soy or peanuts (soy lecithin* used as suspension agent CFC metered dose inhaler ONLY>) [5,7] HFA inhaler DOESN'T have soy, neither does ipratropium nasal spray or inhalation solution> 2) maintenance therapy; NOT for acute exacerbations 3) combined use with long-acting anticholinergic agent (tiotropium) [6,8] * soy lecithin can contain small amounts of soy protein, which can cause a reaction in a small number of people with peanut allergy Caution: -> temporary blurred vision may occur if sprayed into eyes Inhaler: 1) 2 puffs QID or 1 vial nebulized every 6-8 hours 2) max: 12 puffs/24 hours. Aerosol: 18 ug/metered dose (14 g) Solution for inhalation: 0.02% (2.5 mL) (box of 25) Pharmacokinetics: 1) onset of action is within 3 minutes 2) maximal effect within 1.5-2 hours 3) duration of action 3-6 hours [6] Adverse effects: 1) common (> 10%) - cough, dry mouth, headache, dizziness, nausea, gastrointestinal upset 2) less common (1-10%) - blurred vision, insomnia, hypotension, nasal congestion, palpitations, urinary retention, trembling 3) uncommon (< 1%) - rash, stomatitis, hives 4) other - nervousness - may aggravate: - narrow-angle glaucoma - prostatic hypertrophy - bladder neck obstruction - increased cardiovascular risk of inhaled anticholinergics (see inhaled anticholinergic agents) 5) nasal spray: - not common (1-10%) - epistaxis, nasal dryness - uncommon (< 1%) - nasal burning, coughing, dizziness, palpitations, thirst, tinnitus, blurred vision Mechanism of action: 1) short-actinb anticholinergic agent causing relaxation of the bronchial smooth muscle, especially in the upper bronchial tree 2) inhibits vagally-mediated reflexes 3) prevents increase in cGMP caused by stimulation of muscarinic receptors in bronchial smooth muscle Ipatropium does not: 1) prevent bronchoconstriction induced by: a) tobacco smoke b) citric acid c) sulfur dioxide d) carbon dust 2) affect mucous production or transport or ciliary action Allergen-induced bronchoconstriction responds poorly to ipratropium.

Interactions

drug interactions drug adverse effects of parasympatholytics

General

antiasthmatic agent inhaled anticholinergic agent

Properties

MISC-INFO: elimination route LUNG pregnancy-category B safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 742
  4. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  5. Prescriber's Letter 10(3):13 2003
  6. Prescriber's Letter 15(1): 2008 Combined Use of Tiotropium (Spiriva) and Ipratropium (Atrovent) Detail-Document#: 240109 (subscription needed) http://www.prescribersletter.com
  7. Prescriber's Letter 16(6): 2009 Drug Therapy Considerations for Patients with Peanut Allergy Detail-Document#: 250608 (subscription needed) http://www.prescribersletter.com
  8. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
  9. Deprecated Reference

Component-of

albuterol/ipratropium (Combivent, DuoNeb)