Ipratropium
ATROVENT
Pronunciation: ip-ra-TROE-pee-um
“It’s practically atropine (Atropine ventilated)”
“red as a beet” → anticholinergic
“mad as a hatter” → BBB-crossing anticholinergic
What it isShort-acting muscarinic antagonist; COPD, and off-label for acute asthma with or instead of a SABA.
Why this oneAdds to a beta agonist in acute exacerbation and still bronchodilates when beta receptors are blocked.
What limits itSlower onset makes it an adjunct rather than solo rescue. Nebulized drug reaching the eye can precipitate angle closure.
Pearls
- Dry mouth and throat irritation are the usual complaints
- Nebulized form suits the very young, elderly, or inhaler-incapable
Ipratropium prescription history
Animated chart of estimated U.S. prescriptions per year, Asthma/COPD meds (1924–2026). Ipratropium enters in 1987 (estimated).
FDA-approved for
- COPD/bronchospasm (1986)
Principal riskAnticholinergic effects; paradoxical bronchospasm
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityTremor, tachycardia or anticholinergic effects; excessive beta-agonist exposure can cause hypokalemia and arrhythmia.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| COPD (chronic bronchitis, emphysema) - bronchodilator for maintenance treatment of bronchospasm, alone or with other bronchodilators (especially beta-adrenergics) | Adults | 500 mcg (one 2.5 mL unit-dose vial) nebulized TID-QID, doses 6-8 h apart | 500 mcg nebulized TID-QID | 500 mcg QID (2,000 mcg/day) |
Renal Undefined
Hepatic Undefined
Doses must be 6-8 hours apart; headache, dry mouth and worsening COPD symptoms become more common once the total daily dose reaches or exceeds 2,000 mcg.
Instructions
- Give by oral nebulization only; each unit-dose vial contains 500 mcg anhydrous ipratropium bromide in 2.5 mL of normal saline.
- Space doses 6 to 8 hours apart.
- May be mixed in the nebulizer with albuterol or metaproterenol if used within one hour; stability and safety with other drugs in a nebulizer have not been established.
Available strengths
- sol 0.02 %
- nasal spray 21, 42 mcg/spray
- inhaler 21 mcg/inh
Contraindications
- Known or suspected hypersensitivity to atropine or its derivatives
Cautions
- Not adequately studied as a single agent for relief of bronchospasm in acute COPD exacerbation - faster-onset drugs may be preferable as initial therapy; adding a beta-agonist has not been shown more effective than either drug alone in this setting.
- Immediate hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm, oropharyngeal edema); many affected patients had other drug or food allergies.
- Use with caution in narrow-angle glaucoma, prostatic hypertrophy or bladder-neck obstruction.
- Avoid eye contact with the nebulized solution - temporary blurred vision, precipitation or worsening of narrow-angle glaucoma, or eye pain can result; a nebulizer with mouthpiece rather than face mask may be preferable.
- Urinary retention and urinary tract infection reported.
- Paradoxical bronchospasm and worsening dyspnea were the most common reasons for discontinuation in the 12-week trials.
- Headache, dry mouth and aggravation of COPD symptoms increase at total daily doses at or above 2,000 mcg.
Adverse reactions
- Bronchitis (14.6%), upper respiratory tract infection (13.2%), dyspnea (9.6%)
- Headache (6.4%)
- Cough (4.6%), bronchospasm (2.3%)
- Nausea (4.1%), dry mouth (3.2%)
- Pain, back pain, chest pain, influenza-like symptoms
- Dizziness, insomnia
- Pharyngitis, rhinitis, sinusitis
- Less common: tachycardia, palpitations, eye pain, urinary retention, urinary tract infection, urticaria
- Narrow-angle glaucoma precipitation/worsening, mydriasis
Pregnancy Oral and inhalation animal reproduction studies showed no teratogenicity; there are no adequate, well-controlled studies in pregnant women - use only if clearly needed (former Pregnancy Category B).
Lactation Undefined
Cost
Generic entry1997
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Self-check
- Why is ipratropium an adjunct rather than solo rescue?
Slower onset. - What can nebulized ipratropium reaching the eye precipitate?
Angle closure.