At·ro·vent ( t r -v nt ) A trademark for the drug ipratropium bromide. |
ipratropium bromide
Alti-Ipratropium (CA), Apo-Ipravent (CA), Atrovent, Novo-Ipramide (CA), Respontin (UK), Rinatec (UK)
Pharmacologic class: Anticholinergic
Therapeutic class: Allergy, cold, and cough remedy; bronchodilator
Pregnancy risk category B
Action
Inhibits cholinergic receptors in bronchial smooth muscle, decreasing level of cyclic guanosine monophosphate and dilating bronchioles. When used locally, inhibits secretions from glands lining the nasal mucosa.
Availability
Aerosol inhaler: 18 mcg/spray in 14-g canister (200 inhalations)
Nasal spray: 0.03% solution (21 mcg/spray in 30-ml bottle, 345 sprays/bottle); 0.06% solution (42 mcg/spray in 15-ml bottle, 165 sprays/bottle)
Solution for inhalation: 0.02% in single-dose vials
⊘Indications and dosages
➣ Chronic obstructive pulmonary disease; bronchospasm; asthma; perennial rhinitis; common cold
Aerosol -
Adults: Two inhalations (36 mcg) q.i.d. Don't exceed 12 inhalations in 24 hours.
Inhalation solution -
Adults: 500 mcg three to four times daily by oral nebulizer. Space doses 6 to 8 hours apart as needed.
Nasal spray (0.03% solution) -
Adults and children ages 6 and older: Two sprays (42 mcg) per nostril two to three times daily (total daily dosage of 168 to 252 mcg)
Nasal spray (0.06% solution) -
Adults and children ages 12 and older: Two sprays (84 mcg) per nostril three to four times daily (total daily dosage of 504 to 672 mcg)
Contraindications
• Hypersensitivity to drug, its components, atropine, belladonna alkaloids, bromide, fluorocarbons, or soy lecithin and related foods (such as soybeans, peanuts)
Precautions
Use cautiously in:
• acute bronchospasm, bladder neck obstruction, prostatic hypertrophy, glaucoma, urinary retention, undiagnosed abdominal pain
• elderly patients
• pregnant or breastfeeding patients
• children ages 5 and younger (safety not established).
Administration
• Give by inhalation or intranasal route as directed.
• When using nasal spray, prime with seven actuations to initiate pump. Give two actuations if spray hasn't been used within past 24 hours.
• With aerosol inhaler, prime new inhaler with three sprays. Also prime with three sprays if inhaler hasn't been used within past 24 hours.
| Route | Onset | Peak | Duration |
| Inhalation | 5-15 min | 1-2 hr | 3-4 hr (up to 8 hr) |
| Intranasal | 15 min | Unknown | 6-12 hr |
Adverse reactions
CNS: dizziness, headache, nervousness
CV: hypotension, palpitations, chest pain
EENT: blurred vision, epistaxis, nasal dryness and irritation (with nasal spray), sore throat
GI: nausea, vomiting, GI irritation
Musculoskeletal: back pain
Respiratory: cough, upper respiratory tract infection, bronchitis, increased sputum, oropharyngeal edema, bronchospasm
Skin: rash
Other: flulike symptoms, hypersensitivity reactions including anaphylaxis
Interactions
Drug-drug. Antihistamines, disopyramide, phenothiazines: additive anticholinergic effects
Drug-herbs. Jaborandi, pill-bearing spurge: decreased drug effects
Patient monitoring
• Evaluate for urinary retention. Have patient void before giving drug.
• Ensure proper fit of mouthpiece or face mask.
• Monitor patient's response to therapy, vital signs, and neurologic, cardiovascular, and respiratory status.
• Monitor fluid intake and output. Keep patient well hydrated.
☞ Monitor closely for hypersensitivity reactions, including anaphylaxis.
Patient teaching
• Teach patient how to use nasal spray or inhaler.
• Advise patient to rinse mouth after each dose to minimize throat irritation and dryness.
• Caution patient to keep drug out of eyes. If contact occurs, instruct him to rinse eyes with cool water and call prescriber right away.
• Caution patient to avoid driving and other dangerous activities if drug causes dizziness or blurred vision.
• Tell patient drug may cause GI upset, nausea, vomiting, or cough.
☞ Instruct patient to promptly report vision changes, rash, or palpitations.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and herbs mentioned above.
Atrovent®
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