Atrovent


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Related to Atrovent: Atrovent HFA

ipratropium

(i-pra-troe-pee-um) ,

Atrovent

(trade name),

Atrovent HFA

(trade name)

Classification

Therapeutic: allergy cold cough remedies
Pharmacologic: anticholinergics
Pregnancy Category: B

Indications

Inhalation: Maintenance therapy of reversible airway obstruction due to COPD, including chronic bronchitis and emphysema. Intranasal: Rhinorrhea associated with allergic and nonallergic perennial rhinitis (0.03% solution) or the common cold (0.06% solution). Inhalation: Adjunctive management of bronchospasm caused by asthma.

Action

Inhalation: Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased concentrations of cyclic guanosine monophosphate (cGMP). Decreased levels of cGMP produce local bronchodilation.
Intranasal: Local application inhibits secretions from glands lining the nasal mucosa.

Therapeutic effects

Inhalation: Bronchodilation without systemic anticholinergic effects.
Intranasal: Decreased rhinorrhea.

Pharmacokinetics

Absorption: Minimal systemic absorption (2% for inhalation solution; 20% for inhalation aerosol; <20% following nasal use).
Distribution: 15% of dose reaches lower airways after inhalation.
Metabolism and Excretion: Small amounts absorbed are metabolized by the liver.
Half-life: 2 hr.

Time/action profile (bronchodilation)

ROUTEONSETPEAKDURATION
Inhalation1–3 min1–2 hr4–6 hr
Intranasal15 minunknown 6–12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to ipratropium, atropine, belladonna alkaloids, or bromide;Avoid use during acute bronchospasm;Note: Atrovent HFA has replaced the discontinued Atrovent CFC (chlorofluorocarbon). Soy and CFC-allergic patients can now safely use the Atrovent HFA formulation. However, Combivent (ipratropium/albuterol combination) MDI does contain soya lecithin and is contraindicated in patients with a history of hypersensitivity to soy and peanuts.
Use Cautiously in: Patients with bladder neck obstruction, prostatic hyperplasia, glaucoma, or urinary retention; Geriatric: May be more sensitive to effects.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache
  • nervousness

Ear, Eye, Nose, Throat

  • blurred vision
  • sore throat
  • nasal only:
  • epistaxis
  • nasal dryness/irritation

Respiratory

  • bronchospasm
  • cough

Cardiovascular

  • hypotension
  • palpitations

Gastrointestinal

  • GI irritation
  • nausea

Dermatologic

  • rash

Miscellaneous

  • allergic reactions

Interactions

Drug-Drug interaction

↑ anticholinergic effects with other drugs having anticholinergic properties (antihistamines, phenothiazines, disopyramide ).

Route/Dosage

Inhalation (Adults and Children >12 yr) Metered-dose inhaler (nonacute)—2 inhalations 4 times daily (not to exceed 12 inhalations/24 hr or more frequently than q 4 hr). Acute exacerbations—4–8 puffs using a spacer device as needed. Via nebulization (nonacute)—500 mcg 3–4 times daily. Via nebulization (acute exacerbations)—500 mcg q 30 min for 3 doses then q 2–4 hr as needed.
Inhalation (Children 5–12 yr) Metered-dose inhaler (nonacute)—1–2 inhalations q 6 hr as needed (not to exceed 12 inhalations/24 hr). Acute exacerbations—4–8 puffs as needed Via nebulization (nonacute)—250–500 mcg 4 times daily given q 6 hr. Acute exacerbations—250 mcg q 20 min for 3 doses then q 2–4 hr as needed.
Inhalation (Infants) Nebulization—125–250 mcg 3 times a day.
Inhalation (Neonates) Nebulization—25 mcg/kg/dose 3 times a day.
Intranasal (Adults and Children > 6 yr) 0.03% solution—2 sprays in each nostril 2–3 times daily (21 mcg/spray).
Inhalation (Adults and Children > 5 yr) 0.06% solution—2 sprays in each nostril 3–4 times daily (42 mcg/spray).

Availability (generic available)

Aerosol inhaler (HFA) (chlorofluorocarbon-free): 17 mcg/spray in 12.9-g canister (200 inhalations)
Inhalation solution: 0.0125%, 0.02% in single-dose vials containing 500 mcg, 0.025%
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)
In combination with: albuterol (Combivent, Duoneb). See combination drugs.

Nursing implications

Nursing assessment

  • Assess for allergy to atropine and belladonna alkaloids; patients with these allergies may also be sensitive to ipratropium. Atrovent HFA MDI does not contain CFC or soy and may be used safely in soy or CFC-allergic patients. However, Combivent MDI should be avoided in soy or peanut-allergic patients.
  • Inhalation: Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration and at peak of medication. Consult health care professional about alternative medication if severe bronchospasm is present; onset of action is too slow for patients in acute distress. If paradoxical bronchospasm (wheezing) occurs, withhold medication and notify health care professional immediately.
  • Nasal Spray: Assess patient for rhinorrhea.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)
Activity intolerance (Indications)

Implementation

  • Inhalation: See for administration of inhalation medications.
    • When ipratropium is administered concurrently with other inhalation medications, administer adrenergic bronchodilators first, followed by ipratropium, then corticosteroids. Wait 5 min between medications.
    • Solution for nebulization can be diluted with preservative-free 0.9% NaCl. Diluted solution should be used within 24 hr at room temperature or 48 hr if refrigerated. Solution can be mixed with preservative-free albuterol, cromolyn, or metaproterenol if used within 1 hr of mixing.

Patient/Family Teaching

  • Instruct patient in proper use of inhaler, nebulizer, or nasal spray and to take medication as directed. Take missed doses as soon as remembered unless almost time for the next dose; space remaining doses evenly during day. Do not double doses.
    • Advise patient that rinsing mouth after using inhaler, good oral hygiene, and sugarless gum or candy may minimize dry mouth. Health care professional should be notified if stomatitis occurs or if dry mouth persists for more than 2 wk.
  • Inhalation: Caution patient not to exceed 12 doses within 24 hr. Patient should notify health care professional if symptoms do not improve within 30 min after administration of medication or if condition worsens.
    • Explain need for pulmonary function tests prior to and periodically during therapy to determine effectiveness of medication.
    • Caution patient to avoid spraying medication in eyes; may cause blurring of vision or irritation.
    • Advise patient to inform health care professional if cough, nervousness, headache, dizziness, nausea, or GI distress occurs.
  • Nasal Spray: Instruct patient in proper use of nasal spray. Clear nasal passages gently before administration. Do not inhale during administration, so medication remains in nasal passages. Prime pump initially with 7 actuations. If used regularly, no further priming is needed. If not used in 24 hr, prime with 2 actuations. If not used for >7 days, prime with 7 actuations.
    • Advise patient to contact health care professional if symptoms do not improve within 1–2 wk or if condition worsens.

Evaluation/Desired Outcomes

  • Decreased dyspnea.
    • Improved breath sounds.
  • Decrease in rhinorrhea from perennial rhinitis or the common cold.

Atrovent

(ăt′rə-vĕnt′)
A trademark for the drug ipratropium bromide.

Atrovent®

Ipratropium Br, see there.

Atrovent

A brand name for IPRATROPIUM BROMIDE in inhaler form or as a liquid for nebulization.
References in periodicals archive ?
The county's 350 volunteer CFRs were equipped with 13 life-saving drugs but an internal review concluded they were not adequately trained to use Atrovent, Diazepam, Entonox, GTN, Midazolam, Pulmicorte and Salbutamol.
Anticholinergic medications may be prescribed to prevent cramps and spasms (Bentyl), relax and open airways (Atrovent) and for other purposes.
Nasal spray Atrovent .03% or .06% Prescription (ipratropium bromide) Inhaled Atrovent (ipratropium Prescription bromide) In combination with antihistamine Chlorpheniramine, Prescription Methscopolamine, and Phenylephrine combined (numerous brand names).
She now has an atrovent inhaler which she uses three times a day, a Beclazone preventor of which she has two puffs in the morning and two at night and a reliever, Salamol, which she can use throughout the day.
The Food and Drug Administration approved ipratropium bromide HFA (Atrovent HFA Inhalation Aerosol), a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema in patients 12 years and older.
The bronchodilator Atrovent, an anticholinergic drug, also is an effective COPD therapy, but needs to be taken every 4 times a day, he noted.
At the time, her doctor had prescribed two to three puffs of Proventil, a fast-acting bronchodilator, followed by three puffs of a slower-acting one called Atrovent, which takes about 20 minutes to work.
Atrovent, for treating respiratory illnesses, increased in price eight times and went from $382 per year in 1994 to $546 in 1999.
A derivative of this drug which has fewer side effects is ipratropium (Atrovent).
(A) Atrovent, a pMDI SAMA (also available in a nebulized format), (B) Symbicort, a pMDI LABA/ICS, (C) Serevent, a DPI LABA, (D) Anoro, a DPI LAMA/LABA, (E) Spiriva, an SMI LAMA (also available in a DPI device), (F) Vortex, a small volume valve spacer with nonelectrostatic interior, (G) Volumatic, a large volume spacer.
(BIPI) regarding alleged off-label marketing and deceptive and misleading representations made in BIPIs promotion of four of its prescription drugs: Micardis, Aggrenox, Atrovent, and Combivent.
[38] Atrovent HFA (Ipratropium) [Product Monograph], Boehringer Ingelheim (Canada) Ltd, Burlington, Ontario, Canada, February 2016.