Drug information of Ipratropium bromide

Ipratropium bromide

Drug group:

Ipratropium is a bronchodilator that relaxes muscles in the airways and increases air flow to the lungs. Ipratropium inhalation is used to prevent bronchospasm, or narrowing airways in the lungs, in people with bronchitis, emphysema, or COPD (chronic obstructive pulmonary disease).

Mechanism of effect

Ipratropium bromide is an anticholinergic agent. It blocks muscarinic cholinergic receptors, without specificity for subtypes, resulting in a decrease in the formation of cyclic guanosine monophosphate (cGMP). Most likely due to actions of cGMP on intracellular calcium, this results in decreased contractility of smooth muscle.

Pharmacodynamic

Ipratropium bromide, a synthetic ammonium compound structurally similar to atropine, is used as a bronchodilator in the management of cholinergic-mediated bronchospasm associated with chronic obstructive pulmonary disease and in the treatment of rhinorrhea associated with the common cold or with allergic or nonallergic seasonal rhinitis.

Pharmacokinetics

Absorption: Inhalation (local)-minimal; Nasal-rapid and minimal. Volume of distribution: 4.6 L/kg. Route of elimination:Primarily eliminated renally via active secretion. Half life:2-4 hours after administration orally, IV or by oral inhalation (radiolabeled ipratropium bromide assay measures parent drug and its metabolites). Using a radioreceptor assay that measures only unchanged ipratropium bromide, the initial distribution-phase half-life (t1/2 α) and terminal elimination-phase half-life (t1/2 β) were 0.07 and 1.6 hours, respectively, following a single 2 mg IV dose of the drug in healthy adults.

Dosage

Usual Adult Dose for Chronic Obstructive Pulmonary Disease - Maintenance
Inhalation aerosol: 2 inhalations (36 mcg) 4 times a day up to 12 inhalations a day. CFC free inhalation aerosol: 2 inhalations (34 mcg) 4 times a day up to 12 inhalations a day.
Nebulized solution: 500 mcg (1 unit dose vial) 3 to 4 times a day.
Usual Pediatric Dose for Chronic Obstructive Pulmonary Disease - Maintenance
Neonates:
Nebulized solution: 25 mcg/kg 3 times daily.
Infants and children:
Nebulized solution: 125 to 250 mcg 3 times daily.
3 to 12 years:
Inhalation aerosol: : 1 to 2 inhalations (18 to 36 mcg) 3 times a day, up to 6 inhalations a day.
CFC free inhalation aerosol: 1 to 2 inhalations (17 to 34 mcg) 4 times a day up to 12 inhalations a day.
> 12 years:
Inhalation aerosol: 2 inhalations (36 mcg) 4 times a day up to 12 inhalations a day. CFC free inhalation aerosol: 2 inhalations (34 mcg) 4 times a day up to 12 inhalations a day.
Nebulized solution: 500 mcg (1 unit dose vial) 3 to 4 times a day.

Alerts

1-The use of Ipratropium bromide inhalation solution as a single agent for the relief of bronchospasm in acute COPD exacerbation has not been adequately studied. Drugs with faster onset of action may be preferable as initial therapy in this situation. Combination of Ipratropium bromide and beta agonists has not been shown to be more effective than either drug alone in reversing the bronchospasm associated with acute COPD exacerbation.
2-Immediate hypersensitivity reactions may occur after administration of Ipratropium bromide, as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm and oropharyngeal edema.

Points of recommendation

1-Patients should be advised that temporary blurring of vision, precipitation or worsening of narrow-angle glaucoma or eye pain may result if the solution comes into direct contact with the eyes. Use of a nebulizer with mouthpiece rather than face mask may be preferable, to reduce the likelihood of the nebulizer solution reaching the eyes.
2- Patients should be advised that Ipratropium bromide inhalation solution can be mixed in the nebulizer with albuterol or metaproterenol if used within one hour. Drug stability and safety of Ipratropium Bromide Inhalation Solution when mixed with other drugs in a nebulizer have not been established.
3-Patients should be reminded that Ipratropium bromide inhalation solution should be used consistently as prescribed throughout the course of therapy.
4-The total number of inhalations should not exceed 12 in 24 hours.

Pregnancy level

B

Related drugs

Tiotropium bromid , Aclidinium


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