Atrovent (Inhalation)

Ipratropium is an effective bronchodilator which is breathed in through the mouth in order to make the bronchial tubes dilated in the lungs.

It acts by blocking the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation.

Thus, it is indicated to control the symptoms of a wide variety of lung diseases, such as asthma, chronic obstructive pulmonary disease (COPD) including chronic bronchitis, and emphysema.

The parasympathetic tone is the major reversible factor in COPD. Therefore, ipratropium is more effective in COPD than in bronchial asthma.

It is also used to prevent the worsening of chronic obstructive pulmonary disease (COPD) and to treat air flow blockage.

This product is usually available in both solution and aerosol powder.

Nowadays, a new form of ipratropium has become popular in the market combining with salbutamol which is readily available in a pressurized container.

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Ipratropium exerts its bronchodilatory effects by antagonizing the action of acetylcholine. It comes with limited systemic adverse effects and valuable in patients intolerant of inhaled beta-agonist drugs.

It may be slightly less effective than beta-agonist in reversing bronchospasm. It is highly effective for patients with chronic obstructive pulmonary disease (COPD).

Ipratropium also enhances beta-agonist mediated bronchodilation. For this reason, it is often combined with salbutamol or theophylline.

The site of action of ipratropium is completely different from that of salbutamol or theophylline that accounts for the additive action of the drugs.

It is especially effective in the management of asthma in an elderly patient. It is the treatment of choice for beta-blocker induced bronchospasm.

The preferred route of administration is inhalation which enhances the organ selectivity.

Ipratropium bromide by inhalation acts selectively on bronchial muscle without altering volume or consistency of respiratory secretions.

Another desirable feature is that in contrast to atropine, it does not depress mucociliary clearance by bronchial epithelium.

It has a gradual onset and late peak (at 40-60 minutes) in comparison to inhaled sympathomimetics.

Thus, it is more suitable for regular prophylactic use rather than for rapid symptomatic relief during an attack. The action of this drug usually lasts for 4-6 hours.

It acts on receptor located mainly in the larger central airways.

Transient local side effects like dryness of mouth, scratching sensation in the trachea, bad taste and nervousness are reported in 20-30% patients.

But systemic effects are rare because of poor absorption from lungs and GIT (major fraction of any inhaled drug is swallowed).

Animal reproduction studies have failed to demonstrate a risk to the fetus in any trimester of pregnancy and there are no adequate and well-controlled studies in pregnant women.

That’s why this drug is often prescribed in pregnancy, but it is better to avoid such medicine during pregnancy and lactation.

Regular visits are recommended to make sure this medicine is working properly or not. The actual use of such medicine improves the disease condition.

On the other hand, if you fail to take this medicine following instructions that usually comes with it, the medicine may no help you to get rid of your respiratory difficulty.

So, always read those instructions carefully before you start to use the medicine.

If you are not sure how to use the inhaler or nebulized vapor because of poor understanding of the directions given by your doctor, ask him/her to show you how to use it.

Never use this medicine in more dosage or more frequently than your doctor ordered. In the case of an adult, 1-2 puffs (20mg/puff) is recommended 3-4 times daily while using an inhaler.

Children should not be given more than 1-2 puffs for 2-3 times daily.

When this medicine is used in a form of a nebulized solution, the usual dose for the adults including elderly and adolescents over 12 years of age, is 0.4-2.0 ml ipratropium bromide solution (100-500 micrograms) up to four times daily.

Ipratropium should not be taken by patients with known hypersensitivity to atropine or its derivatives or to any other component of the product.

You must keep in mind that increased toxicity occurs with other anticholinergic drugs. Increased cardiovascular effects (e.g. tachycardia, palpitation) have been reported when used with MAOIs, TCAs, and amphetamines.

Always it is better to remain ready to face any adverse effect after taking any drug. Some important measures should be taken if you feel any discomfort following this drug therapy.

Firstly, you should stop using the drug and then consult with your physician immediately. You should be careful to protect your eyes from the nebulized drug.

In the case of children, be careful not to exceed the maximum safe dose. This drug is contraindicated to those who are hypersensitive to soy lecithin or related food products e.g. peanuts.

In the case of renal failure and hepatic impairment, it is better not to use such medicines. Moreover, it is safe to consult with your doctor if you are in need of some drugs for another health problem. 

Although each drug comes with little or more side effects, but most of the time remain subtle.

Ipratropium is well tolerated by most of the patients, especially if daily dose is kept below maximum therapeutic dose.

But sometimes you may need to consult with the doctor if you feel any discomfort like dryness of mouth, urinary retention, buccal ulceration, paralytic ileus, headache, nausea, constipation, immediate hypersensitivity reactions like urticaria, angioedema, acute angle-closure glaucoma etc.

Potentially fatal conditions such as anaphylactic reactions, atrial fibrillation, supraventricular tachycardia etc. warrant immediate medical attention.