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Ipratropium; Indications/Uses, Dosage, Side Effects, Drug Interaction ,Pregnancy

Ipratropium is a synthetic derivative of the alkaloid atropine with anticholinergic properties. Ipratropium antagonizes the actions of acetylcholine at parasympathetic postganglionic effector cell junctions. When inhaled, ipratropium binds competitively to cholinergic receptors in the bronchial smooth muscle thereby blocking the bronchoconstrictor actions of the acetylcholine (Ach) mediated vagal impulses. Inhibition of the vagal tone leads to dilation of the large central airways resulting in bronchodilation.

Ipratropium bromide is a bronchodilator that dilates (enlarges) airways (bronchi) in the lungs. It is used in treating, symptoms of asthma, colds, allergies, and chronic obstructive pulmonary disease (COPD) due to emphysema or chronic bronchitis. Ipratropium blocks the effect of acetylcholine on airways (bronchi) and nasal passages. Acetylcholine is a chemical that nerves use to communicate with muscle cells.

Ipratropium is a synthetic anticholinergic agent that is used as an inhalant for treatment of acute bronchospasm due to chronic bronchitis and emphysema. Ipratropium has not been implicated in causing liver enzyme elevations or clinically apparent acute liver injury.

Mechanism of Action of Ipratropium

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.

Ipratropium is a synthetic derivative of the alkaloid atropine with anticholinergic properties. Ipratropium antagonizes the actions of acetylcholine at parasympathetic postganglionic effector cell junctions. When inhaled, ipratropium binds competitively to cholinergic receptors in the bronchial smooth muscle thereby blocking the bronchoconstrictor actions of the acetylcholine (Ach) mediated vagal impulses. Inhibition of the vagal tone leads to dilation of the large central airways resulting in bronchodilation.

Indications of Ipratropium

Asthma Bronchial
Asthma
Bronchiectasis
COPD, Maintenance
Chronic Obstructive Pulmonary Disease (COPD)
Rhinorrhea
Chronic bronchitis and emphysema.

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Contra-Indications of Ipratropium

closed angle glaucoma
Blockage of Urinary Bladder
Enlarged Prostate
Cannot Empty Bladder

Allergies

Anticholinergics – Quaternary
Ipratropium Analogues

Dosage of Ipratropium

Strengths: 500 mcg/2.5 mL; 18 mcg/inh; 17 mcg/inh

Chronic Obstructive Pulmonary Disease

Inhalation aerosol: 2 inhalations (34 mcg) orally four times a day, or as needed up to 12 inhalations in 24 hours
Nebulizer inhalation solution: 500 mcg three or four times a day by oral nebulization, with doses 6 to 8 hours apart.

Pediatric Chronic Obstructive Pulmonary Disease

Nebulizer inhalation solution

Less than 12 years: Safety has not been established.
12 years or older: 500 mcg three or four times a day by oral nebulization, with doses 6 to 8 hours apart.

Side Effects of Ipratropium

The most common

Shakiness in the legs, arms, hands, or feet
trembling or shaking of the hands or feet
stomach pain or cramping
diarrhea
a headache
dizziness
confusion
stomach pain;
back pain, joint or muscle pain.
problems with your vision (including color vision);
sudden chest pain or trouble breathing;
pain or swelling in one or both legs;
a migraine headache;
pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; or
feeling like you might pass out.

More common

Abdominal or stomach pain, discomfort, or tenderness
chills or fever
difficulty with moving
a headache, severe and throbbing
joint or back pain
muscle aching or cramping
muscle pains or stiffness
chest pressure or squeezing pain in the chest
discomfort in arms, shoulders, neck or upper back
excessive sweating
feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis
sudden tingling or coldness in an arm or leg
sudden slow or difficult speech
sudden drowsiness or need to sleep
fast breathing
sharp pain when taking a deep breath
fast or slow heartbeat
coughing up blood
rust colored urine
decreased amount of urine

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Rare

Anxiety
change in vision
chest pain or tightness
confusion
a cough
Agitation
arm, back, or jaw pain
blurred vision
chest pain or discomfort
convulsions
extra heartbeats
fainting
hallucinations
a headache
irritability
lightheadedness
mood or mental changes
muscle pain or cramps
muscle spasm or jerking of all extremities
nervousness

Drug Interactions of Ipratropium

Ipratropium bromide may interact with the following drugs, supplements & may change the efficacy of drugs

antidepressants such as amitriptyline amoxapine; clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, and trimipramine
beta blockers such as atenolol, labetalol, metoprolol, nadolol, and propranolol
diuretics
epinephrine
medications for colds, irritable bowel disease, Parkinson’s disease, ulcers, or urinary problems
monoamine oxidase inhibitors such as isocarboxazid, phenelzine, tranylcypromine
other inhaled medications, especially other medications for asthma such as arformoterol, formoterol, metaproterenol, levalbuterol, and salmeterol
terbutaline

Pregnancy Catagory of Ipratropium

FDA Pregnancy Category B

Pregnancy

This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while using this medication, contact your doctor immediately.

Lactation

It is not known if ipratropium nasal spray passes into breast milk. If you are a breast-feeding mother and are using this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.The safety and effectiveness of using this medication have not been established for children under 12 years of age.