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Ipratropium

Classification

Anticholinergic bronchodilator

Indications

⚠️ PCP: Requires BCEHS-specific education

Severe bronchospasm in asthma and chronic obstructive pulmonary disease

Contraindications

Known hypersensitivity to ipratropium or any formulation components

Adult dosages

PCP: Severe bronchospasm in asthma or chronic obstructive pulmonary disease

⚠️ Requires BCEHS-specific education.
500 mcg via nebulizer. Both salbutamol and ipratropium can be combined in the same nebulizer for co-administration purposes. (Note: Ipratropium is a single dose, salbutamol may be repeated).
160 mcg via metered-dose inhaler (8 x 20 mcg sprays)
- MDI and spacer use is strongly recommended for patients with signs of influenza-like illness, or other infectious respiratory conditions

Pediatric Considerations And Dosing

PCP: Severe bronchospasm in asthma

⚠️ Requires completion of BCEHS-specific education.
Not for use in neonates < 30 days
250 mcg via nebulizer
80 mcg via MDI (20 mcg x 4)
- In patients without influenza-like illness (ILI), nebules are preferred. In patients with ILI or other infectious respiratory conditions, MDI and spacer use is strongly recommended.
CliniCall consultation required for PCP to discuss care planning options, recommended for ACP.

How Supplied

Note:

Once the nebule package is opened, nebules are given an expiry of 90 days. Please write the date the package is opened on the package with a sharpie or other non-erasable marker.

Mechanism Of Action

Ipratropium antagonizes the activity of acetylcholine in bronchial smooth muscle, producing bronchodilation and muscle relaxation.

Pharmacokinetics

Inhaled:

Onset: 3-15 minutes
Peak: 1.5-2 hours
Duration: 6 hours

Adverse Effects

Adverse effects are similar to other anticholinergics and can include atrial arrhythmias and blurred vision
Coughing is common
Although not common, be aware that paradoxical bronchospasm can occur during the use of inhaled bronchodilators (this is not the same thing as an inadequate response to treatment). It typically occurs upon the initial use of the medication.

Overdose

Very high doses of ipratropium (up to 1.2 mg) have been given to volunteers without the development of serious systemic side effects.

Warning And Precautions

Ipratropium is intended to act synergistically with salbutamol as part of a management plan for bronchospasm. It is not indicated for episodes of acute bronchospasm as monotherapy.
Use with caution in patients with narrow- angle glaucoma, as it may increase intraocular pressure
Use with caution in patients with prostatic hyperplasia or bladder neck obstruction as it may cause urinary retention