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Ipratropium bromide, sold under the trade name Atrovent among others, is a medication which opens up the medium and large airways in the lungs.
Common side effects include dry mouth, cough, and inflammation of the airways.
Ipratropium bromide was developed in Germany in 1976.
1 Medical uses
2 Contraindications
2.1 Peanut allergy
3 Side effects
4 Interactions
5 Pharmacology
6 References
Medical uses
Ipratropium is administered by inhalation for the treatment of chronic obstructive pulmonary disease (COPD) and asthma exacerbation. For that purpose, it is supplied in a canister for use in an inhaler or in single dose vials for use in a nebulizer.
It is also used to treat and prevent minor and moderate bronchial asthma, especially asthma that is accompanied by cardiovascular system diseases.
It is also combined with salbutamol ( albuterol — USAN ) under the trade names Combivent (a non-aerosol metered-dose inhaler or MDI) and Duoneb ( nebulizer ) for the management of COPD and asthma, and with fenoterol (trade names Duovent and Berodual N) for the management of asthma.
Ipratropium as a nasal solution sprayed into the nostrils can reduce rhinorrhea but will not help nasal congestion.
Combination with beta-adrenergic agonists increases the dilating effect on the bronchi.
The main contraindication for inhaled ipratropium is hypersensitivity to atropine and related substances. For oral administration, contraindications are similar to other anticholinergics; they include narrow angle glaucoma and obstructions in the gastrointestinal tract and urinary system.
Peanut allergy
Previously atrovent inhalers used chlorofluorocarbon (CFC) as a propellant and contained soy lecithin in the propellant ingredients. In 2008 all CFC inhalers were phased out and hydrofluoroalkane (HFA) inhalers replaced them. Allergy to peanuts was noted for the inhaler as a contraindication but now is not. It has never been a contraindication when administered as a nebulized solution.
Side effects
If ipratropium is inhaled, side effects resembling those of other anticholinergics are minimal. However, dry mouth and sedation have been reported. Also, effects such as skin flushing, tachycardia, acute angle-closure glaucoma, nausea, palpitations and headache have been observed. Inhaled ipratropium does not decrease mucociliary clearance.
Urinary retention has been reported in patients receiving doses by nebulizer. As a result, caution may be warranted, especially by men with prostatic hypertrophy.
Interactions with other anticholinergics like tricyclic antidepressants, anti-Parkinson drugs and quinidine, which theoretically increase side effects, are clinically irrelevant when ipratropium is administered as an inhalant.
Chemically, ipratropium bromide is a quaternary ammonium compound (which is indicated by the -ium per the BAN and the USAN )
Ipratropium exhibits broncholytic action by reducing cholinergic influence on the bronchial musculature. It blocks muscarinic acetylcholine receptors, without specificity for subtypes, and therefore promotes the degradation of cyclic guanosine monophosphate (cGMP), resulting in a decreased intracellular concentration of cGMP. but is a quaternary amine and therefore does not cross the blood–brain barrier, which prevents central side effects (anticholinergic syndrome). Ipratropium should never be used in place of salbutamol (albuterol) as a rescue medication.

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