Dosing and uses of Atrovent, Atrovent HFA (ipratropium)
Adult dosage forms and strengths
metered-dose inhaler
- 17mcg/actuation
nasal spray
- 0.03%
nebulized solution
- 0.02%
Chronic Obstructive Pulmonary Disease
Maintenance treatment of bronchospasm, including chronic bronchitis and emphysema
Inhaler: 2 actuations q6hr, then additional actuations PRN; not to exceed 12 actuations/day
Nebulizer: 2.5 mL (500 mcg) q6-8hr
Perennial Allergic/Nonallergic Rhinitis
Symptomatic relief of rhinorrhea
Nasal spray: 2 sprays per nostril q8-12hr
Seasonal Allergic Rhinitis
Nasal spray: 2 sprays per nostril q6hr
Acute Asthma Exacerbation (Off-label)
Inhaler: 8 actuations q20min PRN for 3 doses
Nebulizer: 500 mcg q20min for 3 doses, then PRn
Administration
Prime before initial use by releasing 2 test sprays into air; repeat priming if unused for ≥3 days
Dosing Considerations
In treatment of acute asthma exacerbation with inhaler, short-acting beta agonist (SABA) must be coadministered
In treatment of allergic rhinitis, do not use for >3 weeks
Pediatric dosage forms and strengths
metered-dose inhaler
- 17 mcg/actuation
nebulized solution
- 0.02%
Perennial Allergic/Nonallergic Rhinitis
<6 years (nasal spray): Use not recommended
>6 years (nasal spray): 2 sprays per nostril q8-12hr
Seasonal Allergic Rhinitis
<5 years (nasal spray): Use not recommended
>5 years (nasal spray): 2 sprays per nostril q6hr
Acute Asthma Exacerbation (Off-label)
NIH asthma guidelines
- <12 years (inhaler): 4-8 actuations q20 min PRN for 3 doses
- ≥12 years (inhaler): 8 actuations q20 min PRN for 3 doses
- <12 years (nebulizer): 250-500 mcg q20 min for 3 doses, then PRN
- ≥12 years (nebulizer): 500 mcg q20 min for 3 doses, then PRN
Atrovent, Atrovent HFA (ipratropium) adverse (side) effects
>10%
Bronchitis (10-23%)
Chronic obstructive pulmonary disease (COPD) exacerbation (8-23%)
Sinusitis (1-14%)
1-10%
Dyspnea (4-10%)
Urinary tract infection (UTI) (2-10%)
Headache (5-9%)
Flulike symptoms (2-8%)
Back pain (2-7%)
Cough (5.9%)
Dyspepsia (1-5%)
Dry mouth (2-4%)
Dizziness (1-3%)
Nausea (2.8%)
Frequency not defined
Cardiovascular: Hypotension, palpitations, tachycardia
General: Dry throat, throat irritation
Gastrointestinal (GI): Constipation, stomatitis, mouth edema
Sensory: Narrow-angle glaucoma, glaucoma, halo vision, conjunctival hyperemia, corneal edema, mydriasis, acute eye pain, blurry vision
Respiratory: Bronchospasm, including paradoxical bronchospasm
Renal: Urinary retention
Warnings
Contraindications
Documented hypersensitivity to ipratropium, atropine, or derivatives
Cautions
Use for maintenance treatment only; should not be used as rescue therapy
May cause life-threatening paradoxical bronchospasm or hypersensitivity reactions (skin rash, pruritus, angioedema, urticaria/giant urticaria, laryngospasm); discontinue immediately, and use alternative treatment
May cause urinary retention; use with caution in patients with benign prostatic hyperplasia (BPH) or bladder-neck obstruction
May worsen narrow-angle glaucoma
Contact with eye can cause burning, stinging, mydriasis, visual halos
Pregnancy and lactation
Pregnancy category: B
Lactation: Unknown whether drug is excreted in breast milk
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Atrovent, Atrovent HFA (ipratropium)
Mechanism of action
Anticholinergic (parasympatholytic) agent; inhibits vagally mediated reflexes by antagonizing acetylcholine action; prevents increase in intracellular calcium concentration that is caused by interaction of acetylcholine with muscarinic receptors on bronchial smooth muscle
Absorption
Minimal systemic absorption
Onset: 15 min
Duration: 3-4 hr
Peak plasma time: 1-3 hr
Peak plasma concentration: 0.06 ng/mL
Distribution
Protein bound: 0-9%
Vd: 338 L
Metabolism
Metabolized in liver
Metabolites: N-isopropylnortropium methobromide, a-phenylacrylic acid-N-isopropylnortropine-ester methobromide, 6 others
Elimination
Half-life: 2 hr
Excretion: Urine (46%)
