Ipratropium Bromide - Characteristics

16 February, 2020
Doctors usually prescribe Ipratropium bromide for the treatment of reversible bronchospasm (asthma) associated with chronic obstructive pulmonary disease (COPD).

Ipratropium bromide is an active substance that belongs to the group of medications labeled as inhalation anticholinergic bronchodilators. They relax the muscles of the bronchi and facilitate the passage of air and help a person to breathe normally again.

Doctors prescribe this drug for the treatment of bronchospasms associated with chronic obstructive pulmonary disease (COPD). When used together with inhaled β2 agonist drugs, doctors also prescribe them for the treatment of acute and chronic asthma.

How does it work?

A woman holding an inhaler containing Ipratropium Bromide.

Ipratropium bromide is a competitive antagonist of muscarinic acetylcholine receptors. It has a potent effect on bronchial receptors, both administered intravenously and by inhalation. However, it doesn’t produce tachycardia. In addition, it reverses bronchoconstriction induced by any inhaled cholinergic agonists.

Recommended doses of ipratropium bromide

The dose must adapt to the individual needs of a patient and they may administer repeated doses until they stabilize. However, only a doctor should determine the time intervals between doses.

You must neither exceed the recommended daily dose in acute nor in maintenance treatments. There may be a combination of Ipratropium bromide with short-acting beta-2-adrenergic agonists in the same nebulization chamber.

You must use the solution as soon as possible after mixing it and discard any leftovers. Also, there are various types of nebulizers in the market with which to administer this medication.

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Contraindications and precautions to consider

A person using an inhaler.

Ipratropium bromide is not recommended if you’re allergic to it or to other similar substances, such as atropine or its derivatives. Also, you shouldn’t use it in cases where there are acute coughing, wheezing, and bronchospasm attacks that require a quick response.

You must exercise caution in the use of anticholinergic agents in patients with narrow-angle glaucoma, prostatic hyperplasia or bladder obstruction. In addition, you must give special attention to patients with cystic fibrosis, as they may be more susceptible to gastrointestinal motility disorders.

Exceptionally, there have been hypersensitivity reactions immediately after the administration of Ipratropium bromide. These reactions manifest as hives, angioedema, rash, bronchospasm, oropharyngeal edema and anaphylaxis.

Incorrect use of Ipratropium bromide spray could penetrate the eyes and can lead to eye complications such as:

  • Mydriasis
  • Increased intraocular pressure
  • Narrow-angle glaucoma
  • Eye pain or discomfort
  • Blurry vision

How to use the Ipratropium bromide inhaler?

You must learn to use this medication properly if you’re to undergo treatment. In particular, you should avoid spraying it in your eyes.

Follow these steps whenever you use it:

  • Remove the protective cap
  • Take a deep breath
  • Firmly squeeze the inhaler’s mouthpiece with your lips
  • Inhale as energetically as possible and, at the same time, press the base of the container to release a spray of the solution so you can inhale it
  • Hold your breath for a few seconds, then remove the mouthpiece and slowly release the air
  • Finally, replace the protective cap

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Its interaction with other drugs

An inhaler shooting blue gas.

There’s some evidence that co-administration of Ipratropium bromide with beta-adrenergic and xanthine derivatives may enhance the bronchodilator effect. However, you can use this medication together with other drugs commonly used in the treatment of chronic obstructive pulmonary disease (COPD).

The risk of acute glaucoma in patients with a history of narrow-angle glaucoma may increase by the co-administration of nebulized Ipratropium bromide and beta-2-adrenergic agonists.

Adverse reactions of Ipratropium bromide

Like all medications, Ipratropium bromide can lead to side effects. However, these don’t appear in everyone. The most frequent adverse effects are:

  • Headache
  • Dizziness
  • Cough and throat irritation
  • Sickness
  • Dry mouth
  • Gastrointestinal motility disorders

Similarly, other rare side effects may occur such as hypersensitivity, severe allergic reaction, blurred vision, mydriasis, increased internal eye lesion, and red eyes and pain.

Conclusion

Be it on its own or associated with a beta-adrenergic, Ipratropium bromide has a therapeutic effect in the treatment of bronchospasms. This is especially the case when associated with viral bronchiolitis and bronchopulmonary dysplasia in infants and young children.

  • López, V. P., & Carreras Farmacéuticas Atención Primaria Puertollano Alcázar de San Juan, M. M. (2004). Bromuro De Tiotropio. Sescam. https://doi.org/R03BB04

  • Benito Fernández, J., Mintegui Raso, S., Sánchez Echaniz, J., Vázquez Ronco, M. A., & Pijoan Zubizarreta, J. I. (2000). Eficacia de la administración precoz de bromuro de ipratropio nebulizado en niños con crisis asmática. Anales Espanoles de Pediatria. https://doi.org/10.1016/s1695-4033(00)77446-7

  • Mallol, J., Aguirre, V., Simonds, S., & Cortes, F. (1995). Características diferenciales de inhaladores de dosis medida: número total de inhalaciones y masa liberada. Rev. Chil. Enferm. Respir.