Generic Atrovent

IPRATROPIUM BROMIDE
Aerosol: Each actuation delivers 18 mcg (Rx) Atrovent (Boehringer Ingelheim)
Solution for Inhalation: 0.02% (500 mcg/viol) (Rx) Various, Atrovent {Boehringer Ingelheim)
Nasal spray: 0.03% (21 mcg/spray) and Atrovent (Boehringer Ingelheim)
0.06% (42 mcg/spray) (Rx)

Indications
Bronchospasm (solution and aerosol): Used alone or in combination with other bronchodilators (especially beta-adrenergics) as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. Ipratropium is not indicated for the initial treatment of acute episodes of bronchospasms.
Rhinorrhea:
Perennial rhinitis (0.03% nasal spray) - Symptomatic relief of rhinorrhea associated with allergic and non-allergic perennial rhinitis in patients > 6 years of age.
Common cold (0.06% nasal spray) - Symptomatic relief of rhinorrhea associated with the common cold in patients > 5 years of age.

Administration and Dosage
Aerosol: The usual dose is 2 inhalations (36 mcg) 4 times/day. Patients may take additional inhalations as required; however, do not exceed 12 inhalations in 24 hours.
Solution: The usual dose is 500 mcg (1 unit dose vial) administered 3 to 4 times/day by oral nebulization, with doses 6 to 8 hours apart. The solution can be mixed in the nebulizer with albuterol if used within 1 hour.
Nasal spray:
0.03% (patients > 6 years of age) - The usual dose is 2 sprays (42 mcg) per nostril 2 or 3 times/day (total dose, 168 to 252 mcg/day). Optimum dosage varies.
0.06% (patients > 5 years of age) - Recommended dose is 2 sprays (84 mcg) per nostril 3 or 4 times/day (total dose, 504 to 672 mcg/day). Optimum dosage varies.
Children 5 to 11 years of age: Recommended dose is 2 sprays (84 mcg) per nostril 3 times/day (total dose, 504 mcg/day).
The safety and efficacy of use > 4 days in patients with the common cold have not been established.

Actions
Pharmacology: Ipratropium for oral inhalation is a synthetic quaternary anticholinergic
(parasympatholytic) ammonium compound chemically related to atropine. It appears to inhibit vagally mediated reflexes by antagonizing the action of acetylcholine. The bronchodilation following inhalation is primarily a local, site-specific effect, not a systemic one.
Pharmacokinetics: Much of an inhaled dose is swallowed as shown by fecal excretion studies. Ipratropium is not readily absorbed into the systemic circulation either from the surface of the lung or from the GI tract as confirmed by blood levels and renal excretion studies. The elimination half-life is about 1.6 hours.

Contraindications
Hypersensitivity to ipratropium, atropine, or its derivatives; a history of hypersensitivity to soya lecithin or related food products such as soy bean or peanut (inhalation aerosol).

Warnings
Acute bronchospasm: Ipratropium is not indicated as a single agent for relief of bronchospasm in acute COPD exacerbation.
Special risk patients: Use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder neck obstruction.
Pregnancy: Category B.
Lactation: It is not known whether this drug is excreted in breast milk.
Children: Safety and efficacy in children

Drug Interactions
Ipratropium has been used concomitantly with other drugs, including sympathomimetic bronchodilators, methylxanthines, steroids, and cromolyn sodium, commonly used in the treatment of chronic obstructive pulmonary disease, without adverse drug reactions.

Adverse Reactions
Adverse reactions from inhalational products may include nervousness, cough, dryness of the oropharynx, irritation from aerosol, exacerbation of symptoms, dizziness, headache, GI distress, dry mouth, influenza-like symptoms, back or chest pain, nausea, dyspnea, bronchitis, upper respiratory tract infection, epistaxis, pharyngitis, nasal dryness, and miscellaneous nasal symptoms.
Adverse reactions from nasal spray may include epistaxis, nasal dryness, headache, and upper respiratory tract infection.
ANTI-ALLERGIC/ASTHMA

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