ATROVENT 250 MCG UDV

Indications

• Chronic obstructive pulmonary disease (COPD)
• Asthma
• Acute bronchospasm
• Bronchospasm associated with COPD

Dosage

Children: For children aged 6 to 12 years, the recommended dose is 250 micrograms via inhalation, up to three times a day. For children under 6 years, dosing should be determined by a healthcare professional, and the use of ipratropium in this age group requires careful consideration.

Adults: The usual adult dose for ipratropium is 500 micrograms via inhalation, administered up to four times a day. The maximum dose should not exceed 2000 micrograms in 24 hours.

Mechanism of action

Ipratropium works by inhibiting the action of acetylcholine on muscarinic receptors in the bronchial smooth muscle, leading to bronchodilation. It prevents bronchoconstriction and reduces mucus secretion in the airways, thus improving airflow and decreasing respiratory distress.

Pharmacodynamics

The onset of action for ipratropium is typically within 15 minutes, with a peak effect occurring around 1 to 2 hours after administration. Its effect can last for approximately 4 to 6 hours. It is more effective in patients with COPD than in those with asthma, though it can be used in both conditions. The drug is sometimes used in conjunction with beta-agonists to enhance bronchodilation.

Pharmacokinetics

Ipratropium is poorly absorbed from the gastrointestinal tract and has minimal systemic bioavailability when inhaled. It has a half-life of approximately 1.5 hours. The drug is primarily excreted unchanged in the urine. Its pharmacokinetic profile supports its use in inhaled formulations, as it provides localized effects with reduced systemic side effects.

Contra-indications

• Hypersensitivity to ipratropium or any component of the formulation
• Acute exacerbation of bronchospasm

Adverse effects

• Dry mouth
• Cough
• Headache
• Nausea
• Dizziness
• Pharyngeal irritation

Interactions

• Clozapine: Unknown (additive effect)
• Beta 2-agonists: Unknown (increases risk of glaucoma)
• Second-generation antipsychotics: Unknown (additive effect)

Precautions

• Use with caution in patients with glaucoma
• Patients with prostatic hyperplasia or bladder neck obstruction should be monitored closely
• Caution in patients with cardiovascular disorders

Pregnancy

Ipratropium is classified as category B. Limited data suggest it is not expected to cause harm to the fetus.

Breast-feeding

Ipratropium is excreted in breast milk but is not expected to harm a nursing infant. Consider benefits versus risks.

Storage

Store in a cool, dry place, away from light. Do not freeze.

Formulations

• Inhalation solution
• Aerosol inhaler
• Nasal spray

Indications

• Maintenance treatment of chronic obstructive pulmonary disease (COPD)
• Reversible airways obstruction in asthma
• Rhinorrhea associated with allergic and non-allergic rhinitis

Dosage

Children: For inhalation: Child 1 month

Adults: For inhalation: 20–40 micrograms 3–4 times a day. For intranasal administration: Apply 2–3 drops 2–3 times a day into each nostril.

Mechanism of action

Ipratropium bromide acts as a competitive antagonist of acetylcholine at muscarinic receptors. This inhibition prevents bronchoconstriction and promotes bronchodilation, thereby easing airflow in obstructive airway diseases. It primarily affects M1 and M3 muscarinic receptors in the airway smooth muscle and secretory glands, reducing mucus secretion and aiding ventilation.

Pharmacodynamics

The onset of action for ipratropium bromide typically occurs within 30 to 60 minutes after inhalation, with peak effects observed at this time. Its bronchodilatory effects can last for approximately 3 to 6 hours, making it suitable for multiple doses throughout the day. The drug is less effective than beta-agonists in producing bronchodilation but has a complementary role in therapy, especially for patients with chronic conditions requiring long-term management.

Pharmacokinetics

Ipratropium bromide is administered via inhalation, leading to localized action in the lungs with minimal systemic absorption. The systemic bioavailability is low, resulting in a reduced incidence of systemic side effects. It undergoes hepatic metabolism, with metabolites excreted primarily in the urine. The elimination half-life varies but is generally around 2 hours, allowing for flexible dosing intervals. The maximal effect is usually achieved within an hour post-administration.

Adverse effects

• dizziness
• epistaxis
• dry mouth
• nausea

Interactions

• beta2 agonists

Precautions

• Avoid spraying near eyes
• Patients with convulsive disorders should use with caution

Pregnancy

Ipratropium bromide should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult a healthcare provider for individual assessment.

Breast-feeding

Ipratropium bromide is excreted in breast milk. Caution should be exercised when administering to nursing mothers.

Storage

Store at room temperature, away from light and moisture. Do not freeze.

Formulations

• Inhalation aerosol: 20-40 micrograms per actuation
• Nebulised solution: 250 micrograms per dose
• Nasal spray: 20 micrograms per actuation