Atrovent, Atrovent HFA
Classifications: autonomic nervous system agent; anticholinergic (parasympatholytic); antimuscarinic; bronchodilator
Pregnancy Category: B


0.02% solution for inhalation; 18 mcg inhaler; 0.03%, 0.06% nasal spray


Quaternary compound, chemically related to atropine, with low solubility; does not cross blood–brain barrier. Produces local, site-specific effects on the larger central airways including bronchodilation and prevention of bronchospasms.

Therapeutic Effects

Bronchodilation inhibits acetylcholine at its receptor sites, thereby blocking cholinergic bronchomotor tone (bronchoconstriction); also abolishes vagally mediated reflex bronchospasm triggered by such nonspecific agents as cigarette smoke, inert dusts, cold air, and a range of inflammatory mediators (e.g., histamine).


Maintenance therapy in COPD including chronic bronchitis and emphysema; nasal spray for perennial rhinitis and symptomatic relief of rhinorrhea associated with the common cold.

Unlabeled Uses

Perennial nonallergic rhinitis.


Use as primary treatment for acute episodes; hypersensitivity to atropine or derivatives. Safe use in children 3 y is not established.

Cautious Use

Pregnancy (category B), lactation; narrow-angle glaucoma; prostatic hypertrophy, bladder neck obstruction.

Route & Dosage

Adult: Inhalation 2 inhalations of MDI q.i.d. at no less than 4 h intervals (max: 12 inhalations in 24 h) Nebulizer 500 mcg (1 unit dose vial) q6–8h
Child: Inhalation 312 y, 1–2 inhalations t.i.d. (max: 6/d) Nebulizer 125–250 mcg t.i.d.

Adult: Intranasal 5 y, 2 sprays of 0.03% each nostril b.i.d. or t.i.d.

Common Cold
Adult: Intranasal 2 sprays of 0.06% each nostril t.i.d. or q.i.d. up to 4 d



Adverse Effects (1%)

Special Senses: Blurred vision (especially if sprayed into eye), difficulty in accommodation, acute eye pain, worsening of narrow-angle glaucoma. GI: Bitter taste, dry oropharyngeal membranes. With higher doses: nausea, constipation. Respiratory: Cough, hoarseness, exacerbation of symptoms, drying of bronchial secretions, mucosal ulcers, epistaxis, nasal dryness. Skin: Rash, hives. Urogenital: Urinary retention. CNS: Headache.


Absorption: 10% of inhaled dose reaches lower airway; approximately 0.5% of dose is systemically absorbed. Peak: 1.5–2 h. Duration: 4–6 h. Elimination: 48% of dose excreted in feces; <5% excreted in urine. Half-Life: 1.5–2 h.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug