IPRATROPIUM BROMIDE

(i-pra-troe'pee-um)
Atrovent, Atrovent HFA
Classifications: autonomic nervous system agent; anticholinergic (parasympatholytic); antimuscarinic; bronchodilator
Pregnancy Category: B

Availability

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

Actions

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).

Uses

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.

Contraindications

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

COPD
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 3–12 y, 1–2 inhalations t.i.d. (max: 6/d) Nebulizer 125–250 mcg t.i.d.

Rhinitis
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

Administration

Intranasal/Inhalation/Nebulizer

Demonstrate aerosol use and check return demonstration.
Wait 3 min between inhalations if more than one inhalation per dose is ordered.
Avoid contact with eyes.

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.

Pharmacokinetics

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

Monitor respiratory status; auscultate lungs before and after inhalation.
Report treatment failure (exacerbation of respiratory symptoms) to physician.

Patient & Family Education

Note: This medication is not an emergency agent because of its delayed onset and the time required to reach peak bronchodilation.
Review patient information sheet on proper use of nasal spray.
Allow 30–60 sec between puffs for optimum results. Do not let medication contact your eyes.
Wait 5 min between this and other inhaled medications. Check with physician about sequence of administration.
Take medication only as directed, noting some leniency in number of puffs within 24 h. Supervise child's administration until certain all of dose is being administered.
Rinse mouth after medication puffs to reduce bitter taste.
Discuss changes in normal urinary pattern with the physician (more common in older adults).
Call physician if you note changes in sputum color or amount, ankle edema, or significant weight gain.
Do not breast feed while taking this drug without consulting physician.

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