Anticholinergic bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (chronic bronchitis and emphysema), alone or with other bronchodilators, especially beta-adrenergics.
Also known as: Atrovent, ipratrópio, ipratropium
DailyMed approved label (Ipratropium Bromide Solution; setID 6b730dd7-4d93-403a-bfd2-fa0efa298b75).
DailyMed approved label (Ipratropium Bromide Solution; setID 6b730dd7-4d93-403a-bfd2-fa0efa298b75).
Ipratropium + tiotropium: additive anticholinergic effect — avoid combining anticholinergics.
The FDA labels of ipratropium (section 7.1) and tiotropium (section 7.2) document that anticholinergics interact additively with other anticholinergic medications and recommend avoiding administration with other anticholinergic-containing drugs. Combining two inhaled anticholinergics (LAMA + SAMA) adds no proven bronchodilator benefit and increases the risk of systemic anticholinergic effects — dry mouth, constipation, urinary retention, tachycardia and angle-closure glaucoma, especially in the elderly with prostatic hypertrophy or prior constipation. The practical guidance is to use only one inhaled anticholinergic, choosing the most appropriate for the patient; if the combination is unavoidable, monitor systemic symptoms and urinary function.
Ipratropium + tiotropium: additive anticholinergic effect — avoid combining two inhaled anticholinergics.
The FDA labels of ipratropium (section 7.1) and tiotropium (section 7.2) document: "Anticholinergics: May interact additively with concomitantly used anticholinergic medications. Avoid administration with other anticholinergic-containing drugs". Combining two inhaled anticholinergics increases the risk of systemic anticholinergic effects (dry mouth, urinary retention, angle-closure glaucoma, constipation) without proven additional bronchodilator benefit.
If unavoidable, monitor for dry mouth, urinary retention, constipation and visual changes.
Acute urinary retention, acute glaucoma or tachycardia with the combination.
Avoid combining two inhaled anticholinergics (ipratropium + tiotropium); choose monotherapy with the most appropriate agent.
DailyMed/FDA (NIH/NLM) — approved Ipratropium label (section 7.1): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=133cc2ed-f018-4295-b84e-b24382299360 ; approved Tiotropium label (section 7.2): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=496b38ee-45b6-4bb2-a35e-9023c3b73719
Ipratropium is given by inhalation; food does not affect its pharmacokinetics.
May be administered regardless of meals.
DailyMed approved label (Ipratropium Bromide Solution; setID 6b730dd7-4d93-403a-bfd2-fa0efa298b75).
No relevant pharmacokinetic interaction; usual moderation during treatment.
Moderate alcohol intake.
DailyMed approved label (Ipratropium Bromide Solution; setID 6b730dd7-4d93-403a-bfd2-fa0efa298b75).
The anticholinergic effect may worsen urinary retention.
Use with caution in patients with obstructive urinary symptoms.
EMC-UK (MHRA) — approved Ipratropium bromide SmPC: https://www.medicines.org.uk/emc/product/61/smpc
Inhalation of anticholinergics may precipitate an acute angle-closure glaucoma attack.
Avoid contact with the eyes; use with caution in patients with glaucoma.
EMC-UK (MHRA) — approved Ipratropium bromide SmPC: https://www.medicines.org.uk/emc/product/61/smpc
Data on ipratropium in pregnancy are limited; use only if needed.
Avoid unless usual bronchodilators are insufficient.
Excreted in small amounts into breast milk; probably compatible.
No specific additional contraception.
EMC-UK (MHRA) — approved Ipratropium bromide SmPC: https://www.medicines.org.uk/emc/product/61/smpc ; Prontuário Terapêutico do INFARMED (11th ed., 2012) — Annex 1, Drugs and Pregnancy: It is unknown whether it is harmful; no information available.
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Bronchodilation predominantly local and site-specific: antagonism of acetylcholine at muscarinic receptors of bronchial smooth muscle prevents the rise of intracellular cyclic GMP, reversing cholinergic bronchoconstriction.
Competitive antagonism of acetylcholine at bronchial muscarinic receptors (parasympatholytic action), blocking vagally mediated reflexes.
After nebulization of 2 mg, only ~7% of the dose reaches the systemic circulation (from the lung or GI tract). Minimal (0–9%) plasma protein binding.
Partially metabolized; excretion is predominantly fecal (much of the inhaled dose is swallowed and not absorbed).
Elimination half-life ~1.6 h after intravenous administration.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
