Drugs List

Therapeutic Indications

Uses

Chronic asthma
Chronic obstructive airways disease (with reversible element)

Contraindications

None known

Precautions and Warnings

Predisposition to narrow angle glaucoma
Benign prostatic hyperplasia
Bladder outflow obstruction
Breastfeeding
Cystic fibrosis
Narrow angle glaucoma
Pregnancy

Advise ability to drive/operate machinery may be affected by side effects
Advise patient dizziness may affect ability to drive or operate machinery
Ensure patient has a fast acting bronchodilator available
Not all available brands are licensed for all age groups
Avoid contact with eyes
Check patient is using correct inhaler technique
Advise patient to contact their doctor if dyspnoea rapidly worsens
Advise patient to report any blurred vision or any other eye symptoms
Discontinue if paradoxical bronchospasm occurs
Advise patient that CFC-free inhalers may have different taste or sensation
Patient should seek medical advice if usual relief is diminished

Eye pain or discomfort, blurred vision, visual halos or coloured images in association with red eyes from conjunctival congestion and corneal oedema may be signs of acute narrow-angle glaucoma. Should any combination of these symptoms develop, treatment with miotic drops should be initiated and specialist advice sought immediately.

Pregnancy and Lactation

Pregnancy

Use ipratropium with caution during pregnancy.

The manufacturer recommends ipratropium bromide is not used in pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus.

There is no data from the use of ipratropium in pregnancy. The consensus appears to be that there is no evidence that the drug is hazardous to the foetus. Moreover, it produces fewer systemic effects than atropine and may have an additive bronchodilatory effect to Beta2 agonists.

Lactation

Use ipratropium with caution during breastfeeding.

The manufacturer advises caution if ipratropium bromide is used when breastfeeding.

It is not known if ipratropium is excreted in breast milk. Ipratropium is lipid-insoluble, and similar to other quaternary bases, may appear in milk. The amounts are unknown but probably clinically insignificant because of low maternal serum concentrations after inhalation.

Side Effects

Anaphylactic reaction
Angioedema of tongue, lips and face
Atrial fibrillation
Blurred vision
Bronchospasm
Bronchospasm (paradoxical)
Conjunctival hyperaemia
Constipation
Corneal oedema
Cough
Diarrhoea
Disturbances in accommodation
Dizziness
Dry mouth
Dry throat
Gastro-intestinal motility disturbances
Headache
Hypersensitivity reactions
Increased intra-ocular pressure
Laryngospasm
Local irritation of throat and nose
Mydriasis
Narrow angle glaucoma
Nausea
Ocular pain
Oropharyngeal oedema
Palpitations
Pruritus
Rash
Stomatitis
Supraventricular tachycardia
Tachycardia
Taste disturbances
Urinary retention
Urticaria
Visual haloes
Vomiting

Presentation

Inhalation formulations of ipratropium bromide.

Drugs List

Therapeutic Indications

Uses

Chronic asthma
Chronic obstructive airways disease (with reversible element)

Dosage

Adults

Children

Contraindications

None known

Precautions and Warnings

Predisposition to narrow angle glaucoma
Benign prostatic hyperplasia
Bladder outflow obstruction
Breastfeeding
Cystic fibrosis
Narrow angle glaucoma
Pregnancy

Advise ability to drive/operate machinery may be affected by side effects
Advise patient dizziness may affect ability to drive or operate machinery
Ensure patient has a fast acting bronchodilator available
Not all available brands are licensed for all age groups
Avoid contact with eyes
Check patient is using correct inhaler technique
Advise patient to contact their doctor if dyspnoea rapidly worsens
Advise patient to report any blurred vision or any other eye symptoms
Discontinue if paradoxical bronchospasm occurs
Advise patient that CFC-free inhalers may have different taste or sensation
Patient should seek medical advice if usual relief is diminished

Eye pain or discomfort, blurred vision, visual halos or coloured images in association with red eyes from conjunctival congestion and corneal oedema may be signs of acute narrow-angle glaucoma. Should any combination of these symptoms develop, treatment with miotic drops should be initiated and specialist advice sought immediately.

Pregnancy and Lactation

Pregnancy

Use ipratropium with caution during pregnancy.

The manufacturer recommends ipratropium bromide is not used in pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus.

There is no data from the use of ipratropium in pregnancy. The consensus appears to be that there is no evidence that the drug is hazardous to the foetus. Moreover, it produces fewer systemic effects than atropine and may have an additive bronchodilatory effect to Beta2 agonists.

Lactation

Use ipratropium with caution during breastfeeding.

The manufacturer advises caution if ipratropium bromide is used when breastfeeding.

It is not known if ipratropium is excreted in breast milk. Ipratropium is lipid-insoluble, and similar to other quaternary bases, may appear in milk. The amounts are unknown but probably clinically insignificant because of low maternal serum concentrations after inhalation.

Side Effects

Anaphylactic reaction
Angioedema of tongue, lips and face
Atrial fibrillation
Blurred vision
Bronchospasm
Bronchospasm (paradoxical)
Conjunctival hyperaemia
Constipation
Corneal oedema
Cough
Diarrhoea
Disturbances in accommodation
Dizziness
Dry mouth
Dry throat
Gastro-intestinal motility disturbances
Headache
Hypersensitivity reactions
Increased intra-ocular pressure
Laryngospasm
Local irritation of throat and nose
Mydriasis
Narrow angle glaucoma
Nausea
Ocular pain
Oropharyngeal oedema
Palpitations
Pruritus
Rash
Stomatitis
Supraventricular tachycardia
Tachycardia
Taste disturbances
Urinary retention
Urticaria
Visual haloes
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: November 2019.

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Product Characteristics: Atrovent Inhaler CFC-Free, Boehringer Ingelheim Limited, revised December 2015.

Summary of Product Characteristics: Inhalvent Inhaler, Alissa healthcare, revised March 2017.

Summary of Product Characteristics: Ipravent CFC-Free Inhaler, Cipla (EU) Limited, revised June 2019.