Ipratropium bromide inh 20mcg/dose,breath act inh 20mcg/dose, cfc-free inh
- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Inhalation formulations of ipratropium bromide.
Chronic obstructive airways disease (with reversible element)
1 or 2 inhalations three or four times daily. Some patients may need up to 4 inhalations at a time to obtain maximum benefit during early treatment.
Recommended maximum daily dose is 12 inhalations.
Children 6 to 12 years
1 or 2 inhalations three times daily.
Children under 6 years
1 inhalation three times daily.
Not all formulations are licensed for children under 18.
Precautions and Warnings
Predisposition to narrow angle glaucoma
Benign prostatic hyperplasia
Bladder outflow obstruction
Narrow angle glaucoma
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
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.
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.
Angioedema of tongue, lips and face
Disturbances in accommodation
Gastro-intestinal motility disturbances
Increased intra-ocular pressure
Local irritation of throat and nose
Narrow angle glaucoma
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 ).
Last Full Review Date: November 2019.
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.
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