ipratropium bromide

ipratropium bromide

(i pra troe' pee um)

Apo-Ipravent (CAN), Atrovent, Novo-Ipramide (CAN)

Pregnancy Category B

Drug classes

Anticholinergic

Antimuscarinic drug

Parasympatholytic

Therapeutic actions

Anticholinergic, chemically related to atropine, which blocks vagally mediated reflexes by antagonizing the action of acetylcholine. Causes bronchodilation and inhibits secretion from serous and seromucous glands lining the nasal mucosa.

Indications

·        Bronchodilator for maintenance treatment of bronchospasm associated with COPD (solution, aerosol), chronic bronchitis, and emphysema

·        Nasal spray: Symptomatic relief of rhinorrhea associated with perennial rhinitis, common cold

Contraindications and cautions

·        Contraindicated with hypersensitivity to atropine or its derivatives, soy bean or peanut allergies (aerosol).

·        Use cautiously with narrow-angle glaucoma, prostatic hypertrophy, bladder neck obstruction, pregnancy, lactation.

Available forms

Aerosol—18 mcg/actuation; solution for inhalation—0.02% (500 mcg/vial) nasal spray—0.03% (21 mcg/spray), 0.06% (42 mcg/spray)

Dosages

Aerosol

ADULTS AND PEDIATRIC PATIENTS > 12 YR

The usual dosage is 2 inhalations (36 mcg) qid. Patients may take additional inhalations as required. Do not exceed 12 inhalations/24 hr.

Solution for inhalation

ADULTS AND PEDIATRIC PATIENTS > 12 YR

500 mcg tid–qid with doses 6–8 hr apart.

Nasal spray

ADULTS AND PEDIATRIC PATIENTS > 12 YR

2 sprays 0.06% per nostril tid–qid for relief with common cold.

PEDIATRIC PATIENTS 5-11 YR

2 sprays 0.06% per nostril tid for relief with common cold.

ADULTS AND PEDIATRIC PATIENTS > 6 YR

2 sprays 0.03% per nostril bid-tid for rhinitis.

Pharmacokinetics

Route	Onset	Peak	Duration
Inhalation	15 min	1–2 hr	3–4 hr

Metabolism: Hepatic, T _1/2: 1.6 hr

Distribution: May cross placenta, may enter breast milk

Excretion: Unknown

Adverse effects

·        CNS: Nervousness, dizziness, headache, fatigue, insomnia, blurred vision

·        GI: Nausea, GI distress, dry mouth

·        Respiratory: Dyspnea, bronchitis, bronchospasms, URI, cough, exacerbation of symptoms, hoarseness

·        Other: Back pain, chest pain, allergic-type reactions, palpitations, rash

Nursing considerations

Assessment

·        History: Hypersensitivity to atropine, soybeans, peanuts (aerosol preparation); acute bronchospasm, narrow-angle glaucoma, prostatic hypertrophy, bladder neck obstruction, pregnancy, lactation

·        Physical: Skin color, lesions, texture; T; orientation, reflexes, bilateral grip strength; affect; ophthalmic examination; P, BP; R, adventitious sounds; bowel sounds, normal output; normal urinary output, prostate palpation

Interventions

·        Protect solution for inhalation from light. Store unused vials in foil pouch.

·        Use nebulizer mouthpiece instead of face mask to avoid blurred vision or aggravation of narrow-angle glaucoma.

·        Can mix albuterol in nebulizer for up to 1 hr.

·        Ensure adequate hydration, control environmental temperature to prevent hyperpyrexia.

·        Have patient void before taking medication to avoid urinary retention.

·        Teach patient proper use of inhalator.

Teaching points

·        Use this drug as an inhalation product. Review the proper use of inhalator; for nasal spray, initiation of pump requires 7 actuations; if not used for 24 hours, 2 actuations will be needed before use. Protect from light; do not freeze.

·        You may experience these side effects: Dizziness, headache, blurred vision (avoid driving or performing hazardous tasks); nausea, vomiting, GI upset (proper nutrition is important; consult with your dietitian to maintain nutrition); cough.

·        Report rash, eye pain, difficulty voiding, palpitations, vision changes.

Adverse effects in Italic are most common; those in Bold are life-threatening.