<!-- Definition and medical uses -->
Ipratropium bromide, sold under the trade name Atrovent among others, is a type of anticholinergic medication which is applied by different routes: inhaler, nebulizer, or nasal spray, for different reasons.
The inhalant opens up the medium and large airways in the lungs. It is used to treat the symptoms of chronic obstructive pulmonary disease (COPD) and asthma. It is used to treat rhinorrhea (runny nose) caused by allergic rhinitis, nonallergic rhinitis, Potentially serious side effects include urinary retention, worsening spasms of the airways, and a severe allergic reaction. Ipratropium is a short-acting muscarinic antagonist, which works by causing smooth muscles to relax.
<!-- Society and culture -->
Ipratropium bromide was patented in 1966, and approved for medical use in 1974. It is on the World Health Organization's List of Essential Medicines, the most important medicines needed in a health system. Ipratropium is available as a generic medication.
Medical uses
Ipratropium as an inhalant can be used for the treatment of chronic obstructive pulmonary disease (COPD) and asthma exacerbation. It is supplied in a canister for use in an inhaler or in single dose vials for use in a nebulizer.
It is also used to treat and prevent minor and moderate bronchial asthma, especially asthma that is accompanied by cardiovascular system diseases, as it has been shown to produce fewer cardiovascular side effects.
Combination with beta-adrenergic agonists increases the dilating effect on the bronchi, as when ipratropium is combined with salbutamol (albuterol — USAN) under the trade names Combivent (a non-aerosol metered-dose inhaler or MDI) and Duoneb (nebulizer) for the management of COPD and asthma, and with fenoterol (trade names Duovent and Berodual N) for the management of asthma.
Ipratropium as a nasal solution sprayed into the nostrils can reduce rhinorrhea (runny nose) but will not help nasal congestion. It is supplied in a metered-dose manual pump spray.
Conditions such as narrow-angle glaucoma, prostatic hyperplasia, or bladder neck obstruction are not necessarily contraindicators, but should be taken into account, particularly if the patient is receiving an anticholinergic by another route.
Side effects
If ipratropium is inhaled, side effects resembling those of other anticholinergics are minimal. However, dry mouth and sedation have been reported. Also, effects such as skin flushing, tachycardia, acute angle-closure glaucoma, nausea, palpitations, and headache have been observed. Inhaled ipratropium does not decrease mucociliary clearance.
Common side effects of nasal spray are experienced at a rate of 1-6% (versus the control group of 0-3%), and may include headache, dry nose, dry mouth or throat, nasal or throat irritation, nosebleeds, bad taste in mouth, nausea, dizziness, or constipation. Potentially serious side effects from nasal spray are rare, but include severe allergic reaction, eye pain or change in vision, or difficulty urinating. obtained by treating atropine with isopropyl bromide, thus the name: isopropyl + atropine. It is chemically related to components of the plant Datura stramonium, which was used in ancient India for asthma.
Ipratropium exhibits broncholytic action by reducing cholinergic influence on the bronchial musculature. It blocks muscarinic acetylcholine receptors, without specificity for subtypes, and therefore promotes the degradation of cyclic guanosine monophosphate (cGMP), resulting in a decreased intracellular concentration of cGMP. Most likely due to actions of cGMP on intracellular calcium, this results in decreased contractility of smooth muscle in the lung, inhibiting bronchoconstriction and mucus secretion. It is a nonselective muscarinic antagonist, but is a quaternary amine and therefore does not cross the blood–brain barrier, which prevents central side effects. Ipratropium should never be used in place of salbutamol (albuterol) as a rescue medication.