Names and pronunciation
(i-pra-troe′pee-um) Atrovent , Atrovent HFA, Atrovent Nasal Spray
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Individual generic drug information
Extracted information for ipratropium only.
(i-pra-troe′pee-um) Atrovent , Atrovent HFA, Atrovent Nasal Spray
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Func. class.: Anticholinergic, bronchodilator
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Chem. class.: Synthetic quaternary ammonium compound
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Do not confuse: Atrovent/Natru-Vent
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ACTION: Inhibits interaction of ace- tylcholine at receptor sites on the bron- chial smooth muscle, thereby resulting in decreased cGMP and bronchodilation
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USES: Maintenance treatment of bronchospasm associated with COPD; rhinorrhea (nasal spray)
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Extracted information for ipratropium only.
CONTRAINDICATIONS: Hyper- sensitivity to this product, atropine, bro- mide, soybean or peanut products Precautions: Breastfeeding, children <12 yr, angioedema, heart failure, surgery, acute bronchospasm, bladder obstruction, closed-angle glaucoma, prostatic hypertro- phy, urinary retention, pregnancy
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SIDE EFFECTS CNS: Anxiety, dizziness, headache, ner- vousness CV: Palpitation EENT: Dry mouth, blurred vision, nasal congestion GI: Nausea, vomiting, cramps INTEG: Rash RESP: Cough, worsening of symptoms, bronchospasms
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INTERACTIONS Increase: toxicity—other bronchodila- tors (INH) Increase: anticholinergic action— phenothiazines, antihistamines, diso- pyramide Drug/Herb Increase: anticholinergic effect—bella- donna Increase: bronchodilator effect—green tea (large amts), guarana
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Extracted information for ipratropium only.
DOSAGE AND ROUTES Bronchospasm in chronic bronchitis/emphysema • Adult: INH 2 sprays (17 mcg/spray) 3-4×/day, max 12 INH/24 hr; SOL 500 mcg (1 unit dose) given 3-4×/day by nebulizer; nasal spray: 2 sprays (42 mcg/ spray) 3-4×/day • Child 5-11 yr: INH 4-8 inhalations q20min as needed for ≤3 hr (asthma, unlabeled); NEB 250-500 mcg q20min as needed for ≤3 hr (asthma, unlabeled) Rhinorrhea perennial rhinitis • Adult/child ≥6 yr: INTRANASAL 2 sprays (43 mcg)/nostril bid or tid • Child 5-12 yr: INTRANASAL 2 sprays (0.03%) in each nostril 3×/day
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Available forms: Aerosol 17 mcg/actu- ation; nasal spray 0.03%, 0.06%; sol for inh 0.0125% , 0.02%
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Administer: • Store at room temperature I Nebulizer route • Use sol in nebulizer with a mouthpiece rather than a face mask Intranasal route • Priming pump initially requires 7 ac- tuations of pump; priming again is not necessary if used regularly, tilt head backward after dose
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Extracted information for ipratropium only.
Assess: • Palpitations: if severe, product may have to be changed • Tolerance over long-term therapy; dose may have to be increased or changed • Atropine sensitivity: patient may also be sensitive to this product • Respiratory status: rate, rhythm, aus- cultate breath sounds before and after administration, vital capacity, FEV, ABGs/ VBGs, heart rate, rhythm • Hard candy, frequent drinks, sugarless gum to relieve dry mouth • Pregnancy/breastfeeding: use only if benefit outweighs fetal risk; use caution in breastfeeding, excretion unknown
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Evaluate: • Therapeutic response: ability to breathe adequately
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That compliance is necessary with number of inhalations/24 hr or overdose may occur; about spacer device for geri- atric patients; that max therapeutic ef- fects may take 2-3 mo • How to use equipment properly and take medication as directed; to take missed doses as soon as remembered unless almost time for the next dose; to space remaining doses evenly during the day; not to double doses • That rinsing mouth after use of the in- haler, good oral hygiene, and sugarless gum or candy may minimize dry mouth; to notify health care professional if stomatitis occurs or if dry mouth persists for more than 2 wk • Inhalation: not to exceed 12 doses within 24 hr; to notify heath care profes- sional if symptoms do not improve within 30 min after administration of medica- tion or if condition worsens • About the need for pulmonary function tests baseline and periodically during therapy to determine effectiveness • To avoid spraying in eyes; may cause irritation • To inform prescriber if cough, nervous- ness, headache, dizziness, nausea occurs • Nasal spray: instruct patient in proper use of nasal spray. Clear nasal passages before use. Do not inhale during admin- istration. Prime pump initially with 7 ac- tuations. If used regularly, no further priming is needed. If not used in 24 hr, prime with 2 actuations. If not used for >7 days, prime with 7 actuations
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Extracted information for ipratropium only.
PHARMACOKINETICS Half-life 2 hr, does not cross blood-brain barrier
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Filter the extracted dose blocks for this individual drug.
Bronchospasm in chronic bronchitis/emphysema
• Child 5-11 yr: INH 4-8 inhalations q20min as needed for ≤3 hr (asthma, unlabeled); NEB 250-500 mcg q20min as needed for ≤3 hr (asthma, unlabeled) Rhinorrhea perennial rhinitis
Candidate age grouping · source page 715
Bronchospasm in chronic bronchitis/emphysema
• Adult/child ≥6 yr: INTRANASAL 2 sprays (43 mcg)/nostril bid or tid
Candidate age grouping · source page 715
Bronchospasm in chronic bronchitis/emphysema
• Child 5-12 yr: INTRANASAL 2 sprays (0.03%) in each nostril 3×/day
Candidate age grouping · source page 715