ipratropium (Atrovent)
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Introduction
Tradename: Atrovent.
Indications
- chronic bronchitis
- asthmatic bronchitis
- not useful in patients with pure pulmonary emphysema
- useful used concurrently with beta2 agonists
Contraindications
- allergy to soy or peanuts (soy lecithin* used as suspension agent <Atrovent CFC metered dose inhaler ONLY>)[5][7] <Atrovent HFA inhaler DOESN'T have soy, neither does ipratropium nasal spray or inhalation solution>
- maintenance therapy; NOT for acute exacerbations
- combined use with long-acting anticholinergic agent (tiotropium)[6][8]
* soy lecithin can contain small amounts of soy protein, which can cause a reaction in a small number of people with peanut allergy
Caution:
- temporary blurred vision may occur if sprayed into eyes Inhaler:
- 2 puffs QID or 1 vial nebulized every 6-8 hours
- max: 12 puffs/24 hours.
Aerosol: 18 ug/metered dose (14 g) Solution for inhalation: 0.02% (2.5 mL) (box of 25)
Pharmacokinetics
- onset of action is within 3 minutes
- maximal effect within 1.5-2 hours
- duration of action 3-6 hours[6]
elimination via lung
Adverse effects
- common (> 10%)
- less common (1-10%)
- blurred vision, insomnia, hypotension, nasal congestion, palpitations, urinary retention, trembling
- uncommon (< 1%)
- other
- nervousness
- may aggravate:
- increased cardiovascular risk of inhaled anticholinergics (see inhaled anticholinergic agents)
- nasal spray:
- not common (1-10%)
- uncommon (< 1%)
- nasal burning, coughing, dizziness, palpitations, thirst, tinnitus, blurred vision
Mechanism of action
- short-actinb anticholinergic agent causing relaxation of the bronchial smooth muscle, especially in the upper bronchial tree
- inhibits vagally-mediated reflexes
- prevents increase in cGMP caused by stimulation of muscarinic receptors in bronchial smooth muscle
Ipatropium does not:
- prevent bronchoconstriction induced by:
- affect mucous production or transport or ciliary action
Allergen-induced bronchoconstriction responds poorly to ipratropium.
More general terms
Component of
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 742
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 5.0 5.1 Prescriber's Letter 10(3):13 2003
- ↑ 6.0 6.1 6.2 Prescriber's Letter 15(1): 2008 Combined Use of Tiotropium (Spiriva) and Ipratropium (Atrovent) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240109&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 7.0 7.1 Prescriber's Letter 16(6): 2009 Drug Therapy Considerations for Patients with Peanut Allergy Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250608&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 8.0 8.1 Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
- ↑ Deprecated Reference
Database
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=3746
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=43232
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=657309
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=441337
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=31098
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=592261
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=657308