ipratropium bromide monohydrate: clinical use

Prescribing considerations

• Confirm chronic asthma or COPD with reversible bronchospasm.
• The selected inhaler is licensed for adults, not children or adolescents.
• Check inhaler technique and consider the licensed spacer when coordination is difficult.
• Its onset is slower than inhaled sympathomimetic bronchodilators; worsening asthma control requires review.
• Minimise ocular exposure and explain symptoms of acute angle-closure glaucoma.

Contraindications and cautions

• Hypersensitivity to ipratropium bromide, atropine, atropine derivatives or any excipient.
• Use caution with narrow-angle glaucoma or predisposition to it.
• Use caution with prostatic hyperplasia, bladder-outflow obstruction or other urinary retention risk.
• Use caution in cystic fibrosis because gastrointestinal motility disturbance may be more likely.
• Renal and hepatic impairment have not been studied for this product; use requires caution.

Monitoring

• Clinical response, symptom deterioration and reduced treatment effect
• Inhaler technique and device coordination
• Paradoxical bronchospasm
• Dry mouth, urinary retention, gastrointestinal disturbance and ocular symptoms
• Palpitations or arrhythmia symptoms where clinically relevant

Clinical pharmacology

A quaternary ammonium antimuscarinic that antagonises acetylcholine at muscarinic receptors in bronchial smooth muscle, inhibiting vagally mediated bronchoconstriction. Its therapeutic effect is predominantly local within the airways.

Formulation and product differences

• The selected product is a CFC-free pressurised inhalation solution using HFA-134a propellant.
• It contains ethanol, citric acid and purified water.
• Its mouthpiece is product-specific and should not be exchanged with another inhaler’s mouthpiece.
• The opaque canister prevents visual assessment of remaining contents.
• It can be used with the AeroChamber Plus spacer.

Inhaled preparation

Route: Inhaled

Strengths: 20 micrograms/actuation