ipratropium bromide: clinical use

Prescribing considerations

• Confirm correct nebuliser technique and minimise ocular exposure; prefer a mouthpiece where practical.
• Initial use of the nebuliser solution should be under close medical supervision.
• Home nebulised rescue treatment for asthma in children and adolescents should be initiated and managed by a respiratory specialist.
• Use caution with narrow-angle glaucoma risk, urinary outflow obstruction and cystic fibrosis-associated gastrointestinal motility problems.

Contraindications and cautions

• Hypersensitivity to ipratropium bromide, atropine or atropine derivatives, or another product component.

Monitoring

• Clinical response and deterioration in respiratory symptoms
• Nebuliser technique, mask fit and eye exposure
• Eye pain, visual disturbance or signs of raised intraocular pressure
• Urinary retention and systemic anticholinergic effects
• Paradoxical bronchospasm

Clinical pharmacology

A quaternary ammonium muscarinic antagonist that inhibits vagally mediated bronchoconstriction. Inhaled efficacy is predominantly local, with limited systemic bioavailability and little contribution from the swallowed fraction.

Formulation and product differences

• The selected product information covers preservative-free, single-use nebuliser vials in two volumes.
• Open a fresh vial immediately before administration and discard unused solution.
• The larger selected vial presentation is not intended for children aged 12 years or younger.