Ipratropium bromide

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. == Contraindications ==

The main contraindication for ipratropium in any form is hypersensitivity to atropine and related substances. 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. Accidental contact with the eye should be avoided. == Interactions ==

Interactions with other anticholinergics like tricyclic antidepressants, anti-Parkinson drugs and quinidine, which theoretically increase side effects, are clinically irrelevant when ipratropium is administered as an inhalant. Ipratropium nasal spray may interact with certain medications for depression, anxiety, or other mental health conditions, certain medications for Parkinson's disease such as benztropine and trihexyphenidyl, atropine, certain antihistamines for allergy, cough, and cold, certain medications for bladder problems such as oxybutynin and tolterodine, certain medications for stomach problems such as dicyclomine and hyoscyamine, and certain medications for motion sickness such as scopolamine. == Pharmacology ==

Chemically, ipratropium bromide is a quaternary ammonium compound (which is indicated by the -ium per the BAN and the USAN) 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. == References ==