• Inhaln: Maintenance therapy of reversible airway obstruction due to COPD, including chronic bronchitis and emphysema.
• Intranasal: Rhinorrhea associated with allergic and nonallergic perennial rhinitis (0.03% solution) or the common cold (0.06% solution).

Unlabeled Uses:

• Inhaln: Adjunctive management of bronchospasm caused by asthma.

Contraindicated in:

• Hypersensitivity to ipratropium, atropine, belladonna alkaloids, or bromide
• Acute bronchospasm.

Use Cautiously in:

• Bladder-neck obstruction, prostatic hyperplasia, glaucoma, or urinary retention
• Lactation: Safety not established in breastfeeding
• Geri: Older adults may be more sensitive to effects.

CV: hypotension, palpitations.

Derm: rash.

EENT: blurred vision, sore throat.
nasal only: epistaxis, nasal dryness/irritation.

GI: GI irritation, nausea.

Neuro: dizziness, headache, nervousness.

Resp: bronchospasm, cough.
Misc: (INCLUDING ANAPHYLAXIS)HYPERSENSITIVITY REACTIONS .

Drug-Drug:

• ↑anticholinergic effects with other drugs having anticholinergic properties, including antihistamines, phenothiazines, and disopyramide.

(Generic available)

• Aerosol inhaler (HFA) (chlorofluorocarbon-free): 17 mcg/inhalation in 12.9-g canister (200 inhalations);
• Inhalation solution: 0.0125%; 0.02%; 0.025%;
• Nasal spray: 0.03% solution — 21 mcg/spray in 30-mL bottle (345 sprays/bottle); 0.06% solution — 42 mcg/spray in 15-mL bottle (165 sprays);
• In combination with: albuterol (Combivent Respimat). See Appendix [not included in this PDA edition].

• Inhaln (Adults and Children >12 yr): Metered-dose inhaler (nonacute): 2 inhalations 4 times daily (not to exceed 12 inhalations/24 hr or more frequently than every 4 hr). Acute exacerbations: 4–8 puffs using a spacer device as needed. Via nebulization (nonacute): 500 mcg 3–4 times daily. Via nebulization (acute exacerbations): 500 mcg every 30 min for 3 doses, then every 2–4 hr as needed.
• Inhaln (Adults and Children 5–12 yr): Metered-dose inhaler (nonacute): 1–2 inhalations every 6 hr as needed (not to exceed 12 inhalations/24 hr). Acute exacerbations: 4–8 puffs as needed. Via nebulization (nonacute): 250–500 mcg 4 times daily given every 6 hr. Acute exacerbations: 250 mcg every 20 min for 3 doses, then every 2–4 hr as needed.
• Inhaln (Infants): Nebulization: 125–250 mcg 3 times a day.
• Inhaln (Neonates): Nebulization: 25 mcg/kg/dose 3 times a day.
• Intranasal (Adults and Children >6 yr): 0.03% solution: 2 sprays in each nostril 2–3 times daily (21 mcg/spray).
• Inhaln (Adults and Children >5 yr): 0.06% solution: 2 sprays in each nostril 3–4 times daily (42 mcg/spray).

Atrovent HFA

• Inhaln: Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased concentrations of cyclic guanosine monophosphate (cGMP). Decreased levels of cGMP produce local bronchodilation.
• Intranasal: Local application inhibits secretions from glands lining the nasal mucosa.

• Inhaln: Bronchodilation without systemic anticholinergic effects.
• Intranasal: Decreased rhinorrhea.

Therapeutic Classification: allergy, cold and cough remedies, bronchodilators

Pharmacologic Classification: anticholinergics

Absorption: Minimal systemic absorption (2% for inhalation solution; 20% for inhalation aerosol; <20% following nasal use).

Distribution: 15% of dose reaches lower airways after inhalation.

Metabolism/Excretion: Small amounts absorbed are metabolized by the liver.

Half-life: 2 hr.

(bronchodilation)

• Instruct patient in proper use of inhaler, nebulizer, or nasal spray and to take medication as directed. Take missed doses as soon as remembered unless almost time for the next dose; space remaining doses evenly during day. Do not double doses.
  • Advise patient that rinsing mouth after using inhaler, good oral hygiene, and sugarless gum or candy may minimize dry mouth. Health care professional should be notified if stomatitis occurs or if dry mouth persists for more than 2 wk.
  • Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
• Inhalation: Caution patient not to exceed 12 doses within 24 hr. Patient should notify health care professional if symptoms do not improve within 30 min after administration of medication or if condition worsens.
  • Explain need for pulmonary function tests prior to and periodically during therapy to determine effectiveness of medication.
  • Caution patient to avoid spraying medication in eyes; may cause blurring of vision or irritation.
  • Advise patient to inform health care professional if cough, nervousness, headache, dizziness, nausea, or GI distress occurs.
• Nasal Spray: Instruct patient in proper use of nasal spray. Clear nasal passages gently before administration. Do not inhale during administration, so medication remains in nasal passages. Prime pump initially with 7 actuations. 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.
  • Advise patient to contact health care professional if symptoms do not improve within 1–2 wk or if condition worsens.

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