ipratropium (Rx)

Brand and Other Names:Atrovent, Atrovent HFA
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

metered-dose inhaler

  • 17mcg/actuation

nebulized solution

  • 0.02%

Chronic Obstructive Pulmonary Disease

Maintenance treatment of bronchospasm, including chronic bronchitis and emphysema

Inhaler: 2 actuations (34 mcg) q6hr, then additional actuations PRN; not to exceed 12 actuations/day (408 mcg/day)

Nebulizer: 2.5 mL (500 mcg) q6-8hr

Acute Asthma Exacerbation (Off-label)

Inhaler: 8 actuations (136 mcg) q20min PRN for 3 hr

Nebulizer: 500 mcg q20min for 3 doses, then PRN

Administration

Prime before initial use by releasing 2 test sprays into air; repeat priming if unused for ≥3 days

Dosing Considerations

In treatment of acute asthma exacerbation with inhaler, short-acting beta agonist (SABA) must be coadministered

Dosage Forms & Strengths

metered-dose inhaler

  • 17 mcg/actuation

nebulized solution

  • 0.02%

Acute Asthma Exacerbation (Off-label)

NIH asthma guidelines

  • <5 years (inhaler): 2 inhalations q20min for 1 hr if necessary
  • 5-12 years (inhaler): 4-8 actuations q20 min PRN for up to 3 hr
  • ≥12 years (inhaler): 8 actuations q20 min PRN for up to 3 hr
  • <5 years (nebulizer): 0.25 mg (250 mcg) q20min for 1 hr if necessary
  • 5-12 years (nebulizer): 250-500 mcg q20 min for 3 doses, then PRN
  • ≥12 years (nebulizer): 500 mcg q20 min for 3 doses, then PRN
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Interactions

Interaction Checker

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              Serious - Use Alternative (6)

              • glucagon

                glucagon increases toxicity of ipratropium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .

              • glucagon intranasal

                glucagon intranasal increases toxicity of ipratropium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .

              • macimorelin

                ipratropium, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that may blunt the growth hormone (GH) response to macrimorelin may impact the accuracy of the diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering macimorelin.

              • pramlintide

                pramlintide, ipratropium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

              • revefenacin

                revefenacin and ipratropium both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. Coadministration may cause additive anticholinergic effects.

              • umeclidinium bromide/vilanterol inhaled

                ipratropium, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Concomitant use with other anticholinergic-containing drugs may lead to additive anticholinergic adverse effects.

              Monitor Closely (94)

              • abobotulinumtoxinA

                abobotulinumtoxinA increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

              • aclidinium

                ipratropium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • amantadine

                ipratropium, amantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Potential for increased anticholinergic adverse effects.

              • amitriptyline

                ipratropium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • amoxapine

                ipratropium and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • anticholinergic/sedative combos

                anticholinergic/sedative combos and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • aripiprazole

                ipratropium decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.

                aripiprazole increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • atracurium

                atracurium and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • atropine

                atropine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • atropine IV/IM

                atropine IV/IM and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • belladonna alkaloids

                belladonna alkaloids and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • belladonna and opium

                ipratropium and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • benperidol

                ipratropium decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                benperidol increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • benztropine

                benztropine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.

              • bethanechol

                bethanechol increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • carbachol

                carbachol increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • cevimeline

                cevimeline increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • chlorpromazine

                ipratropium decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.

                chlorpromazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • cisatracurium

                cisatracurium and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • clomipramine

                ipratropium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • clozapine

                ipratropium decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.

                clozapine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • cyclizine

                cyclizine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • cyclobenzaprine

                cyclobenzaprine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • darifenacin

                darifenacin and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • desipramine

                ipratropium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • dicyclomine

                dicyclomine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • diphenhydramine

                diphenhydramine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • donepezil

                donepezil increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • donepezil transdermal

                donepezil transdermal, ipratropium. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.

              • dosulepin

                ipratropium and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • doxepin

                ipratropium and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • droperidol

                ipratropium decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                droperidol increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • echothiophate iodide

                echothiophate iodide increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • fesoterodine

                fesoterodine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • flavoxate

                flavoxate and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • fluphenazine

                ipratropium decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

                fluphenazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • galantamine

                galantamine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • glycopyrrolate

                glycopyrrolate and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • glycopyrrolate inhaled

                glycopyrrolate inhaled and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • glycopyrronium tosylate topical

                glycopyrronium tosylate topical, ipratropium. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

              • haloperidol

                ipratropium decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                haloperidol increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • henbane

                henbane and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • homatropine

                homatropine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • huperzine A

                huperzine A increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • hyoscyamine

                hyoscyamine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • hyoscyamine spray

                hyoscyamine spray and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • iloperidone

                ipratropium decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                iloperidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • imipramine

                ipratropium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • lofepramine

                ipratropium and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • loxapine

                ipratropium decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor.

                loxapine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • loxapine inhaled

                loxapine inhaled increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                ipratropium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.

              • maprotiline

                ipratropium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • meclizine

                ipratropium and meclizine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • methscopolamine

                ipratropium and methscopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • neostigmine

                neostigmine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nortriptyline

                ipratropium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • olanzapine

                ipratropium decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.

                olanzapine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • onabotulinumtoxinA

                onabotulinumtoxinA and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • orphenadrine

                ipratropium and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin

                ipratropium and oxybutynin both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • oxybutynin topical

                ipratropium and oxybutynin topical both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • oxybutynin transdermal

                ipratropium and oxybutynin transdermal both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • paliperidone

                ipratropium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                paliperidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • pancuronium

                ipratropium and pancuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • perphenazine

                ipratropium decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

                perphenazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • physostigmine

                physostigmine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pilocarpine

                pilocarpine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pimozide

                ipratropium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

                pimozide increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • pralidoxime

                ipratropium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • prochlorperazine

                ipratropium decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.

                prochlorperazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • promethazine

                ipratropium decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.

                promethazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • propantheline

                ipratropium and propantheline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • protriptyline

                ipratropium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • pyridostigmine

                pyridostigmine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • quetiapine

                ipratropium decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.

                quetiapine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • rapacuronium

                ipratropium and rapacuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • risperidone

                risperidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • rocuronium

                ipratropium and rocuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • scopolamine

                ipratropium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • solifenacin

                ipratropium and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • succinylcholine

                succinylcholine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • thioridazine

                ipratropium decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.

                thioridazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • thiothixene

                ipratropium decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.

                thiothixene increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • tiotropium

                ipratropium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • tolterodine

                ipratropium and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • trazodone

                ipratropium and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • trifluoperazine

                ipratropium decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.

                trifluoperazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • trihexyphenidyl

                ipratropium and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

              • trimipramine

                ipratropium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • trospium chloride

                ipratropium and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • umeclidinium bromide

                umeclidinium bromide and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agents

              • vecuronium

                ipratropium and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • ziprasidone

                ipratropium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

                ziprasidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • zotepine

                ipratropium decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                ipratropium decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.

              Minor (4)

              • dimenhydrinate

                dimenhydrinate increases toxicity of ipratropium by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

              • donepezil

                donepezil decreases effects of ipratropium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • galantamine

                galantamine decreases effects of ipratropium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • levodopa

                ipratropium, levodopa. Other (see comment). Minor/Significance Unknown. Comment: Anticholinergic agents may enhance the therapeutic effects of levodopa; however, anticholinergic agents can exacerbate tardive dyskinesia. In high dosage, anticholinergics may decrease the effects of levodopa by delaying its GI absorption. .

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              Adverse Effects

              >10%

              Bronchitis (10-23%)

              Chronic obstructive pulmonary disease (COPD) exacerbation (8-23%)

              Sinusitis (1-14%)

              1-10%

              Dyspnea (4-10%)

              Urinary tract infection (UTI) (2-10%)

              Headache (5-9%)

              Flulike symptoms (2-8%)

              Back pain (2-7%)

              Cough (5.9%)

              Dyspepsia (1-5%)

              Dry mouth (2-4%)

              Dizziness (1-3%)

              Nausea (2.8%)

              Frequency Not Defined

              Cardiovascular: Hypotension, palpitations, tachycardia

              General: Dry throat, throat irritation

              Gastrointestinal (GI): Constipation, stomatitis, mouth edema

              Sensory: Narrow-angle glaucoma, glaucoma, halo vision, conjunctival hyperemia, corneal edema, mydriasis, acute eye pain, blurry vision

              Respiratory: Bronchospasm, including paradoxical bronchospasm

              Renal: Urinary retention

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              Warnings

              Contraindications

              Documented hypersensitivity to ipratropium, atropine, or derivatives

              Cautions

              Use for maintenance treatment only; should not be used as rescue therapy

              Inhaled bronchodilating agents may cause life-threatening paradoxical bronchospasm that should be differentiated from inadequate response

              Hypersensitivity reactions (skin rash, pruritus, angioedema, urticaria/giant urticaria, laryngospasm) reported; discontinue immediately, and use alternative treatment

              May cause urinary retention; use with caution in patients with benign prostatic hyperplasia (BPH) or bladder-neck obstruction

              Use caution in patients with myasthenia gravis

              May worsen narrow-angle glaucoma

              Inhalation/nebulizer not indicated for initial treatment of acute episodes of bronchospasm; rescue therapy required

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              Pregnancy & Lactation

              Pregnancy

              Ipratropium is negligibly absorbed systemically following oral inhalation; therefore, maternal use is not expected to result in fetal exposure to the drug

              Experience with ipratropium bromide use in pregnant women over several decades, based on published literature, including cohort studies, case control studies and case series, have not identified a drug associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes

              Animal data

              • Based on animal reproduction animal studies, no evidence of structural alternations was observed when ipratropium bromide was administered to pregnant mice, rats and rabbits during organogenesis at doses up to approximately 200, 40,000, and 10,000 times, respectively, the maximum recommended human daily inhalation dose (MRHDID) in adults

              Lactation

              There are no data on presence of drug in either human or animal milk, effects on breastfed infant, or on milk production; although lipid- insoluble quaternary cations pass into breast milk, drug concentrations in plasma after inhaled therapeutic doses are low; therefore, drug levels in human breast milk are expected to be low

              Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed child from drug or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Anticholinergic (parasympatholytic) agent; inhibits vagally mediated reflexes by antagonizing acetylcholine action; prevents increase in intracellular calcium concentration that is caused by interaction of acetylcholine with muscarinic receptors on bronchial smooth muscle

              Absorption

              Minimal systemic absorption

              Onset: 15 min

              Duration: 3-4 hr

              Peak plasma time: 1-3 hr

              Peak plasma concentration: 0.06 ng/mL

              Distribution

              Protein bound: 0-9%

              Vd: 338 L

              Metabolism

              Metabolized in liver

              Metabolites: N-isopropylnortropium methobromide, a-phenylacrylic acid-N-isopropylnortropine-ester methobromide, 6 others

              Elimination

              Half-life: 2 hr

              Excretion: Urine (46%)

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              ipratropium bromide nasal
              -
              21 mcg (0.03 %) aerosol
              ipratropium bromide nasal
              -
              42 mcg (0.06 %) aerosol
              ipratropium bromide nasal
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              42 mcg (0.06 %) aerosol
              ipratropium bromide nasal
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              21 mcg (0.03 %) aerosol
              ipratropium bromide nasal
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              42 mcg (0.06 %) aerosol
              ipratropium bromide nasal
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              21 mcg (0.03 %) aerosol
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              ipratropium bromide inhalation
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              0.02 % solution
              Atrovent HFA inhalation
              -
              17 mcg/actuation aerosol

              Copyright © 2010 First DataBank, Inc.

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              Patient Education
              ipratropium bromide inhalation

              IPRATROPIUM HFA INHALER - ORAL INHALATION

              (IP-ra-TROE-pee-um)

              COMMON BRAND NAME(S): Atrovent

              USES: Ipratropium is used to control and prevent symptoms (wheezing and shortness of breath) caused by ongoing lung disease (chronic obstructive pulmonary disease-COPD which includes bronchitis and emphysema). It works by relaxing the muscles around the airways so that they open up and you can breathe more easily. Controlling symptoms of breathing problems can decrease time lost from work or school.For preventing symptoms of lung disease, this medication must be used regularly to be effective. Use your quick-relief inhaler (such as albuterol, also called salbutamol in some countries) for wheezing or sudden shortness of breath unless otherwise directed by your doctor. Ipratropium does not work as fast as your quick-relief inhaler, but may sometimes be used to relieve symptoms of wheezing or sudden shortness of breath if so prescribed by your doctor.

              HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start using ipratropium and each time you get a refill. Learn how to use this inhaler properly. If you have any questions, ask your doctor or pharmacist.Follow the instructions for priming the inhaler if you are using it for the first time or if you have not used it for more than 3 days. When priming the inhaler, make sure to spray away from the face so that you do not get the medication into your eyes.Inhale this medication by mouth as directed by your doctor, usually 4 times a day. Avoid getting this medication into your eyes. It may cause eye pain/irritation, temporary blurred vision, and other vision changes. When using the inhaler, put your lips tightly around the mouthpiece and keep your eyes closed.If your prescribed dose is 2 puffs, wait at least one minute between them. If you are using other inhalers at the same time, wait at least 1 minute between the use of each medication.Rinse your mouth after using the inhaler to prevent dry mouth and throat irritation.Dosage is based on your medical condition and response to treatment.Clean the mouthpiece of the inhaler once a week with water. Allow to air-dry fully before using again.If you are directed to use this medication regularly, it works best if used at evenly spaced intervals. To help you remember, use it at the same times each day. Do not increase your dose, use this medication more frequently, or stop using it without first consulting your doctor.Keep track of the number of inhalations you use, and throw away the canister after you have used the labeled number of inhalations on the package.Tell your doctor if your symptoms do not improve or if they worsen.Learn which of your inhalers you should use every day (controller drugs) and which you should use if your breathing suddenly worsens (quick-relief drugs). Ask your doctor ahead of time what you should do if you have new or worsening cough or shortness of breath, wheezing, increased sputum, worsening peak flow meter readings, waking up at night with trouble breathing, if you use your quick-relief inhaler more often (more than 2 days a week), or if your quick-relief inhaler does not seem to be working well. Learn when you can treat sudden breathing problems by yourself and when you must get medical help right away.

              SIDE EFFECTS: See also How to Use section.Dizziness, nausea, stomach upset, dry mouth, or constipation may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Rarely, this medication may cause severe sudden worsening of breathing problems right after use. If you have sudden worsening of breathing, use your quick-relief inhaler and get medical help right away.Tell your doctor right away if you have any serious side effects, including: fast/pounding heartbeat, difficult/painful urination.Get medical help right away if you have any very serious side effects, including: eye pain/swelling/redness, vision changes (such as seeing rainbows around lights at night, blurred vision).A very serious allergic reaction to this product is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using ipratropium, tell your doctor or pharmacist if you are allergic to it or tiotropium; or to atropine or other belladonna-type drugs; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal or family history of glaucoma (angle-closure type), difficulty urinating (for example, due to enlarged prostate).This drug may make you dizzy or blur your vision or cause vision changes. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially problems urinating or constipation.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.

              MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Do not puncture the canister or use near an open flame. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised August 2021. Copyright(c) 2022 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.