Ipratropium Bromide

Registered South African indications:

• Chronic obstructive pulmonary disease
• Asthma

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients 
• Children (Inhaler)
• Children under 6 (Nebulised solution)

Cautions

• Breastfeeding
• Closed angle glaucoma
• Urinary outflow tract obstruction
• Cystic fibrosis

Forms avail. in SA and covered in this monograph: inh, neb

Chronic obstructive pulmonary disease

• Inhaled (inh): 20-80μg, 6-8hrly; Max: 320μg/24hrs
• Inhaled (neb): 250-500μg, 6-8hrly; Max: 2mg/24hrs 

Acute asthma (Additional agent required)

• Inhaled (inh): 20-80μg, 6-8hrly; Max: 320μg/24hrs
• Inhaled (neb): 500μg, can be repeated until patient is stable (dosing interval to be determined by doctor); Max: 2mg/24hrs 

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Nebulised solution can be diluted to a final volume of 2-4ml

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Flow rate of oxygen 6-8 liters per minute

Paed. forms avail. in SA and covered in this monograph: neb

Acute asthma (Additional agent required)

Younger than 6 years

• Not established for use  

Between 6-12 years

• Inhaled (neb): 0.25mg, 6-8hrly; Max: 1mg/24hrs 

Older than 12 years

• See adult dosage 

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Nebulised solution can be diluted to a final volume of 2-4ml

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Flow rate of oxygen 6-8 liters per minute

Pregnancy

• Caution; no evidence of risk in studies
• The safety of ipratropium during human pregnancy has not been established. The benefits of using ipratropium during a confirmed or suspected pregnancy must be weighed against the possible hazards to the unborn child. Nonclinical studies have shown no embryotoxic or teratogenic effects following inhalation or intranasal application at doses considerably higher than those recommended in man

Breastfeeding

• Caution
• It is not known whether ipratropium bromide is excreted into breast milk. It is unlikely that ipratropium bromide would reach the infant to an important extent, however, caution should be exercised when ipratropium is administered to nursing mothers

Renal Impairment

• No dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended

Elderly

• No dose adjustment recommended

Porphyria Information

• Probably not porphyrinogenic (PNP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Headache
• Dizziness

Cardiovascular Disorders

• Palpitations
• Supraventricular tachycardia
• Atrial fibrillation

Respiratory Disorders

• Throat irritation
• Cough
• Bronchospasm
• Paradoxical bronchospasm
• Laryngospasm
• Pharyngeal oedema

Gastrointestinal  Disorders

• Diarrhoea
• Constipation
• Nausea and vomiting 
• Stomatitis
• Dry mouth

Genitourinary Disorders

• Urinary retention

Skin and Subcutaneous Tissue Disorders

• Rash
• Pruritus
• Urticaria

Immune, Blood and Lymphatic System Disorder

• Hypersensitivity
• Anaphylactic reaction
• Angioedema

Sensory Disorders

• Blurred vision
• Mydriasis 
• Increased intraocular pressure 
• Glaucoma 
• Eye pain 
• Halo vision
• Conjunctival hyperaemia
• Corneal oedema
• Accommodation disorder 

• Beta agonists
• Methylxanthines

None routine 

Ipratopium Bromide inhaler, Ipratropium Bromide solution - EML (Primary healthcare level) 

Ipratropium bromide is a quaternary ammonium compound with anticholinergic properties. It inhibits vagally-mediated reflexes by antagonising the action of acetylcholine in bronchial smooth muscle cells, facilitating bronchodilation.

Inhaler 0.02mg

• Atrovent 20 Hfa (Ingelheim) originator

Inhaler 40μg

• Ipvent-40 Hfa (Cipla Medpro)

Nebuliser Solution (per ml) 0.25mg

• Tropivent (Arrow)

Nebuliser Solution (per 2ml) 0.25mg

• Adco Ipatropium (adcock)
• Atrovent 0.25 UDV (Ingelheim) originator
• Sabax Ipratropium Br 0,25Mg/2Ml (Adcock) originator 

Nebuliser solution (2ml) 0.5mg

• Adco Ipatropium (adcock)
• Atrovent 0.5 UDV (Ingelheim) originator
• Ipvent Respules (Cipla Medpro)
• Sabax Ipratropium Br 0,5Mg/2Ml (Adcock) originator

COMBINATION PREPARATIONS

Salbutamol/ Ipratropium bromide

Inhaler 100μg/20μg

• Duolin Hfa Inhaler (Cipla Medpro)

Nebuliser Solution (per 2.5ml) 3mg/0.5mg

• Co-Iprasal Solution (Arrow)

Nebuliser Solution (per 2.5ml) 2.5mg/0.5mg 

• Sabax Combineb (Adcock) 
• Combivent UDV (Ingelheim) originator
• Duolin Respules (Cipla Medpro)

Fenoterol hydrobromide/ Ipratropium bromide

Nebuliser solution (per 4ml) 1.25mg/0.5mg

• Sabax Nebrafen (Adcock)

Inhaler 50μg/20μg

• Duovent HFA (Ingelheim) originator

Nebuliser Solution (per 4ml) 1.25mg/0.5mg

• Atrovent Beta UDV (Ingelheim) originator