Ipratropium Bromide

Ipratropium Bromide

[1 nebule 26 cents]

ADMINISTRATION ROUTES:

  • INH, NEB

ALTERNATIVE NAMES:

  • Atrovent, Combivent (ipratropium + salbutamol), Duolin (ipratropium + salbutamol)

ICU INDICATIONS:

  1. bronchospasm

PRESENTATION AND ADMINISTRATION:

  • Inh:
    Atrovent inhaler 20mcg/dose
    Combivent inhaler 20mcg atrovent per dose and 100mcg salbutamol per dose
  • Neb:
    Ipratropium steri-neb 500mcg/2ml
    Duolin 500mcg ipratropium and salbutamol 2.5mg per 2.5ml

DOSAGE:

  • Inh:
    2 puffs 4 times per day or, if ventilated, 5 puffs via metered dose inhaler adaptor into ventilator circuit
  • Neb
    1 ampoule of Ipratropium or Duolin four times a day

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • Neb:
    0.25-1ml of 250mcg/ml solution diluted to 4ml. In a severe attack administer every 20 minutes for 3 doses then administer 4 to 6 hourly after that.

CLINICAL PHARMACOLOGY:

  • Ipratropium bromide is an anticholinergic (parasympatholytic) agent. Anticholinergics prevent the increases in intracellular concentration of cyclic guanosine monophosphate (cyclic GMP) which are caused by interaction of acetylcholine with the muscarinic receptor on bronchial smooth muscle.

CONTRAINDICATIONS

  1. hypersensitivity to ipratropium bromide
  2. hypersensitivity to atropine or its derivatives.

WARNINGS

  • Immediate hypersensitivity reactions may occur after administration of ipratropium bromide, as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, anaphylaxis and oropharyngeal edema. Inhaled medicines, including ipratropium bromide, may cause paradoxical bronchospasm. If this occurs, treatment with ipratropium bromide aerosol should be stopped and other treatments

PRECAUTIONS

  • General:
    Ipratropium should be used with caution in patients with narrow-angle glaucoma, prostatic hypertrophy or bladder-neck obstruction.
  • Laboratory Tests: No tests in addition to routine ICU tests are required.
  • Drug/Laboratory Test Interactions: None noted.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • None of note.

ADVERSE REACTIONS

  • Body as a Whole:
    Back pain, headache
  • Central and Peripheral Nervous System:
    Dizziness
  • GI System:
    Dyspepsia, mouth dry, nausea
  • Respiratory System:
    Coughing, dyspnoea, rhinitis, sinusitis
  • Urinary System:
    Urinary tract infection

Critical Care Drug Manual

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