Ipratropium bromide

Ipratropium bromide
Clinical data
Trade namesAtrovent, Apovent, Ipraxa, others
AHFS/Drugs.comMonograph
MedlinePlusa618013
License data
Pregnancy
category
  • AU: B1
Routes of
administration
Inhalation, intranasal
Drug classAnticholinergic (muscarinic antagonist)
ATC code
Legal status
Legal status
  • NZ: Prescription only
  • UK: POM (Prescription only)
  • US: ℞-only
Pharmacokinetic data
Protein binding0–9% in vitro
MetabolismLiver
Onset of action15–30 minutes
Elimination half-life2 hours
Duration of action3–5 hours
Identifiers
  • [8-methyl-8-(1-methylethyl)- 8-azoniabicyclo[3.2.1] oct-3-yl] 3-hydroxy-2-phenyl-propanoate
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.040.779 Edit this at Wikidata
Chemical and physical data
FormulaC20H30BrNO3
Molar mass412.368 g·mol−1
3D model (JSmol)
  • CC(C)[N+]1(C2CCC1CC(C2)OC(=O)C(CO)C3=CC=CC=C3)C.[Br-]
  • InChI=1S/C20H30NO3.BrH/c1-14(2)21(3)16-9-10-17(21)12-18(11-16)24-20(23)19(13-22)15-7-5-4-6-8-15;/h4-8,14,16-19,22H,9-13H2,1-3H3;1H/q+1;/p-1/t16-,17+,18+,19?,21?;
  • Key:LHLMOSXCXGLMMN-WDTICOSOSA-M
 ☒NcheckY (what is this?)  (verify)

Ipratropium bromide, sold under the brand name Atrovent among others, is a type of anticholinergic medication which is applied by different routes: inhaler, nebulizer, or nasal spray, for different reasons.[1][2]

The inhalant opens up the medium and large airways in the lungs.[3][4] It is used to treat the symptoms of chronic obstructive pulmonary disease (COPD) and asthma.[3] It is used by inhaler or nebulizer.[3] Onset of action is typically within 15 to 30 minutes and lasts for three to five hours.[3]

The nasal spray prevents the glands in the nose from producing large amounts of fluid.[5][6] It is used to treat rhinorrhea (runny nose) caused by allergic rhinitis, nonallergic rhinitis,[5] and the common cold.[7][2] It is used by metered-dose manual pump spray. Onset of action is within an hour.[7]

Common side effects of inhalant use include dry mouth, cough, inflammation of the airways,[3] and shortness of breath.[8] Potentially serious side effects include urinary retention, worsening spasms of the airways, and a severe allergic reaction.[3] It appears to be safe in pregnancy and breastfeeding.[3][9] Ipratropium is a short-acting muscarinic antagonist,[10] which works by causing smooth muscles to relax.[3]

Common side effects of nasal spray may include headache, dry nose, dry mouth or throat, nasal or throat irritation, nosebleeds, bad taste in mouth, nausea, dizziness, or constipation.[7] Potentially serious side effects are unusual, but include severe allergic reaction, eye pain or change in vision, or urinary retention. It is considered safe during pregnancy, but it can pass into breast milk and may harm a nursing baby.[11]

Ipratropium bromide was patented in 1966, and approved for medical use in 1974.[12] It is on the World Health Organization's List of Essential Medicines, the most important medicines needed in a health system.[13] Ipratropium is available as a generic medication.[3] In 2021, it was the 269th most commonly prescribed medication in the United States, with more than 1 million prescriptions.[14][15]

Ipratropium nasal spray is no longer sold under the brand name Atrovent, just the generic. The FDA has found Atrovent was not withdrawn from sale for reasons of safety or effectiveness.[16]

  1. ^ Rxlist.com: Search Atrovent
  2. ^ a b Rx.com: Ipratropium
  3. ^ a b c d e f g h i "Ipratropium Bromide". The American Society of Health-System Pharmacists. Archived from the original on 8 December 2015. Retrieved 2 December 2015.
  4. ^ Al-Ahmad M, Hassab M, Al Ansari A (21 December 2020). "Allergic and Non-allergic Rhinitis". Textbook of Clinical Otolaryngology. Cham: Springer International Publishing. pp. 241–252. doi:10.1007/978-3-030-54088-3_22. ISBN 978-3-030-54087-6. S2CID 234142758. Nasal anticholinergics such as ipratropium bromide 0.03% are effective in controlling rhinorrhea, but do not relief other nasal symptoms. They block muscarinic receptors, leading to a decrease in the parasympathetic function.
  5. ^ a b Mayo Clinic: Ipratropium (Nasal Route)
  6. ^ Cleveland Clinic: Ipratropium Nasal Spray
  7. ^ a b c Rxlist.com: Atrovent Nasal Spray
  8. ^ RxList.com: Atrovent HFA
  9. ^ Briggs G, Freeman RK, Yaffe SJ (2011). Drugs in pregnancy and lactation : a reference guide to fetal and neonatal risk (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 763. ISBN 978-1-60831-708-0.
  10. ^ Ritter J, Flower RJ, Henderson G, Loke YK, MacEwan DJ, Rang HP (2020). Rang and Dale's pharmacology (9th ed.). Edinburgh. p. 377. ISBN 978-0-7020-8060-9. OCLC 1081403059.{{cite book}}: CS1 maint: location missing publisher (link)
  11. ^ Drugs.com: Ipratropium nasal
  12. ^ Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 446. ISBN 978-3-527-60749-5.
  13. ^ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  14. ^ "The Top 300 of 2021". ClinCalc. Archived from the original on 15 January 2024. Retrieved 14 January 2024.
  15. ^ "Ipratropium - Drug Usage Statistics". ClinCalc. Retrieved 14 January 2024.
  16. ^ Federal Register: Determination That ATROVENT (Ipratropium Bromide) Metered Spray, 0.021 Micrograms/Spray and 0.042 Micrograms/Spray, Were Not Withdrawn From Sale for Reasons of Safety or Effectiveness