Embedded Files
Pharmacologic Category
Dosing: Adult
COPD: Inhalation:
Metered-dose inhaler (MDI): 2 inhalations (34 mcg) 4 times daily; maximum dose: 12 inhalations (204 mcg)/day
Nebulization solution: 0.5 mg (500 mcg, one unit-dose vial) every 6 to 8 hours
Acute asthma (exacerbations) (off-label use): Moderate to severe exacerbations:
Inhalation: Note: Should be given in combination with a short-acting beta-adrenergic agonist.
MDI: 8 inhalations (136 mcg) every 20 minutes as needed for up to 3 hours (NAEPP 2007)
Nebulization solution: 0.5 mg (500 mcg, one unit-dose vial) every 20 minutes for 3 doses, then as needed (NAEPP 2007)
* See Dosage and Administration in AHFS Essentials for additional information.
Dosing: Geriatric
Refer to adult dosing.
Dosing: Renal Impairment: Adult
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
Dosing: Hepatic Impairment: Adult
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
Dosing: Pediatric
Asthma, acute exacerbation: Limited data available (GINA 2018; NAEPP 2007): Note: For moderate to severe exacerbations, ipratropium may be considered if poor response to initial short-acting beta-2 agonist (SABA) therapy during initial management in an acute care setting (eg, emergency department). Ipratropium has not been shown to provide further benefit (eg, after first 24 hours) once the patient is hospitalized (GINA 2018; Vézina 2014):
Children:
Nebulization: 0.25 to 0.5 mg (250 to 500 mcg) every 20 minutes for 1 hour (ie, 3 doses), then as needed; in trials, the usual reported dose is 0.25 mg (250 mcg) and reported interval range is every 1 to 8 hours typically with an increasing dosing interval as patient improves; some trials continued combination SABA/ipratropium therapy for duration of hospitalization (up to 49 hours) although trials have not demonstrated additional benefit with extended use (Vézina 2014)
Metered-dose inhaler: 4 to 8 puffs every 20 minutes as needed for up to 3 hours
Adolescents:
Nebulization: 0.5 mg (500 mcg) every 20 minutes for 3 doses, then as needed
Metered-dose inhaler: 8 puffs every 20 minutes as needed for up to 3 hours
Asthma, maintenance (nonacute): Limited data available: Note: Evidence is lacking that ipratropium provides added benefit to beta-2 agonists in long-term control asthma therapy (GINA 2018; NAEPP 2007):
Children <12 years:
Nebulization: 0.25 to 0.5 mg (250 to 500 mcg) every 6 to 8 hours
Metered-dose inhaler: 1 to 2 inhalations every 6 hours; not to exceed 12 inhalations/day
Children ≥12 years and Adolescents:
Nebulization: 0.25 to 0.5 mg (250 to 500 mcg) every 6 hours
Metered-dose inhaler: 2 to 3 inhalations every 6 hours; maximum daily dose: 12 inhalations/day
Bronchospasm associated with chronic pulmonary conditions: Children ≥12 years and Adolescents: Nebulization: 0.5 mg (500 mcg, one unit-dose vial) 3 to 4 times daily with doses 6 to 8 hours apart
Bronchospasm, wheezing: Limited data available; efficacy results variable: Infants: Nebulization: 0.125 to 0.25 mg (125 to 250 mcg) every 4 hours has been found helpful in some infants with chronic or recurrent wheezing, and some patients with bronchiolitis; however, most bronchiolitis data suggests ipratropium is not effective (Hodges 1981; Prendiville 1987; Schuh 1992; Stokes 1983; Wang 1992).
Dosing: Renal Impairment: Pediatric
There are no dosage adjustments provided in the manufacturer's labeling (not studied); however, dosage adjustment unlikely necessary due to low systemic absorption.
Dosing: Hepatic Impairment: Pediatric
There are no dosage adjustments provided in the manufacturer's labeling (not studied); however, dosage adjustment unlikely necessary due to low systemic absorption.
Use: Labeled Indications
Chronic obstructive pulmonary disease: Maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema
* See Uses in AHFS Essentials for additional information.
Use: Off-Label: Adult
Acute asthma (exacerbations)Level of Evidence [A, G]
Based on the National Heart, Lung, and Blood Institute (NHLBI)/National Asthma Education and Prevention Program (NAEPP) guidelines, the use of ipratropium in combination with a short-acting beta-agonist (SABA), such as albuterol, is an effective and recommended treatment in the management of patients with asthma exacerbation. Controlled trials and a meta-analysis have demonstrated that the addition of ipratropium to SABA therapy in the management of moderate to severe acute asthma exacerbations has been associated with a decreased risk of hospitalization and an improvement in lung function. Access Full Off-Label Monograph
Level of Evidence Definitions
Level of Evidence Scale
Class and Related Monographs
Anticholinergics (Bronchodilators)
Clinical Practice Guidelines
Asthma:
Global Strategy for Asthma Management and Prevention (GINA), 2018 Update
NHLBI and NAEPP The Expert Panel Report 3: “Guidelines for the Diagnosis and Management of Asthma,” Full Report 2007
COPD:
ACCP/CTS, “Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: American College of Chest Physicians and Canadian Thoracic Society Guideline,” 2014
Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease, 2007 Update
Global Strategy for Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (GOLD), 2018
Exercise-induced Bronchoconstriction:
AAAAI and ACAAI, “Exercise-induced Bronchoconstriction,” Update - 2016
Administration: Inhalation
For oral inhalation; avoid spraying in eyes.
Metered-dose inhaler: Prior to initial use, prime inhaler by releasing 2 test sprays into the air; inhaler does not require shaking. If the inhaler has not been used for >3 days, reprime. Wash mouthpiece once a week for 30 seconds in warm water only and let air dry. Discard inhaler once dose indicator displays “0.”
Nebulization solution: Remove unit dose vial from foil pouch and squeeze contents into nebulizer reservoir; connect nebulizer to compressor. Breathe deeply and evenly until all medication has been inhaled; inhalation time is about 5 to 15 minutes. Clean nebulizer after use.
Administration: Pediatric
Inhalation:
Nebulization: May be administered with or without dilution in NS; use of a nebulizer with a mouth piece, rather than a face mask, may be preferred to prevent contact with eyes
Oral Inhalation (metered-dose inhaler): Atrovent HFA: Prior to initial use, prime inhaler by releasing 2 test sprays into the air. If the inhaler has not been used for >3 days, reprime. Avoid spraying into the eyes. Use spacer device in children <8 years; use spacer device and face mask for children ≤4 years.
Storage/Stability
Metered-dose inhaler: Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Exposure to temperatures >48°C (120°F) may cause bursting. Do not puncture inhaler, throw into a fire or incinerator, or use or store near heat or open flame.
Nebulization solution: Store at 15°C to 30°C (59°F to 86°F). Protect from light. Store unused vials in foil pouch.
Medication Patient Education with HCAHPS Considerations
What is this drug used for?
• It is used to open the airways in lung diseases where spasm may cause breathing problems.
• This drug is not to be used to treat intense flare-ups of shortness of breath. Use a rescue inhaler. Talk with the doctor.
Frequently reported side effects of this drug
• Back pain
• Headache
• Dry mouth
• Flu-like symptoms
• Nasal irritation
• Sore throat
• Stuffy nose
Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:
• Urinary tract infection like blood in the urine, burning or painful urination, passing a lot of urine, fever, lower abdominal pain, or pelvic pain.
• Vision changes
• Eye pain
• Severe eye irritation
• Seeing halos or bright colors around lights
• Red eyes
• Difficulty urinating
• Unable to pass urine
• Passing a lot of urine
• Severe dizziness
• Passing out
• Fast heartbeat
• Abnormal heartbeat
• Mouth sores
• Mouth irritation
• Difficulty breathing
• Wheezing
• Cough
• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.
Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.
Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.
Medication Safety Issues
Sound-alike/look-alike issues:
Contraindications
Hypersensitivity to ipratropium, atropine (and its derivatives), or any component of the formulation
Warnings/Precautions
Concerns related to adverse effects:
• Bronchospasm: Paradoxical bronchospasm that may be life-threatening and may occur with use of inhaled bronchodilating agents; this should be distinguished from inadequate response. If paradoxical bronchospasm occurs, discontinue ipratropium and institute alternative therapy.
• CNS effects: May cause dizziness and blurred vision; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).
• Hypersensitivity reactions: Hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm, oropharyngeal edema), including anaphylaxis, have been reported. Discontinue therapy immediately if patient develops an allergic reaction.
Disease-related concerns:
• Glaucoma: Use with caution in patients with narrow-angle glaucoma; may increase intraocular pressure.
• Prostatic hyperplasia/bladder neck obstruction: Use with caution in patients with prostatic hyperplasia or bladder neck obstruction; may cause urinary retention.
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions for more detailed information.
Other warnings/precautions:
• Appropriate use: Not indicated for the initial treatment of acute episodes of bronchospasm where rescue therapy is required for rapid response. Only use in acute exacerbations of asthma in conjunction with short-acting beta-adrenergic agonists for acute episodes (NAEPP 2007).
* See Cautions in AHFS Essentials for additional information.
Geriatric Considerations
Older adults may be more susceptible to the anticholinergic side effects of ipratropium (eg, dry eyes, dry mouth). The elderly may find it difficult to use the metered-dose inhaler. A spacer device may be useful. Monitor urinary function in elderly men with benign prostatic hyperplasia while on this medication.
Pregnancy Considerations
Systemic exposure following inhalation is negligible; maternal use is not expected to result in fetal exposure. Based on available information, an increased risk of adverse maternal or fetal outcomes has not been observed following use during pregnancy.
Breast-Feeding Considerations
It is not known if ipratropium is present in breast milk.
Systemic exposure following inhalation is negligible which would limit excretion into breast milk. According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.
Briggs' Drugs in Pregnancy & Lactation
Adverse Reactions
>10%: Respiratory: Bronchitis (10% to 23%), exacerbation of chronic obstructive pulmonary disease (8% to 23%), sinusitis (1% to 11%)
1% to 10%:
Central nervous system: Headache (6% to 7%), dizziness (3%)
Gastrointestinal: Dyspepsia (1% to 5%), nausea (4%), xerostomia (2% to 4%), dysgeusia (1%)
Genitourinary: Urinary tract infection (2% to 10%)
Neuromuscular & skeletal: Back pain (2% to 7%)
Respiratory: Dyspnea (7% to 8%), flu-like symptoms (4% to 8%), cough (>3%), rhinitis (>3%), upper respiratory tract infection (>3%)
<1%, postmarketing, and/or case reports: Accommodation disturbance, acute eye pain, anaphylaxis, angioedema, blurred vision, bronchospasm, conjunctival hyperemia, constipation, corneal edema, decreased gastrointestinal motility, diarrhea, dry throat, glaucoma, hypersensitivity reaction, hypotension, increased intraocular pressure, laryngospasm, mouth edema, mydriasis, nausea, palpitations, pharyngeal edema, pruritus, skin rash, stomatitis, tachycardia, throat irritation, urinary retention, urticaria, visual halos around lights, vomiting
* See Cautions in AHFS Essentials for additional information.
Allergy and Idiosyncratic Reactions
Toxicology
Metabolism/Transport Effects
None known.
Drug Interactions Open Interactions
Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Risk C: Monitor therapy
Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Anticholinergic Agents: Ipratropium (Oral Inhalation) may enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Botulinum Toxin-Containing Products: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol. Risk C: Monitor therapy
Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Risk C: Monitor therapy
Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Risk X: Avoid combination
Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Risk X: Avoid combination
Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Risk C: Monitor therapy
Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor therapy
Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Risk X: Avoid combination
Glycopyrronium (Topical): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Risk C: Monitor therapy
Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Risk X: Avoid combination
Loxapine: Agents to Treat Airway Disease may enhance the adverse/toxic effect of Loxapine. More specifically, the use of Agents to Treat Airway Disease is likely a marker of patients who are likely at a greater risk for experiencing significant bronchospasm from use of inhaled loxapine. Management: This is specific to the Adasuve brand of loxapine, which is an inhaled formulation. This does not apply to non-inhaled formulations of loxapine. Risk X: Avoid combination
Methacholine: Ipratropium (Oral Inhalation) may diminish the therapeutic effect of Methacholine. Management: Hold ipratropium for 12 hours before methacholine use. Risk D: Consider therapy modification
Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Risk C: Monitor therapy
Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Risk C: Monitor therapy
Opioid Agonists: Anticholinergic Agents may enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. Risk C: Monitor therapy
Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid combination
Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Risk X: Avoid combination
Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Risk D: Consider therapy modification
Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Risk C: Monitor therapy
Revefenacin: Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. Risk X: Avoid combination
Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Risk D: Consider therapy modification
Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy
Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Risk X: Avoid combination
Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Risk C: Monitor therapy
Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Monitoring Parameters
FEV1, peak flow, and/or other pulmonary function tests; signs/symptoms of glaucoma; hypersensitivity reactions; urinary retention
Advanced Practitioners Physical Assessment/Monitoring
Assess pulmonary function tests. Educate patient on the importance of proper administration.
Nursing Physical Assessment/Monitoring
Check ordered pulmonary function tests. Educate patient importance of proper administration.
Dosage Forms Considerations
Atrovent HFA 12.9 g canister contains 200 inhalations.
Dosage Forms: US
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Aerosol Solution, Inhalation, as bromide:
Atrovent HFA: 17 mcg/actuation (12.9 g) [contains alcohol, usp]
Solution, Inhalation, as bromide:
Generic: 0.02% (2.5 mL)
Solution, Inhalation, as bromide [preservative free]:
Generic: 0.02% (2.5 mL)
Dosage Forms: Canada
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Aerosol Solution, Inhalation:
Atrovent HFA: 20 mcg/actuation (1 ea) [contains alcohol, usp]
Nebulization Solution, Inhalation:
Generic: 0.125 mg/mL (2 mL); 0.25 mg/mL (0.5 mL, 1 mL, 2 mL, 20 mL)
Anatomic Therapeutic Chemical (ATC) Classification
- R03BB01
Generic Available (US)
May be product dependent
Pricing: US
Aerosol solution (Atrovent HFA Inhalation)
17 mcg/ACT (per gram): $38.27
Solution (Ipratropium Bromide Inhalation)
0.02% (per mL): $0.53 - $0.89
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Mechanism of Action
Blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation; local application to nasal mucosa inhibits serous and seromucous gland secretions.
Pharmacodynamics/Kinetics
Onset of action: Bronchodilation: Within 15 minutes
Peak effect: 1 to 2 hours
Duration: Metered-dose inhaler: 2 to 4 hours; Nebulization solution: 4 to 5 hours, up to 7 to 8 hours in some patients
Absorption: Not readily absorbed into the systemic circulation from the surface of the lung or from the GI tract; ~7% absorbed after nebulization of a 2 mg dose
Distribution: 15% of dose reaches lower airways
Protein Binding: ≤9%
Metabolism: Partially metabolized to inactive ester hydrolysis products
Half-life elimination: 2 hours
Excretion: Urine (50%)
Local Anesthetic/Vasoconstrictor Precautions
No information available to require special precautions
Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Xerostomia and changes in salivation (normal salivary flow resumes upon discontinuation), and dry mucous membranes.
Effects on Bleeding
No information available to require special precautions
Related Information
Index Terms
Ipratropium Bromide
FDA Approval Date
December 29, 1986
References
Atrovent HFA (ipratropium) [prescribing information]. Ridgefield, CT: Boehringer Inhelheim Pharmaceuticals Inc; January 2020.
Brundage KL Mohsini KG, Froese AB, et al. Bronchodilator response to ipratropium bromide in infants with bronchopulmonary dysplasia. Am Rev Respir Dis. 1990;142:1137-1142.[PubMed 2146910]
Fayon M, Tayara N, Germain C, et al. Efficacy and tolerance of high-dose inhaled ipratropium bromide vs. terbutaline in intubated premature human neonates. Neonatology. 2007;91:167-173.[PubMed 17377401]
Global Initiative for Asthma (GINA). GINA report, Global Strategy for Asthma Management and Prevention. https://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/. Updated 2018. Accessed September 30, 2018.
Griffiths B, Ducharme FM. Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. Cochrane Database Syst Rev. 2013;8:CD000060.[PubMed 23966133]
Henry RI, Hiller EG, Milner AD, et al, “Nebulized Ipratropium Bromide and Sodium Cromoglycate in the First 2 Years of Life,” Arch Dis Child, 1984, 59(1):54-7.[PubMed 6230059]
Hodges IGC, Groggins RC, Milner AD, et al. Bronchodilator effect of inhaled ipratropium bromide in wheezy toddlers. Arch Dis Child. 1981;56(9):729-732.[PubMed 6457571]
Hughes DT, “The Use of Anticholinergic Drugs in Nocturnal Asthma,” Postgrad Med J, 1987, 63(Suppl 1):47-51.
Ipratropium bromide inhalation solution [prescribing information]. Morgantown, WV: Mylan Pharmaceuticals Inc; May 2013.
Lee H, Arnon S, Silverman M. Bronchodilator aerosol administered by metered dose inhaler and spacer in subacute neonatal respiratory distress syndrome. Archives of Disease in Childhood. 1994;70:218-222.[PubMed 8198418]
Mann NP and Hiller RG, “Ipratropium Bromide in Children With Asthma,” Thorax, 1982, 37(1):72-4.[PubMed 6461943]
National Asthma Education and Prevention Program (NAEPP), Expert Panel Report 3, "Guidelines for the Diagnosis and Management of Asthma," Clinical Practice Guidelines, National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication No. 08-4051, prepublication 2007. Available at http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
Osmond MH and Klassen TP, “Efficacy of Ipratropium Bromide in Acute Childhood Asthma: A Meta-Analysis,” Acad Emerg Med, 1995, 2(7):651-6.[PubMed 8521214]
Prendiville A, Green S, Silverman M. Ipratropium bromide and airways function in wheezy infants. Archives of Disease in Childhood. 1987;62:397-400.[PubMed 2954510]
Rodrigo GJ, Castro-Rodriguez JA. Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis. Thorax. 2005;60(9):740-746.[PubMed 16055613]
Rodrigo GJ, Rodrigo C. First-line therapy for adult patients with acute asthma receiving a multiple-dose protocol of ipratropium bromide plus albuterol in the emergency department. Am J Respir Crit Care Med. 2000;161(6):1862-1868.[PubMed 10852758]
Schuh S, Johnson DW, Callahan S, et al, "Efficacy of Frequent Nebulized Ipratropium Bromide Added to Frequent High-Dose Albuterol Therapy in Severe Childhood Asthma," J Pediatr, 1995, 126(4):639-45.[PubMed 7699549]
Schuh S, Johnson DW, Canny G, et al, “Efficacy of Adding Nebulized Ipratropium Bromide to Nebulized Albuterol Therapy in Acute Bronchiolitis,” Pediatrics, 1992, 90(6):920-3.[PubMed 1437435]
Stokes GM, Milner AD, Hodges IGC, et al. Nebulized therapy in acute severe bronchitis in infancy. Archives of Disease In Childhood. 1983;58:279-282.[PubMed 6221700]
Vézina K, Chauhan BF, Ducharme FM. Inhaled anticholinergics and short-acting beta(2)-agonists versus short-acting beta2-agonists alone for children with acute asthma in hospital. Cochrane Database Syst Rev. 2014(7):CD010283.[PubMed 25080126]
Wang EE, Milner R, Allen U, et al, "Bronchodilators for Treatment of Mild Bronchiolitis: A Factorial Randomised Trial," Arch Dis Child, 1992, 67(3):289-93.[PubMed 1533504]
Wilkie RA and Bryan MH, “Effect of Bronchodilators on Airway Resistance in Ventilator-dependent Neonates With Chronic Lung Disease,” J Pediatr, 1987, 111(2):278-82.[PubMed 2956405]
Brand Names: International
Aeron (AU); Aerotrop (AR, PY); Aerovent (IL, IQ, IR, LY, OM, YE); Alovent (VE); Atem (AE, BH, CY, IQ, IR, IT, JO, KW, LY, OM, PK, SA, SY, YE); Atropulm (LB); Atrovent (AE, AR, AT, AU, BB, BD, BE, BG, BH, BR, CH, CL, CN, CO, CR, CU, CY, CZ, DK, DO, EC, EE, EG, ES, FI, FR, GB, GR, GT, HK, HN, HR, ID, IE, IL, IS, JO, JP, KW, LB, LU, MT, MY, NI, NL, NO, NZ, PA, PE, PH, PK, PL, PT, PY, RU, SA, SE, SG, SK, SV, SY, TR, TW, UY); Atrovent Aerosol (NZ); Atrovent N (SG); Atrovent Nasal (NZ); Atrovent UDV (KR); I-Patrimol (PE); Ipragard (IE); Ipratec (PK); Ipravent (IN, LK); Ipraxa (NO); Iprex (BD); Ipromate (LK); Iprovent (SG); Midatrol (ID); Nastropium (EG); Optra (PK); Plautis (CR, DO, GT, HN, NI, PA, SV); Rinatec (GB, IE); Tropium (BD); Tropivent (LK)
Last Updated 1/23/20
Google Sites
Report abuse