Ipratropium Bromide

Short-Acting Anticholinergic Bronchodilator (SAMA)

Generic Name

Ipratropium bromide

Drug Class

Anticholinergic (muscarinic antagonist) bronchodilator

Indications

Chronic obstructive pulmonary disease (COPD)
Acute severe asthma (adjunct with β₂-agonists)
Bronchospasm
Rhinorrhea (nasal spray formulation)

Dosage

MDI: 20 mcg per puff; 2–4 puffs every 6–8 hours
Nebulization: 250–500 mcg every 6–8 hours
Acute severe asthma: Combine with salbutamol via nebulization

Route of Administration

Inhalation (MDI, nebulizer), Intranasal

Mechanism of Action

Ipratropium bromide blocks muscarinic (M₃) receptors in bronchial smooth muscle, inhibiting vagally mediated bronchoconstriction and reducing mucus secretion.

Common Adverse Effects

Dry mouth
Throat irritation
Cough
Bitter taste

Serious Adverse Effects

Paradoxical bronchospasm
Acute angle-closure glaucoma (with eye exposure)
Urinary retention (rare)

Contraindications

Hypersensitivity to ipratropium or atropine derivatives

Precautions

Use cautiously in narrow-angle glaucoma
Use cautiously in prostatic hypertrophy
Avoid eye contact during nebulization

Drug Interactions

Other anticholinergics – additive effects
β₂-agonists – complementary bronchodilation

Pregnancy & Lactation

Considered safe in pregnancy and breastfeeding when inhaled.

Patient Counseling

Not a replacement for rescue β₂-agonists
Use spacer to improve delivery
Rinse mouth after use
Avoid spraying into eyes