Ipratropium

Antimuscarinic, Short-acting muscarinic antagonist (SAMA), Bronchodilator

Ipratropium bromide

Atrovent (inhaler, intranasal); also generic

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Summary

Classes

Antimuscarinic, Short-acting muscarinic antagonist (SAMA), Bronchodilator

Pharmacy

Starting dose

Nebulized 500 mcg q6-8h (or with albuterol as DuoNeb); MDI 17 mcg/puff, 2 puffs QID; nasal 0.03% or 0.06% spray BID-TID

Preparations

Atrovent HFA 17 mcg/actuation MDI; 500 mcg/2.5 mL nebulizer solution; 0.03% and 0.06% intranasal sprays; with albuterol as DuoNeb / Combivent Respimat

US FDA Max

12 puffs MDI/d typical; nebulized 2000 mcg/d

Pharmacology

Routes

Inhaled (MDI, nebulized), intranasal

Onset

Bronchodilation 15-30 minutes

Duration

4-6 hours

Half-life

~2 hours (plasma; minimal relevance — local-action drug)

Bioavailability

Inhaled lung deposition with minimal systemic absorption (the basis of the favorable safety profile vs systemic antimuscarinics)

Pregnancy

Limited data; generally considered acceptable when needed.^{[citation needed]}

Legal status

Rx-only in US

Purported mechanism

Ipratropium is a quaternary ammonium derivative of atropine that non-selectively antagonizes airway muscarinic receptors (M1, M2, M3), blocking acetylcholine-mediated bronchoconstriction; the charged quaternary structure prevents BBB crossing, eliminating CNS antimuscarinic effects.▲0▼ Slower onset than β2-agonists; primary role is as add-on to albuterol in COPD/asthma exacerbations, where the combination shows greater bronchodilation than either alone. Inhaled antimuscarinic systemic absorption is minor but can produce dry mouth, tachycardia, and (rarely) urinary retention.