IPRATROPIUM bromide metered dose inhaler

Last updated: June 2023

Therapeutic action

• Bronchodilator, anticholinergic drug

Indications

• Severe asthma attack, in combination with salbutamol 

Forms and strengths

• Solution for inhalation in pressurised metered dose inhaler, delivering 20 micrograms of ipratropium/puff

Dosage and duration

• Child and adult: 4 to 8 puffs (80 to 160 micrograms) every 20 minutes for the first hour

Administration technique

• Shake the inhaler. Remove the mouthpiece cover.
• Inhale and breathe out as completely as possible. Place the lips tightly around the mouthpiece. Inhale deeply while activating the inhaler. Hold breath 10 seconds before exhaling.
• Hand-breath co-ordination is very difficult in children under 6 years, older patients and patients with severe dyspnoea. Use a spacer to facilitate administration and improve the efficacy of treatment.

Contra-indications, adverse effects, precautions

• May cause:
  • throat irritation, headache, cough, vomiting;
  • anticholinergic effects: dryness of the mouth, constipation, dilation of the pupils, blurred vision, urinary retention, tachycardia.
• Administer with caution to older patients and patients with closed-angle glaucoma, urethroprostatic disorders, urinary retention.
• Avoid or monitor combination with drugs known to have anticholinergic effects: tricyclic antidepressants (e.g. amitriptyline), first generation H-1 antihistamines (e.g. hydroxyzine, promethazine), biperiden, antispasmodics (e.g. atropine, hyoscine butylbromide), antipsychotics (e.g. chlorpromazine, haloperidol), etc. (increased risk of adverse effects).
• Pregnancy: no contra-indication
• Breast-feeding: no contra-indication

Remarks

• In severe asthma attack, preferably administer the treatment by nebulisation.
• Clean the mouthpiece before and after each use.
• Do not pierce or incinerate used aerosol containers (risk of explosion).

Storage