Other drug names:	A-Am  An-Az  B  C-Ch  Ci-Cz  D-Dh  Di-Dz  E  F  G  H  I-J  K-L  M-Mh  Mi-Mz  N-Nh  Ni-Nz  O  P-Pl  Pm-Pz  Q-R  S-Sn  So-Sz  T-To  Tp-Tz  U-V  W-Z  0-9

In the U.S.—

Atrovent

In Canada—

Apo-Ipravent Atrovent

Kendral-Ipratropium

• Bronchodilator

Ipratropium ( I-pra-TROE-pee-um) is a bronchodilator (medicine that opens up narrowed breathing passages). It is taken by inhalation to help control the symptoms of lung diseases, such as asthma, chronic bronchitis, and emphysema. Ipratropium helps decrease coughing, wheezing, shortness of breath, and troubled breathing by increasing the flow of air into the lungs.

When ipratropium inhalation is used to treat acute, severe attacks of asthma, bronchitis, or emphysema, it is used only in combination with other bronchodilators.

Ipratropium is available only with your doctor's prescription, in the following dosage forms:

Inhalation
• Inhalation aerosol (U.S. and Canada)
• Inhalation solution (U.S. and Canada)

In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For ipratropium, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to ipratropium, atropine, belladonna, hyoscyamine, or scopolamine, or to other inhalation aerosol medicines. Also tell your health care professional if you are allergic to soya lecithin or related food substances such as soybeans and peanuts.

Pregnancy—Ipratropium has not been studied in pregnant women. However, it has not been shown to cause birth defects or other problems in animal studies.

Breast-feeding—It is not known whether ipratropium passes into the breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are using this medicine and who wish to breast-feed should discuss this with their doctor.

Children—This medicine has been tested in children and, in effective doses, has not been shown to cause different side effects or problems in children than it does in adults.

Older adults—Ipratropium inhalation has been tested in patients 65 years of age or older. This medicine is not expected to cause different side effects or problems in older people than it does in younger adults.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking ipratropium, it is especially important that your health care professional know if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Other medical problems—The presence of other medical problems may affect the use of ipratropium. Make sure you tell your doctor if you have any other medical problem, especially:

• Difficult urination—Ipratropium may make the condition worse

• Glaucoma—Ipratropium may make the condition worse if it gets into the eyes

Ipratropium is used to help control the symptoms of lung diseases, such as chronic bronchitis, emphysema, and asthma. However, for treatment of bronchospasm or asthma attacks that have already started, ipratropium is used only in combination with other bronchodilators.

It is very important that you use ipratropium only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of side effects.

Keep the spray or solution away from the eyes because this medicine may cause irritation or blurred vision. Closing your eyes while you are inhaling ipratropium may keep the medicine from getting into your eyes. Rinsing your eyes with cool water may help if any medicine does get into your eyes.

Ipratropium usually comes with patient directions. Read them carefully before using this medicine.

If you are taking this medicine every day to help control your symptoms, it must be taken at regularly spaced times as ordered by your doctor.

Dosing—

The dose of ipratropium will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of ipratropium. If your dose is different, do not change it unless your doctor tells you to do so.

• For symptoms of chronic obstructive pulmonary disease, such as chronic bronchitis or emphysema:
  • For inhalation aerosol dosage form:
    • Adults and children 12 years of age and older—2 to 4 inhalations (puffs) three or four times a day, at regularly spaced times. Some patients may need up to 6 to 8 puffs three times a day.
  • For inhalation solution dosage form:
    • Adults and children 12 years of age and older—250 to 500 mcg used in a nebulizer three or four times a day, every six to eight hours.
• For symptoms of asthma:
  • For inhalation aerosol dosage form:
    • Adults and children 12 years of age and older—1 to 4 inhalations (puffs) four times a day, at regularly spaced times, as needed.
    • Children up to 12 years of age—1 or 2 inhalations (puffs) three or four times a day, at regularly spaced times, as needed.
  • For inhalation solution dosage form:
    • Adults and children 12 years of age and older—500 mcg used in a nebulizer three or four times a day, every six to eight hours, as needed.
    • Children 5 to 12 years of age—125 to 250 mcg used in a nebulizer three or four times a day, every four to six hours as needed.
    • Children up to 5 years of age—Use and dose must be determined by your doctor.

Missed dose—

If you use ipratropium inhalation regularly and you miss a dose of this medicine, use it as soon as possible. Then use any remaining doses for that day at regularly spaced times.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Store away from heat.
• Store the solution form of this medicine away from direct light. Store the aerosol form of this medicine away from direct sunlight.
• Keep the medicine from freezing.
• Store any opened bottles of the solution form of this medicine in the refrigerator.
• Do not puncture, break, or burn the aerosol container, even if it is empty.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

For patients using ipratropium inhalation aerosol :

• If you do not understand the directions or you are not sure how to use the inhaler, ask your health care professional to show you how to use it. Also, ask your health care professional to check regularly how you use the inhaler to make sure you are using it properly.
• When you use the inhaler for the first time, or if you have not used it for a while, the inhaler may not give the right amount of medicine with the first puff. Therefore, before using the inhaler, test or prime it.
• To test or prime the inhaler:
  • Insert the canister firmly into the clean mouthpiece according to the manufacturer's instructions. Check to make sure it is placed properly into the mouthpiece.
  • Take the cap off the mouthpiece and shake the inhaler three or four times.
  • Hold the inhaler away from you at arm's length and press the top of the canister, spraying the medicine once into the air. The inhaler will now be ready to give the right amount of medicine when you use it.
• To use the inhaler:
  • Using your thumb and one or two fingers, hold the inhaler upright, with the mouthpiece end down and pointing toward you.
  • Take the cap off the mouthpiece. Check the mouthpiece to make sure it is clear. Then, gently shake the inhaler three or four times.
  • Breathe out slowly to the end of a normal breath.
  • Use the inhalation method recommended by your doctor:
    • Open-mouth method—Place the mouthpiece about 1 or 2 inches (2 fingerwidths) in front of your widely opened mouth. Make sure the inhaler is aimed into your mouth so the spray does not hit the roof of your mouth or your tongue.
    • Closed-mouth method—Place the mouthpiece in your mouth between your teeth and over your tongue with your lips closed tightly around it. Make sure your tongue or teeth are not blocking the opening.
  • Start to breathe in slowly and deeply through your mouth. At the same time, press the top of the canister once to get one puff of medicine. Continue to breathe in slowly for 5 to 10 seconds. Count the seconds while breathing in. It is important to press the canister and breathe in slowly at the same time so the medicine gets into your lungs. This step may be difficult at first. If you are using the closed-mouth method and you see a fine mist coming from your mouth or nose, the inhaler is not being used correctly.
  • Hold your breath as long as you can up to 10 seconds. This gives the medicine time to settle into your airways and lungs.
  • Take the mouthpiece away from your mouth and breathe out slowly.
  • If your doctor has told you to inhale more than one puff of medicine at each dose, gently shake the inhaler again, and take the second puff following exactly the same steps you used for the first puff. Press the canister one time for each puff of medicine.
  • When you are finished, wipe off the mouthpiece and replace the cap.
• Your doctor may want you to use a spacer device or holding chamber with the inhaler. A spacer helps get the medicine into the lungs and reduces the amount of medicine that stays in your mouth and throat.
  • To use a spacer device with the inhaler:
    • Attach the spacer to the inhaler according to the manufacturer's directions. There are different types of spacers available, but the method of breathing remains the same with most spacers.
    • Gently shake the inhaler and spacer three or four times.
    • Hold the mouthpiece of the spacer away from your mouth and breathe out slowly to the end of a normal breath.
    • Place the mouthpiece into your mouth between your teeth and over your tongue with your lips closed around it.
    • Press the top of the canister once to release one puff of medicine into the spacer. Within 1 or 2 seconds, start to breathe in slowly and deeply through your mouth for 5 to 10 seconds. Count the seconds while inhaling. Do not breathe in through your nose.
    • Hold your breath as long as you can up to 10 seconds.
    • Take the mouthpiece away from your mouth and breathe out slowly.
    • If your doctor has told you to take more than one puff of medicine at each dose, gently shake the inhaler and spacer again and take the next puff, following exactly the same steps you used for the first puff. Do not put more than one puff of medicine into the spacer at a time.
    • When you are finished, remove the spacer device from the inhaler and replace the cap.
• Clean the inhaler, mouthpiece, and spacer at least twice a week.
  • To clean the inhaler:
    • Remove the canister from the inhaler and set aside.
    • Wash the mouthpiece, cap, and the spacer with warm, soapy water. Then, rinse well with warm, running water.
    • Shake off the excess water and let the inhaler parts air dry completely before putting the inhaler back together.
• The ipratropium canister provides about 200 inhalations. You should keep a record of the number of inhalations you use so you will know when the canister is almost empty. This canister, unlike other aerosol canisters, cannot be floated in water to test its fullness.

For patients using ipratropium inhalation solution :

• Use this medicine only in a power-operated nebulizer with an adequate flow rate and equipped with a face mask or mouthpiece. Your doctor will tell you which nebulizer to use. Make sure you understand exactly how to use it. If you have any questions about this, check with your doctor.
• To prepare the medicine for use in the nebulizer :
  • If you are using the single-dose vial of ipratropium :
    • Break away one vial by pulling it firmly from the strip.
    • Twist off the top to open the vial. Use the contents of the vial as soon as possible after opening it.
    • Squeeze the contents of the vial into the cup of the nebulizer. If your doctor has told you to use less than a full vial of solution, use a syringe to withdraw the correct amount of solution from the vial and add it to the nebulizer cup. Be sure to throw away the syringe after one use.
  • If you are using the multiple-dose bottle of ipratropium:
    • Use a syringe to withdraw the correct amount of solution from the bottle and add it to the nebulizer cup. Do not use the same syringe more than once.
• If you have been told to dilute the ipratropium inhalation solution in the nebulizer cup with the sodium chloride solution provided, use a new syringe to add the sodium chloride solution to the cup as directed by your health care professional.
• If your doctor told you to use another inhalation solution with the ipratropium inhalation solution, add that solution also to the nebulizer cup.
• To use the nebulizer:
  • Gently shake the nebulizer cup to mix the solutions well.
  • Connect the nebulizer tube to the air or oxygen pump and begin the treatment. Adjust the mask, if you are using one, to prevent mist from getting into your eyes.
  • Use the method of breathing your doctor told you to use to take the treatment. One way is to breathe slowly and deeply through the mask or mouthpiece. Another way is to breathe in and out normally with the mouthpiece in your mouth, taking a deep breath every 1 or 2 minutes. Continue to breathe in the medicine as instructed until no more mist is formed in the nebulizer cup or until you hear a sputtering (spitting or popping) sound.
  • When you have finished, replace the caps on the solutions. Store the bottles of solution in the refrigerator until the next treatment.
  • Clean the nebulizer according to the manufacturer's directions.

Check with your doctor at once if your symptoms do not improve within 30 minutes after using a dose of this medicine or if your condition gets worse.

For patients using ipratropium inhalation solution :

• If you are also using cromolyn inhalation solution, do not mix that solution with the ipratropium inhalation solution containing the preservative benzalkonium chloride for use in a nebulizer. To do so will cause the solution to become cloudy. However, if your condition requires you to use cromolyn inhalation solution with ipratropium inhalation solution, it may be mixed with ipratropium inhalation solution that is preservative-free.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may require medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• Rare
  • Constipation (continuing) or lower abdominal pain or bloating ;  increased wheezing, tightness in chest, or difficulty in breathing;  severe eye pain;  skin rash or hives;  swelling of face, lips, or eyelids  
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Cough;  dryness of mouth;  unpleasant taste 
  
  

• Less common or rare
  • Blurred vision or other changes in vision;  burning eyes;  difficult urination;  dizziness;  headache;  nausea ;  nervousness;  pounding heartbeat;  sweating;  trembling  
  
  

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Revised: 12/29/1999