Version June 2024
Allergic/nonallergic rhinitis, perennial: Intranasal (0.03% solution): Two sprays (21 mcg/spray) in each nostril 2 or 3 times daily (total dose: 168 to 252 mcg/day).
Allergic rhinitis, seasonal: Intranasal (0.06% solution): Two sprays (42 mcg/spray) in each nostril 4 times daily (total dose: 672 mcg/day); use beyond 3 weeks has not been established.
Colds (symptomatic relief of rhinorrhea): Intranasal (0.06% solution): Two sprays (42 mcg/spray) in each nostril 3 or 4 times daily (total dose: 504 to 672 mcg/day); use beyond 4 days has not been established.
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use with caution.
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use with caution.
Refer to adult dosing.
(For additional information see "Ipratropium (nasal): Pediatric drug information")
Allergic/nonallergic rhinitis, perennial: Children ≥6 years and Adolescents: 0.03% (21 mcg/spray) solution: Intranasal: 2 sprays (42 mcg) per nostril 2 to 3 times daily; total daily dose range: 168 to 252 mcg/day
Allergic rhinitis, seasonal: 0.06% (42 mcg/spray) solution: Intranasal:
Children 2 to <5 years: Limited data available: 1 spray (42 mcg) per nostril 3 times daily for 14 days (Ref); maximum daily dose: 252 mcg/day
Children ≥5 years and Adolescents: 2 sprays (84 mcg) per nostril 4 times daily; maximum daily dose: 672 mcg/day; use beyond 3 weeks has not been established
Colds (symptomatic relief of rhinorrhea): Note: Use beyond 4 days has not been established. 0.06% (42 mcg/spray) solution: Intranasal:
Children 2 to <5 years: Limited data available: 2 sprays (84 mcg) per nostril 3 times daily; maximum daily dose: 504 mcg/day (Ref)
Children 5 to 11 years: 2 sprays (84 mcg) per nostril 3 times daily; maximum daily dose: 504 mcg/day
Children ≥12 years and Adolescents: 2 sprays (84 mcg) per nostril 3 to 4 times daily; total daily dose range: 504 to 672 mcg/day
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use with caution.
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use with caution.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Central nervous system: Headache (4% to 10%)
Gastrointestinal: Dysgeusia (≤4%), xerostomia (1% to 4%), diarrhea (2%), nausea (2%)
Respiratory: Upper respiratory tract infection (5% to 10%), epistaxis (6% to 9%), pharyngitis (≤8%), dry nose (≤5%), nasal mucosa irritation (2%), nasal congestion (1%)
<2%, postmarketing, and/or case reports: Anaphylaxis, angioedema, blurred vision, burning sensation of the nose, conjunctivitis, cough, dizziness, eye irritation, hoarseness, increased thirst, laryngospasm, palpitations, skin rash, tachycardia, tinnitus, urticaria
Hypersensitivity to ipratropium, atropine (and its derivatives), or any component of the formulation
Concerns related to adverse effects:
• CNS effects: May cause dizziness, accommodation disorder, mydriasis and blurred vision; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery or driving).
• Hypersensitivity reactions: Immediate hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm, oropharyngeal edema, and anaphylaxis) have been reported. Discontinue use immediately if allergic or anaphylactoid/anaphylactic reactions occur.
Disease-related concerns:
• Glaucoma: Use with caution in patients with narrow-angle glaucoma.
• Hepatic impairment: Use with caution in patients with hepatic impairment.
• Prostatic hyperplasia/bladder neck obstruction: Use with caution in patients with prostatic hyperplasia or bladder neck obstruction.
• Renal impairment: Use with caution in patients with renal impairment.
Other warnings/precautions:
• Appropriate use: Avoid direct contact with eye. Temporary blurred vision, precipitating or worsening of narrow-angle glaucoma, mydriasis, increased intraocular pressure, acute eye pain, visual halos or colored images secondary to conjunctival and/or corneal congestion may occur. The 0.03% and 0.06% solutions do not relieve nasal congestion, sneezing, or postnasal drip associated with allergic or nonallergic perennial rhinitis or the common cold.
Atrovent 0.03% (21 mcg/spray) nasal solution 30 mL bottles contain 345 sprays, and the 0.06% (42 mcg/spray) 15 mL bottles contain 165 sprays.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Nasal, as bromide:
Generic: 0.03% (30 mL); 0.06% (15 mL)
Yes
Solution (Ipratropium Bromide Nasal)
0.03% (per mL): $1.52 - $3.72
0.06% (per mL): $3.04 - $6.38
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.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Nasal, as bromide:
Generic: 0.03% (30 mL); 0.06% (15 mL)
Administer by the intranasal route only. Avoid spraying into or around the eyes. Blow nose gently to clear nostrils before use. Prior to initial use, prime pump by releasing 7 test sprays into the air. If the inhaler has not been used for >24 hours, reprime by releasing 2 test sprays into the air. If the inhaler has not been used for more than 7 days, reprime by releasing 7 test sprays into the air.
Intranasal: Administer by the intranasal route only. Avoid spraying into or around the eyes. Blow nose gently to clear nostrils before use. Prior to initial use, prime pump by releasing 7 test sprays into the air away from the face. If not used for >24 hours, reprime pump by releasing 2 test sprays into the air; if not used for >7 days, reprime by releasing 7 test sprays into the air.
Allergic/nonallergic perennial rhinitis (0.03% solution): Symptomatic relief of rhinorrhea associated with allergic and nonallergic perennial rhinitis in adults and children ≥6 years.
Colds (0.06% solution): Symptomatic relief of rhinorrhea associated with the common cold in adults and children ≥5 years.
Seasonal allergic rhinitis (0.06% solution): Symptomatic relief of rhinorrhea associated with seasonal allergic rhinitis in adults and children ≥5 years.
Sialorrhea (drooling)
Atrovent may be confused with Alupent, Serevent
Ipratropium may be confused with tiotropium
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
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: May enhance the adverse/toxic effect of other Anticholinergic Agents. Risk C: Monitor therapy
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. Risk C: Monitor therapy
Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Risk C: Monitor therapy
Chlorprothixene: Anticholinergic Agents may enhance the anticholinergic effect of Chlorprothixene. Risk C: Monitor therapy
Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Risk X: Avoid combination
CloZAPine: Anticholinergic Agents may enhance the constipating effect of CloZAPine. Management: Consider alternatives to this combination whenever possible. If combined, monitor closely for signs and symptoms of gastrointestinal hypomotility and consider prophylactic laxative treatment. Risk D: Consider therapy modification
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
Ipratropium (Oral Inhalation): 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
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. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form 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 X: Avoid combination
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
Rivastigmine: Anticholinergic Agents may diminish the therapeutic effect of Rivastigmine. Rivastigmine may diminish the therapeutic effect of Anticholinergic Agents. Management: Use of rivastigmine with an anticholinergic agent is not recommended unless clinically necessary. If the combination is necessary, monitor for reduced anticholinergic effects. Risk D: Consider therapy modification
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
Adverse events have not been observed in animal reproduction studies.
It is not known if ipratropium (nasal) is excreted in breast milk. The manufacturer recommends that caution be exercised when administering ipratropium (nasal) to breastfeeding women.
Local application to nasal mucosa inhibits serous and seromucous gland secretions.
Onset of action: 15 minutes
Absorption: <20%
Protein binding: Up to 9% (albumin)
Metabolism: To inactive metabolites via ester hydrolysis
Excretion:
Allergic rhinitis: Urine (as unchanged drug): Pediatrics: Up to 11.1%; Adults: Up to 5.6%
Common cold: Urine (as unchanged drug): Pediatrics: Up to 7.8%; Adults: Up to 8.1%
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