Ipratropium bromide

R. Bauer and co-workers ia M. E. Goldhetg, ed., Pharmacological and Biochemical Properties of Drug Suhstances,Yol. 2, Amedcan Pharmaceutical Association, Washington, D.C., 1979, p. 489. A general review on ipratropium bromide. 

The two major types of bronchodilators are the sym-padiomimetics and die xantiiine derivatives. The anticholinergic drug ipratropium bromide (Atrovent) is used for bronchospasm associated witii COPD, chronic bronchitis, and emphysema. Ipratropium is included in die Summary Drug Table Bronchodilators. Chapter 25... 

Jubran A, Gross N, Ramsdell J, et al. Comparative cost-effectiveness analysis of theophylline and ipratropium bromide in chronic obstructive pulmonary disease. A three-center study. Chest 1993 103 678-84. 

Ipratropium with albuterol MDI 1 8 mcg/puff of ipratropium bromide and 90 mcg/puff of albuterol 2-3 puffs every 6 hours 1-2 puffs every 8 hours... 

The addition of ipratropium bromide to inhaled p2-agonist therapy in acute severe asthma improves pulmonary function and decreases hospitalization rates in both adult and pediatric patients.31 The benefit of combining ipratropium and albuterol appears to be greatest in moderate to severe exacerbations, and the combination should be considered first-line therapy in severe exacerbations. 

MDI 18 meg of ipratropium bromide and 90 meg of albuterol per puff 4-8 puffs as needed 4-8 puffs as needed... 

Intranasal anticholinergic agents (e.g., ipratropium) reduce the severity and duration of rhinorrhea but have no effect on other nasal symptoms.11,12,21 Ipratropium reduces cholinergic hyperreactivity and cholinergically mediated histamine- and antigen-induced secretion. Intranasal ipratropium acts locally, with only minimal systemic absorption. Clinical trials demonstrated that ipratropium bromide 0.3% reduced rhinorrhea in adults and children with PAR.11,12 Intranasal ipratropium is an option for patients in whom rhinorrhea is refractory to topical intranasal corticosteroids and/or antihistamines.8,12 Intranasal ipratropium is available only by prescription, and the dose is two sprays nasally two to three times daily.15 Adverse effects are minimal, but dry nasal membranes have been reported.11,12... 

Since water molecules occupy regular positions within the lattice of a hydrate with a specific stoichiometry (e.g., 1 1 monohydrate, 2 1 dihydrate, 5 1 pentahydrate) to the solid, relatively large quantities of water are sorbed. Figure 3 shows a moisture uptake isotherm for ipratropium bromide [39]. This substance undergoes an apparent hydration of the crystal between 63% and 75% relative humidity. Above 75% relative humidity, approximately 4.6% water is sorbed (theoretical monohydrate is 4.4 g/g). Interestingly, as anhydrous ipratropium bromide is equilibrated for extended time periods (e.g., 2 months and 5 months respectively, as shown in Fig. (3), hydration of the crystal appears to occur at... 

Fig. 3 Water vapor sorption and desorption isotherms for ipratropium bromide at 20°C ( ), 2 month sorption (A), 5 month sorption ( ), 2 and 5 month desorption [Note All 2 month sorption results, except at 53% and 63% relative humidity, were verified at 5 months.]...

The answer is c. (Hardman, pp 156-158.) A wide variety of clinical conditions are treated with antimuscarinic drugs. Dicyclomine hydrochloride and methscopolamine bromide are used to reduce Gl motility, although side effects—dryness of the mouth, loss of visual accommodation, and difficulty in urination—may limit their acceptance by patients. Cyclopentolate hydrochloride is used in ophthalmology for its mydriatic and cycloplegic properties during refraction of the eye. Trihexyphenidyl hydrochloride is one of the important antimuscarinic compounds used in the treatment of parkinsonism. For bronchodilation in patients with bronchial asthma and other bronchospastic diseases, ipratropium bromide is used by inhalation. Systemic adverse reactions are low because the actions are largely confined to the mouth and airways. 

Ipratropium bromide (Atrovent) nasal spray is an anticholinergic agent useful in perennial allergic rhinitis. 

Ipratropium bromide nebulizer solution (0.25 mg/mL) Ipratropium bromide MDI (17 mcg/putf)... 

Ipratropium bromide and tiotropium bromide are competitive inhibitors of muscarinic receptors they produce bronchodilation only in cholinergic-mediated bronchoconstriction. Anticholinergics are effective bronchodila-tors but are not as potent as /J2-agonists. They attenuate, but do not block, allergen- or exercise-induced asthma in a dose-dependent fashion. 

The time to reach maximum bronchodilation from aerosolized ipratropium is longer than from aerosolized short-acting / -agonists (30 to 60 minutes vs. 5 to 10 minutes). This is of little clinical consequence because some bronchodilation is seen within 30 seconds and 50% of maximum response occurs within 3 minutes. Ipratropium bromide has a duration of action of 4 to 8 hours tiotropium bromide has a duration of 24 hours. 

Inhaled ipratropium bromide is only indicated as adjunctive therapy in severe acute asthma not completely responsive to / -agonists alone because it does not improve outcomes in chronic asthma. Tiotropium bromide has not been studied in asthma. 

Ipratropium bromide has a slower onset of action than short-acting /J2-agonists (15 to 20 minutes vs. 5 minutes for albuterol). For this reason, it may be less suitable for as-needed use, but it is often prescribed in this manner. Ipratropium has a more prolonged bronchodilator effect than short-acting /l2-agonists. Its peak effect occurs in 1.5 to 2 hours and its duration is 4 to 6 hours. The recommended dose via MDI is two puffs four times a day with upward titration often to 24 puffs/day. It is also available as a solution for nebulization. The most frequent patient complaints are dry mouth, nausea, and, occasionally, metallic taste. Because it is poorly absorbed systemically, anticholinergic side effects are uncommon (e.g., blurred vision, urinary retention, nausea, and tachycardia). 

IPA-water system, evolving separation strategies for, 22 322-325. See also Water-IPA-hexane system (-)-Ipecoside, 2 84, 85 Ipratropium bromide, 4 360t Iproclozide, 73 49... 

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