Ipratropium glaucoma with

Inhaled anticholinergics are well tolerated with the most common adverse effect being dry mouth. Occasional metallic taste has also been reported with ipratropium. Other anticholinergic adverse effects include constipation, tachycardia, blurred vision, and precipitation of narrow-angle glaucoma symptoms. Urinary retention could be a problem, especially for those with concurrent bladder outlet obstruction. 

Special risk Ipratropium bromide nasal spray should be used with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder neck obstruction. 

A number of muscarinic agonists and antagonists are launched or in clinical trials, especially as antiemetics (e.g. scopolamine), as treatment for urinary incontinence (e.g. tolterodine), glaucoma (pilocarpine), and airway diseases (e.g. ipratropium bromide), but, to the best of our knowledge, only few are used as adjuvants in analgesic compositions, e.g. tiemonium iodide which is used in various combinations with analgesics like paracetamol or metamizole (Coffalon , Visceralgine ). 

A small number of cases of acute angle-closure glaucoma have been reported in patients treated with a combination of nebulised salbutamol and ipratropium bromide, caused possibly by local absorption of mist containing both products. A combination of nebulised salbutamol with nebulised anticholinergics should therefore be used cautiously. Patients should receive adequate instruction in correct administration and be warned not to let the solution or mist enter the eyes. Use of a mouthpiece rather than a mask for administration would reduce the risk associated with this. 

IPRATROPIUM BRONCHODILATORS -SALBUTAMOL A few reports of acute angle closure glaucoma when nebulized ipratropium and salbutamol were coadministered Ipratropium dilates the pupil, which i drainage of aqueous humour, while salbutamol t production of aqueous humour Warn patients to prevent the solution to mist or enter the eye. Extreme caution in co-administering these bronchodilators by the nebulized route in patients with a history of acute closed-angle glaucoma... 

Acute angle-closure glaucoma developed rapidly in eight patients given nebulised ipratropium and salbutamol. Increased intra-ocular pressure has been reported in others, including one patient using an ipratropium metered-dose inhaler with nebulised salbutamol. 

ShahP,DhurjonL, Metcalfe T, Gibson JM. Acute angle closure glaucoma associated with nebulised ipratropium bromide and salbutamol. BMJ (1992) 304, 40-1. 

Reuser T, Flanagan DW, Borland C, Bannerjee DK. Acute angle closure glaucoma occurring after nebulized bronchodilator treatment with ipratropium bromide and salbutamol. JR Soc Med (1992) 85, 499-500. 

---