Ipratropium intranasal

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... 

Oral pseudoephedrine should not be used in children under 1 year of age due to safety concerns. Intranasal ipratropium can be used as intermittent therapy for mild rhinitis or as add-on therapy in more severe cases. AIT is recommended for persistent rhinitis, particularly severe disease, because studies have shown that children respond better than adults. Montelukast is indicated for children 2 years of age and older with SAR and for infants 6 months of age and older with PAR. Studies evaluating leukotriene receptor antagonists as monotherapy or in combination with antihistamines have contradictory results.33... 

Consider intranasal ipratropium for resistant rhinorrhea and immunotherapy for those with symptoms that persist despite treatment.16... 

Antihistamines and intranasal corticosteroids are the first-line treatments for allergic rhinitis. Sodium cromoglicate, ipratropium bromide and decongestants, are alternative or add-on treatments. Drug treatment should be selected according to the severity, frequency and duration of symptoms ... 

Moderate-severe persistent intranasal corticosteroids are the drug of choice. Antihistamines, intranasal decongestants, and sodium cromoglicate are alternatives if steroids are contraindicated, or can be used as add-on drugs. Ipratropium bromide is useful for people with persistent watery effusion. 

Perennial rhinitis is common in both adults and children and is usually treated with intranasal corticosteroids, intranasal ipratropium bromide, antihistamines, intranasal cromones, and decongestants. Treatment-related adverse effects are common and monotherapy is often inadequate. There are few published studies of the comparative efficacy of rhinitis treatments. 

Choudry NB, Harrison AJ et al (1992) Inhibition of gustatory rhinorrhea by intranasal ipratropium bromide. Eur J Chn Pharmacol 42 561-562... 

Upper Respiratory Tract A Cochrane meta-analysis studied the effect of intranasal ipratropium versus placebo on the severity of rhinorrhea and nasal congestion in children and adults with the common cold [45 ]. Seven trials, studying 2144 patients were included in the study. Safety assessment showed an association of ipratropium with nasal dryness (OR = 2.55, 95% Cl = 1.50, 4.33), mouth dryness (OR = 3.59, 95% Cl = 1.38, 9.38) and epistaxis (OR = 3.21,95% Cl - 1.68,6.13). 

AlBalawi ZH, Othman SS, Alfaleh K. Intranasal ipratropium bromide for the common cold. Cochrane Database Syst Rev June 19, 2013 6 CD008231. http //dx.doi.Org/10.1002/14651858.CD008231.pub3. 

Intranasal anticholinergics effectively reduce rhinorrhea. Ipratropium bromide, oxitropium bromide, tiotpropium bromide, and glycopyrrolate are quaternary structured ammonium muscarinic receptor antagonists, which are poorly absorbed into the systemic circulation. They reduce nasal secretions by influence on submucosal glands innervated by parasympathetic nerves (74). Intranasal anticholinergics are ineffective for control of allergic rhinitis symptoms other than rhinorrhea (74). 

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