ipratropium
Brand: Atrovent
Prototype: tiotropium
Drug Class: bronchodilator
Drug Family: bronchodilator
Subclass: short-acting muscarinic antagonist (SAMA)
Organ Systems: respiratory
Mechanism of Action
Quaternary ammonium SAMA; minimally absorbed — acts locally in airways; reduces bronchoconstriction and secretions; used in COPD exacerbations and as adjunct in acute asthma.
muscarinic M3 receptor
Indications
- COPD exacerbation
- acute severe asthma (adjunct to SABA)
- chronic COPD maintenance
- rhinorrhea (intranasal)
Contraindications
- urinary retention (relative)
- narrow-angle glaucoma
Adverse Effects
Common
- dry mouth
- urinary retention
- constipation
Serious
- paradoxical bronchospasm
- acute urinary retention
Pharmacokinetics (ADME)
| Absorption | inhaled — minimally absorbed (<10% systemic) |
| Distribution | local |
| Metabolism | local GI/lung |
| Excretion | fecal/renal |
| Half-life | 2 hours |
| Onset | 15-30 min |
| Peak | 1-2 hours |
| Duration | 4-6 hours |
| Protein Binding | ~0% systemic |
| Vd | local |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| other anticholinergics | additive effects | moderate |
Nursing Considerations
- Acute COPD exacerbation: combine with albuterol (Combivent/DuoNeb) for synergistic bronchodilation
- Onset slower than albuterol (15-30 min vs 5 min) — not first-line monotherapy for acute attack
- Monitor for acute urinary retention in men with BPH
Clinical Pearls
- Less effective than SABA for acute bronchospasm but additive in COPD exacerbation
- Fixed combination with albuterol (Combivent) provides complementary mechanisms in COPD
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.