ipratropium intranasal

Action and Spectrum

Actions and Spectrum: 

Actions: 

Ipratropium is a member of the class of drugs called antimuscarinic bronchodilators. It is administered to enhance lung ventilation. It functions by widening the airways in your lungs to allow for more unrestricted airflow. 

Spectrum: 

Ipratropium is a drug used as a bronchodilator to relieve bronchospasm and improve breathing in people with chronic obstructive pulmonary disorders (COPD), such as chronic bronchitis and emphysema, as well as to treat runny nose and nasal inflammation (rhinitis) brought on by colds and allergies.  

Oral inhalations of ipratropium are used as a maintenance treatment for COPD, while nasal sprays are used to treat allergic and nonallergic rhinitis that causes runny nose. 

Drug Interaction

Adverse Reaction

Frequency defined 

1-10 % 

Nasal congestion (1%) 

Pharyngitis (8.1%) 

URI (9.8%) 

Diarrhea (2%) 

Headache (9.8%) 

Nausea (2%) 

Nasal dryness/congestion/irritation (5.1%) 

Epistaxis (9%) 

Taste perversion (4%) 

Xerostomia (1-4%) 

Black Box Warning

Black Box Warning: 

Burning may result from eye contact. 

Caution patients about undertaking duties requiring mental attention, such as operating heavy machinery, as it may produce dizziness, accommodation disorder, mydriasis, and impaired vision. 

Contraindication / Caution

Contraindication/Caution: 

Contraindications 

• Hypersensitivity 

Cautions 

• Renal impairment 
• Narrow-angle glaucoma 
• Enlarged prostrate 
• BPH or bladder neck obstruction 
• Hepatic impairment 
• Drug interactions 
• Pregnancy  
• Breastfeeding 

Pregnancy / Lactation

Pregnancy consideration:  

No data is available regarding the administration of the drug during pregnancy. 

Breastfeeding warnings:  

No data is available regarding the excretion of drug in breast milk. 

Pregnancy category: 

Category A: well-controlled and satisfactory studies show no risk to the fetus in the first or later trimester. 

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: No data is available for the drug under this category. 

Pharmacology

Pharmacology: 

Cholinergic bronchodilator antagonist 

prevents the secretions of serous and seromucous glands. 

reduces vagally mediated reflexes by opposing acetylcholine’s actions. 

Pharmacodynamics: 

Based on research on animals, it appears that ipratropium bromide, an anticholinergic (parasympatholytic) drug, inhibits vagally-mediated reflexes by blocking the activity of acetylcholine, a transmitter agent generated at the neuromuscular junctions in the lung. Ipratropium bromide suppresses the secretions from the serous and seromucous glands that line the nasal mucosa in humans due to its antisecretory characteristics when applied topically.

The quaternary amine ipratropium bromide reduces the systemic anticholinergic effects (e.g., neurologic, ophthalmic, cardiovascular, and gastrointestinal effects) associated with tertiary anticholinergic amines by passing through the blood-brain barrier and nasal and gastrointestinal membranes with minimal difficulty. 

Pharmacokinetics: 

Absorption 

After oral treatment, ipratropium bromide is poorly absorbed (2–3%) into the systemic circulation. For patients with provoked cold, persistent rhinitis, or normal volunteers, the nasal mucosa absorbed less than 20% of an 84 mcg dosage each nostril. 

Distribution 

Ipratropium bromide has modest binding (0 to 9% in vitro) to both α1-acid glycoprotein and plasma albumin. Its estimated blood-to-plasma concentration ratio was 0.89. Ipratropium bromide does not cross the blood-brain barrier, according to rat studies. 

Metabolism 

Tropic acid and tropane are the byproducts of ester hydrolysis produced by partial metabolism of ipratropium bromide. Based on in vitro receptor affinity tests utilizing homogenates of rat brain tissue, these metabolites seem to be inert. 

Elimination and Excretion 

The terminal half-life of ipratropium was roughly 1.6 hours following the intravenous administration of 2 mg of ipratropium bromide to ten healthy individuals. It was estimated that the renal clearance was 1,019 mL/min and the total body clearance was 2,505 mL/min. Approximately half of the whole dose that was given was eliminated unaltered in the urine (Ae) in a 24-hour period. 

Adminstartion

Administration: 

Ipratropium intranasal solution, 0.03%, is prescribed for the symptomatic relief of rhinorrhea associated with allergic and nonallergic perennial rhinitis in adults and children aged six years and older. The recommended dose is two sprays (42 mcg) per nostril, two or three times a day (total dose 168 to 252 mcg/day). The ideal dosage depends on each patient’s unique response.  

Seven pump sprays are needed for the initial priming of the pump. Not even more priming is necessary if taken as prescribed on a regular basis. The pump needs two sprays to reprime it if it isn’t used for more than 24 hours, or seven sprays if it isn’t used for more than 7 days. Do not get spray in your eyes. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: ipratropium intranasal 

Pronounced: eye-pruh-TROH-pee-um in-truh-NEY-zuhl 

Why do we use ipratropium intranasal? 

In adults and children over six, ipratropium bromide intranasal spray is used to treat rhinorrhea, or runny nose, which is a condition linked to both allergic and non-allergic perennial rhinitis.