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Chronic Obstructive Pulmonary Disease (COPD)
- Longer acting Anticholinergic Agents are preferred in COPD
- See Long-acting Anticholinergic Bronchodilator
- Acute Asthma Exacerbation
- Used in combination with Albuterol (duoneb)
- Ipratropium (Atrovent) is a Short-Acting Anticholinergic Bronchodilator
- Acts as a Muscarinic Antagonist, reducing Acetylcholine induced bronchospasm
- Ipratropium Bromide
- Atrovent MDI
- Inhale 2-3 puffs three to four times daily as needed (maximum 12 puffs/day)
- Atrovent Nebulization (0.02%, 500 mcg/ampule)
- Nebulize 1 ampule of Ipratropium solution every 6 to 8 hours as needed
- Combination Ipratropium with Albuterol (Combivent)
- Combivent (older CFC version)
- Will be phased out in 2013 due to CFC
- Dose: 2 puffs up to every 6 hours
- Contraindicated in soybean or peanut allergy
- Combivent Respimat
- Dose: 1 puff every 6 hours
- Does not carry the Food Allergy related contraindications of the older Combivent
- Serious adverse effects
- Anaphylaxis, Angioedema or other Hypersensitivity Reaction
- Paradoxical bronchospasm or Laryngospasm
- Exacerbation of Glaucoma
- Increased cardiovascular events
- Avoid short acting Anticholinergics (Ipratropium) in comorbid cardiovascular disease
- Ogale (2010) Chest 137(1): 13-19 [PubMed]
- Singh (2008) JAMA 300(12): 1439-50 [PubMed]
- Common adverse effects
- Allergy
- Original Atrovent MDI (non-HFA) was contraindicated with soy or peanut allergy
- Pregnancy Category B
- Unknown safety in Lactation
- Ipratropium Bromide Nebulizer Solution (DailyMed)
- Ipratropium Bromide and Albuterol Nebulizer Solution (Duoneb, DailyMed)
- Ipratropium HFA MDI (DailyMed)