at regularly recommended dosages.neostigmineMonitor Closely (1)neostigmine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptylineMonitor Closely (1)ipratropium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.olanzapineMonitor Closely (3)ipratropium decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor. olanzapine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.onabotulinumtoxinAMonitor Closely (1)onabotulinumtoxinA and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.orphenadrineMonitor Closely (1)ipratropium and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutyninMonitor Closely (1)ipratropium and oxybutynin both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.oxybutynin topicalMonitor Closely (1)ipratropium and oxybutynin topical both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.oxybutynin transdermalMonitor Closely (1)ipratropium and oxybutynin transdermal both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.paliperidoneMonitor Closely (3)ipratropium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.pancuroniumMonitor Closely (1)ipratropium and pancuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.perphenazineMonitor Closely (3)ipratropium decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor. perphenazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.physostigmineMonitor Closely (1)physostigmine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.pilocarpineMonitor Closely (1)pilocarpine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.pimozideMonitor Closely (3)ipratropium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor. pimozide increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.pralidoximeMonitor Closely (1)ipratropium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.pramlintideSerious - Use Alternative (1)pramlintide, ipratropium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.prochlorperazineMonitor Closely (3)ipratropium decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor. prochlorperazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.promethazineMonitor Closely (3)ipratropium decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor. promethazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.propanthelineMonitor Closely (1)ipratropium and propantheline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.protriptylineMonitor Closely (1)ipratropium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.pyridostigmineMonitor Closely (1)pyridostigmine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.quetiapineMonitor Closely (3)ipratropium decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor. quetiapine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.rapacuroniumMonitor Closely (1)ipratropium and rapacuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.revefenacinSerious - Use Alternative (1)revefenacin and ipratropium both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. Coadministration may cause additive anticholinergic effects.risperidoneMonitor Closely (1)risperidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.rocuroniumMonitor Closely (1)ipratropium and rocuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.scopolamineMonitor Closely (1)ipratropium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.solifenacinMonitor Closely (1)ipratropium and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.succinylcholineMonitor Closely (1)succinylcholine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.thioridazineMonitor Closely (3)ipratropium decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor. thioridazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.thiothixeneMonitor Closely (3)ipratropium decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor. thiothixene increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tiotropiumMonitor Closely (1)ipratropium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.tolterodineMonitor Closely (1)ipratropium and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.trazodoneMonitor Closely (1)ipratropium and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.trifluoperazineMonitor Closely (3)ipratropium decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor. trifluoperazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.trihexyphenidylMonitor Closely (1)ipratropium and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.trimipramineMonitor Closely (1)ipratropium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.trospium chlorideMonitor Closely (1)ipratropium and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.umeclidinium bromideMonitor Closely (1)umeclidinium bromide and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agents umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (1)ipratropium, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Concomitant use with other anticholinergic-containing drugs may lead to additive anticholinergic adverse effects.vecuroniumMonitor Closely (1)ipratropium and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.ziprasidoneMonitor Closely (3)ipratropium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor. ziprasidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.zotepineMonitor Closely (2)ipratropium decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. >10% Bronchitis (10-23%) Chronic obstructive pulmonary disease (COPD) exacerbation (8-23%) Sinusitis (1-14%) 1-10% Dyspnea (4-10%) Urinary tract infection (UTI) (2-10%) Headache (5-9%) Flulike symptoms (2-8%) Back pain (2-7%) Cough (5.9%) Dyspepsia (1-5%) Dry mouth (2-4%) Dizziness (1-3%) Nausea (2.8%) Frequency Not Defined Cardiovascular: Hypotension, palpitations, tachycardia General: Dry throat, throat irritation Gastrointestinal (GI): Constipation, stomatitis, mouth edema Sensory: Narrow-angle glaucoma, glaucoma, halo vision, conjunctival hyperemia, corneal edema, mydriasis, acute eye pain, blurry vision Respiratory: Bronchospasm, including paradoxical bronchospasm Renal: Urinary retention Contraindications Documented hypersensitivity to ipratropium, atropine, or derivatives Cautions Use for maintenance treatment only; should not be used as rescue therapy Inhaled bronchodilating agents may cause life-threatening paradoxical bronchospasm that should be differentiated from inadequate response Hypersensitivity reactions (skin rash, pruritus, angioedema, urticaria/giant urticaria, laryngospasm) reported; discontinue immediately, and use alternative treatment May cause urinary retention; use with caution in patients with benign prostatic hyperplasia (BPH) or bladder-neck obstruction Use caution in patients with myasthenia gravis May worsen narrow-angle glaucoma Inhalation/nebulizer not indicated for initial treatment of acute episodes of bronchospasm; rescue therapy required Pregnancy Ipratropium is negligibly absorbed systemically following oral inhalation; therefore, maternal use is not expected to result in fetal exposure to the drug Experience with ipratropium bromide use in pregnant women over several decades, based on published literature, including cohort studies, case control studies and case series, have not identified a drug associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes Animal data Based on animal reproduction animal studies, no evidence of structural alternations was observed when ipratropium bromide was administered to pregnant mice, rats and rabbits during organogenesis at doses up to approximately 200, 40,000, and 10,000 times, respectively, the maximum recommended human daily inhalation dose (MRHDID) in adults Lactation There are no data on presence of drug in either human or animal milk, effects on breastfed infant, or on milk production; although lipid- insoluble quaternary cations pass into breast milk, drug concentrations in plasma after inhaled therapeutic doses are low; therefore, drug levels in human breast milk are expected to be low Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed child from drug or from underlying maternal conditionPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Anticholinergic (parasympatholytic) agent; inhibits vagally mediated reflexes by antagonizing acetylcholine action; prevents increase in intracellular calcium concentration that is caused by interaction of acetylcholine with muscarinic receptors on bronchial smooth muscle Absorption Minimal systemic absorption Onset: 15 min Duration: 3-4 hr Peak plasma time: 1-3 hr Peak plasma concentration: 0.06 ng/mL Distribution Protein bound: 0-9% Vd: 338 L Metabolism Metabolized in liver Metabolites: N-isopropylnortropium methobromide, a-phenylacrylic acid-N-isopropylnortropine-ester methobromide, 6 others Elimination Half-life: 2 hr Excretion: Urine (46%) BRAND FORM. UNIT PRICE PILL IMAGE ipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide inhalation- 0.02 % solutionipratropium bromide nasal- 42 mcg (0.06 %) aerosolipratropium bromide nasal- 21 mcg (0.03 %) aerosolipratropium bromide nasal- 21 mcg (0.03 %) aerosolipratropium bromide nasal- 42 mcg (0.06 %) aerosolipratropium bromide nasal- 42 mcg (0.06 %) aerosolipratropium bromide nasal- 21 mcg (0.03 %) aerosolipratropium bromide nasal- 42 mcg (0.06 %) aerosolipratropium bromide nasal- 21 mcg (0.03 %) aerosolAtrovent HFA inhalation- 17 mcg/actuation aerosolCopyright © 2010 First DataBank, Inc.Select a drug:ipratropium bromide inhalationipratropium bromide nasalPrint Patient Educationipratropium bromide inhalation IPRATROPIUM SOLUTION - INHALATION (IP-ra-TROE-pee-um) COMMON BRAND NAME(S): Atrovent USES: Ipratropium is used to control and prevent symptoms (wheezing and shortness of breath) caused by ongoing lung disease (chronic obstructive pulmonary disease-COPD which includes bronchitis and emphysema). It works by relaxing the muscles around the airways so that they open up and you can breathe more easily. Controlling symptoms of breathing problems can decrease time lost from work or school.For preventing symptoms of lung disease, this medication must be used regularly to be effective. Use your quick-relief inhaler or nebulized solution (such as albuterol, also called salbutamol in some countries) for wheezing or sudden shortness of breath unless otherwise directed by your doctor. Ipratropium does not work as fast as your quick-relief medication, but may sometimes be used together with your quick-relief medication to relieve symptoms of wheezing or sudden shortness of breath if so prescribed by