Atrovent Inhalation, oral/nebulization
Generic Name: ipratropium (Inhalation route)
Commonly used brand name(s):
In the U.S.
Available Dosage Forms:
Therapeutic Class: Bronchodilator
Pharmacologic Class: Anticholinergic
Uses For Atrovent
Ipratropium is a bronchodilator (medicine that opens up narrowed breathing passages). It is taken by inhalation to help control the symptoms of lung diseases, such as asthma, chronic bronchitis, and emphysema. Ipratropium helps decrease coughing, wheezing, shortness of breath, and troubled breathing by increasing the flow of air into the lungs.
When ipratropium inhalation is used to treat acute, severe attacks of asthma, bronchitis, or emphysema, it is used only in combination with other bronchodilators.
Ipratropium is available only with your doctor's prescription.
Before Using Atrovent
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
This medicine has been tested in children and, in effective doses, has not been shown to cause different side effects or problems in children than it does in adults.
Ipratropium inhalation has been tested in patients 65 years of age or older. This medicine is not expected to cause different side effects or problems in older people than it does in younger adults.
|All Trimesters||B||Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.|
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
The presence of other medical problems may affect the use of ipratropium. Make sure you tell your doctor if you have any other medical problem, especially:
- Difficult urination or
- Enlarged prostate or
- Urinary bladder blockage—Ipratropium may make the condition worse.
- Glaucoma—Ipratropium may make the condition worse if it gets into the eyes
Proper Use of Atrovent
Ipratropium is used to help control the symptoms of lung diseases, such as chronic bronchitis, emphysema, and asthma. However, for treatment of bronchospasm or asthma attacks that have already started, ipratropium is used only in combination with other bronchodilators.
It is very important that you use ipratropium only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of side effects.
Keep the spray or solution away from the eyes because this medicine may cause irritation or blurred vision. Closing your eyes while you are inhaling ipratropium may keep the medicine from getting into your eyes. Rinsing your eyes with cool water may help if any medicine does get into your eyes.
Ipratropium usually comes with patient directions. Read them carefully before using this medicine.
If you are taking this medicine every day to help control your symptoms, it must be taken at regularly spaced times as ordered by your doctor.
Contact your doctor before using other inhaled medicines.
For patients using ipratropium inhalation aerosol:
- If you do not understand the directions or you are not sure how to use the inhaler, ask your health care professional to show you how to use it. Also, ask your health care professional to check regularly how you use the inhaler to make sure you are using it properly.
- There are two formulas of the inhaled aerosol. One contains chlorofluorocarbons and the other contains HFA as the propellant. The taste and inhalation of these may seem different, but the safety and effectiveness of both formulas are similar.
- The ipratropium aerosol canister provides about 200 inhalations, depending on the size of the canister your doctor ordered. You should try to keep a record of the number of inhalations you use so you will know when the canister is almost empty. This canister, unlike some other aerosol canisters, cannot be floated in water to test its fullness.
- When you use the inhaler for the first time, or if you have not used it for a while, the inhaler may not give the right amount of medicine with the first puff. Therefore, before using the inhaler, test or prime it.
- To test or prime the inhaler:
- Insert the canister firmly into the clean mouthpiece according to the manufacturer's instructions. Check to make sure it is placed properly into the mouthpiece.
- Take the cap off the mouthpiece and shake the inhaler three or four times.
- Hold the inhaler away from you at arm's length and press the top of the canister, spraying the medicine once into the air. The inhaler will now be ready to give the right amount of medicine when you use it.
- To use the inhaler:
- Using your thumb and one or two fingers, hold the inhaler upright, with the mouthpiece end down and pointing toward you.
- Take the cap off the mouthpiece. Check the mouthpiece to make sure it is clear. Then, gently shake the inhaler three or four times.
- Breathe out slowly to the end of a normal breath.
- Use the inhalation method recommended by your doctor:
- Open-mouth method—Place the mouthpiece about 1 or 2 inches (2 fingerwidths) in front of your widely opened mouth. Make sure the inhaler is aimed into your mouth so the spray does not hit the roof of your mouth or your tongue.
- Closed-mouth method—Place the mouthpiece in your mouth between your teeth and over your tongue with your lips closed tightly around it. Make sure your tongue or teeth are not blocking the opening.
- Start to breathe in slowly and deeply through your mouth. At the same time, press the top of the canister once to get one puff of medicine. Continue to breathe in slowly for 5 to 10 seconds. Count the seconds while breathing in. It is important to press the canister and breathe in slowly at the same time so the medicine gets into your lungs. This step may be difficult at first. If you are using the closed-mouth method and you see a fine mist coming from your mouth or nose, the inhaler is not being used correctly.
- Hold your breath as long as you can up to 10 seconds. This gives the medicine time to settle into your airways and lungs.
- Take the mouthpiece away from your mouth and breathe out slowly.
- If your doctor has told you to inhale more than one puff of medicine at each dose, gently shake the inhaler again, and take the second puff following exactly the same steps you used for the first puff. Press the canister one time for each puff of medicine.
- When you are finished, wipe off the mouthpiece and replace the cap.
- Your doctor may want you to use a spacer device or holding chamber with the inhaler. A spacer helps get the medicine into the lungs and reduces the amount of medicine that stays in your mouth and throat.
- To use a spacer device with the inhaler:
- Attach the spacer to the inhaler according to the manufacturer's directions. There are different types of spacers available, but the method of breathing remains the same with most spacers.
- Gently shake the inhaler and spacer three or four times.
- Hold the mouthpiece of the spacer away from your mouth and breathe out slowly to the end of a normal breath.
- Place the mouthpiece into your mouth between your teeth and over your tongue with your lips closed around it.
- Press the top of the canister once to release one puff of medicine into the spacer. Within 1 or 2 seconds, start to breathe in slowly and deeply through your mouth for 5 to 10 seconds. Count the seconds while inhaling. Do not breathe in through your nose.
- Hold your breath as long as you can up to 10 seconds.
- Take the mouthpiece away from your mouth and breathe out slowly.
- If your doctor has told you to take more than one puff of medicine at each dose, gently shake the inhaler and spacer again and take the next puff, following exactly the same steps you used for the first puff. Do not put more than one puff of medicine into the spacer at a time.
- When you are finished, remove the spacer device from the inhaler and replace the cap.
- Clean the inhaler, mouthpiece, and spacer at least twice a week.
- To clean the inhaler:
- Remove the canister from the inhaler and set aside.
- Wash the mouthpiece, cap, and the spacer with warm, soapy water. Then, rinse well with warm, running water.
- Shake off the excess water and let the inhaler parts air dry completely before putting the inhaler back together.
For patients using ipratropium inhalation solution:
- Use this medicine only in a power-operated nebulizer with an adequate flow rate and equipped with a face mask or mouthpiece. Your doctor will tell you which nebulizer to use. Make sure you understand exactly how to use it. If you have any questions about this, check with your doctor.
- To prepare the medicine for use in the nebulizer:
- If you are using the single-dose vial of ipratropium:
- Break away one vial by pulling it firmly from the strip.
- Twist off the top to open the vial. Use the contents of the vial as soon as possible after opening it.
- Squeeze the contents of the vial into the cup of the nebulizer. If your doctor has told you to use less than a full vial of solution, use a syringe to withdraw the correct amount of solution from the vial and add it to the nebulizer cup. Be sure to throw away the syringe after one use.
- If you are using the multiple-dose bottle of ipratropium:
- Use a syringe to withdraw the correct amount of solution from the bottle and add it to the nebulizer cup. Do not use the same syringe more than once.
- If you have been told to dilute the ipratropium inhalation solution in the nebulizer cup with the sodium chloride solution provided, use a new syringe to add the sodium chloride solution to the cup as directed by your health care professional.
- If your doctor told you to use another inhalation solution with the ipratropium inhalation solution, add that solution also to the nebulizer cup.
- To use the nebulizer:
- Gently shake the nebulizer cup to mix the solutions well.
- Connect the nebulizer tube to the air or oxygen pump and begin the treatment. Adjust the mask, if you are using one, to prevent mist from getting into your eyes.
- Use the method of breathing your doctor told you to use to take the treatment. One way is to breathe slowly and deeply through the mask or mouthpiece. Another way is to breathe in and out normally with the mouthpiece in your mouth, taking a deep breath every 1 or 2 minutes. Continue to breathe in the medicine as instructed until no more mist is formed in the nebulizer cup or until you hear a sputtering (spitting or popping) sound.
- When you have finished, replace the caps on the solutions. Store the bottles of solution in the refrigerator until the next treatment.
- Clean the nebulizer according to the manufacturer's directions.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For symptoms of chronic obstructive pulmonary disease, such as chronic bronchitis or emphysema:
- For inhalation aerosol dosage form:
- Adults and children 12 years of age and older—2 to 4 inhalations (puffs) three or four times a day, at regularly spaced times. Some patients may need up to 6 to 8 puffs three times a day.
- For inhalation solution dosage form:
- Adults and children 12 years of age and older—250 to 500 mcg used in a nebulizer three or four times a day, every six to eight hours.
- For symptoms of asthma:
- For inhalation aerosol dosage form:
- Adults and children 12 years of age and older—1 to 4 inhalations (puffs) four times a day, at regularly spaced times, as needed.
- Children up to 12 years of age—1 or 2 inhalations (puffs) three or four times a day, at regularly spaced times, as needed.
- For inhalation solution dosage form:
- Adults and children 12 years of age and older—500 mcg used in a nebulizer three or four times a day, every six to eight hours, as needed.
- Children 5 to 12 years of age—125 to 250 mcg used in a nebulizer three or four times a day, every four to six hours as needed.
- Children up to 5 years of age—Use and dose must be determined by your doctor.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store in the refrigerator. Do not freeze.
Store the canister at room temperature, away from heat and direct light. Do not freeze. Do not keep this medicine inside a car where it could be exposed to extreme heat or cold. Do not poke holes in the canister or throw it into a fire, even if the canister is empty.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Precautions While Using Atrovent
Check with your doctor at once if your symptoms do not improve within 30 minutes after using a dose of this medicine or if your condition gets worse.
If symptoms of an allergic reaction such as abdominal or stomach pain, diarrhea, fever, joint or muscle pain, nausea, numbness or tingling of face, hands, or feet, redness and soreness of eyes, skin rash, shortness of breath, sores in mouth, swelling of feet or lower legs, or vomiting occur, contact your doctor right away.
For patients using ipratropium inhalation solution :
- If you are also using cromolyn inhalation solution, do not mix that solution with the ipratropium inhalation solution containing the preservative benzalkonium chloride for use in a nebulizer. To do so will cause the solution to become cloudy. However, if your condition requires you to use cromolyn inhalation solution with ipratropium inhalation solution, it may be mixed with ipratropium inhalation solution that is preservative-free.
Atrovent Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:Rare
- Constipation (continuing) or lower abdominal pain or bloating
- fast, pounding, or irregular heartbeat or pulse
- increased wheezing, tightness in chest, or difficulty in breathing
- severe eye pain
- skin rash or hives
- swelling of face, lips, or eyelids
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
Less common or rare
- dryness of mouth
- unpleasant taste
- Acid or sour stomach
- bladder pain
- bloody or cloudy urine
- blurred vision or other changes in vision
- body aches or pain
- burning eyes
- cough producing mucus
- difficult, burning, or painful urination
- difficulty breathing
- ear congestion
- frequent urge to urinate
- general feeling of discomfort or illness
- joint pain
- loss of appetite
- loss of voice
- lower back or side pain
- muscle aches and pains
- nasal congestion
- pain or tenderness around eyes and cheekbones
- pounding heartbeat
- runny nose
- shortness of breath or troubled breathing
- sore throat
- stomach discomfort, upset, or pain
- stuffy or runny nose
- tightness in chest
- trouble sleeping
- unusual tiredness or weakness
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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