eiiiiF 152Ipratropium bromide 22-Jan-2018
lINDICATIONS AND DOSE
Reversible airways obstruction
▶BY INHALATION OF AEROSOL
▶Child 1 month–5 years: 20 micrograms 3 times a day
▶Child 6–11 years: 20 – 40 micrograms 3 times a day
▶Child 12–17 years: 20 – 40 micrograms 3 – 4 times a day
Acute bronchospasm
▶BY INHALATION OF NEBULISED SOLUTION
▶Child 1 month–5 years: 125 – 250 micrograms as required;
maximum 1 mg per day
▶Child 6–11 years: 250 micrograms as required; maximum
1 mg per day
▶Child 12–17 years: 500 micrograms as required, doses
higher than max. can be given under medical
supervision; maximum 2 mg per day
Severe or life-threatening acute asthma
▶BY INHALATION OF NEBULISED SOLUTION
▶Child 1 month–11 years: 250 micrograms every
20 – 30 minutes for thefirst 2 hours, then
250 micrograms every 4 – 6 hours as required
▶Child 12–17 years: 500 micrograms every 4 – 6 hours as
required
PHARMACOKINETICS
▶The maximal effect of inhaled ipratropium occurs
30 – 60 minutes after use; its duration of action is 3 to
6 hours and bronchodilation can usually be maintained
with treatment 3 times a day.lUNLICENSED USEgThe dose of ipratropium for severe
or life-threatening acute asthma is unlicensed.h
Inhalvent®not licensed for use in children under 6 years.
lCAUTIONSAvoid spraying near eyes.cysticfibrosis
CAUTIONS, FURTHER INFORMATION
▶GlaucomaAcute angle-closure glaucomahas been reported
with nebulised ipratropium, particularly when given with
nebulised salbutamol (and possibly other beta 2 agonists);
care needed to protect the patient’s eyes from nebulised
drug or from drug powder.
lINTERACTIONS→Appendix 1 : ipratropium
lSIDE-EFFECTS
▶Common or very commonGastrointestinal motility disorder
.throat complaints
▶UncommonCorneal oedema.diarrhoea.eye disorders.
eye pain.respiratory disorders.vision disorders.vomiting
lALLERGY AND CROSS-SENSITIVITYContra-indicated in
patients with hypersensitivity to atropine or its
derivatives.
lPREGNANCYManufacturer advises only use if potential
benefit outweighs the risk.
lBREAST FEEDINGNo information available—manufacturer
advises only use if potential benefit outweighs risk.
lDIRECTIONS FOR ADMINISTRATIONIf dilution of
ipratropium bromide nebuliser solution is necessary use
only sterile sodium chloride 0. 9 %.
lPATIENT AND CARER ADVICEPatients or carers should be
counselled on appropriate administration technique and
warned against accidental contact with the eye (due to risk
of ocular complications).
Driving and skilled tasksManufacturer advises patients and
carers should be counselled on the effects on driving and
performance of skilled tasks—increased risk of dizziness
and vision disorders.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Nebuliser liquid
▶Ipratropium bromide (Non-proprietary)
Ipratropium bromide 250 microgram per 1 mlIpratropium
bromide 500 micrograms/ 2 ml nebuliser liquid unit dose vials| 20 unit
doseP£ 5. 60 DT = £ 3. 36
Ipratropium bromide 250 micrograms/ 1 ml nebuliser liquid unit dose
vials| 20 unit doseP£ 4. 83 DT = £ 4. 65
Ipratropium 250 micrograms/ 1 ml nebuliser liquid Steri-Neb unit dose
vials| 20 unit doseP£ 6. 99 DT = £ 4. 65
Ipratropium 500 micrograms/ 2 ml nebuliser liquid Steri-Neb unit dose
vials| 20 unit doseP£ 15. 99 DT = £ 3. 36
▶Atrovent UDV(Boehringer Ingelheim Ltd)
Ipratropium bromide 250 microgram per 1 mlAtrovent
500 micrograms/ 2 ml nebuliser liquid UDVs| 20 unit doseP£ 4. 87
DT = £ 3. 36 | 60 unit doseP£ 14. 59
Atrovent 250 micrograms/ 1 ml nebuliser liquid UDVs| 20 unit
doseP£ 4. 14 DT = £ 4. 65 | 60 unit doseP£ 12. 44
Pressurised inhalation
▶Atrovent(Boehringer Ingelheim Ltd)
Ipratropium bromide 20 microgram per 1 doseAtrovent
20 micrograms/dose inhaler CFC free| 200 doseP£ 5. 56 DT =
£ 5. 56
▶Inhalvent(Alissa Healthcare Research Ltd)
Ipratropium bromide 20 microgram per 1 doseInhalvent
20 micrograms/dose inhaler| 200 doseP£ 5. 56 DT = £ 5. 56eiiiiF 152Tiotropium 12-Jun-2018
lINDICATIONS AND DOSE
SPIRIVA RESPIMAT®
Severe asthma [add-on to inhaled corticosteroid (over
400 micrograms budesonide daily or equivalent) and 1
controller, or inhaled corticosteroid
( 200 – 400 micrograms budesonide daily or equivalent)
and 2 controllers, in patients who have suffered one or
more severe exacerbations in the last year]
▶BY INHALATION OF AEROSOL
▶Child 6–11 years: 5 micrograms once daily
Severe asthma [add-on to inhaled corticosteroid (over
800 micrograms budesonide daily or equivalent) and 1
controller, or inhaled corticosteroid
( 400 – 800 micrograms budesonide daily or equivalent)
and 2 controllers, in patients who have suffered one or
more severe exacerbations in the last year]
▶BY INHALATION OF AEROSOL
▶Child 12–17 years: 5 micrograms once daily
DOSE EQUIVALENCE AND CONVERSION
▶ 2 puffs is equivalent to 5 micrograms tiotropium.lCAUTIONSArrhythmia (unstable, life-threatening or
requiring intervention in the previous 12 months).heart
failure (hospitalisation for moderate to severe heart failure
in the previous 12 months).myocardial infarction in the
previous 6 months
lINTERACTIONS→Appendix 1 : tiotropium
lSIDE-EFFECTS
▶UncommonGastrointestinal disorders.increased risk of
infection.taste altered
▶Rare or very rareBronchospasm.dysphagia.insomnia.
oral disorders
▶Frequency not knownDehydration.dry skin.joint swelling
.skin ulcer
lPREGNANCYManufacturer advises avoid—limited data
available.
lBREAST FEEDINGManufacturer advises avoid—no
information available.
lRENAL IMPAIRMENTManufacturer advises use only if
potential benefit outweighs risk if creatinine clearance lessBNFC 2018 – 2019 Airways disease, obstructive 153
Respiratory system3