Ipratropium Bromide, Inhalation/Nasal

What are other names for this medicine?

Type of medicine: bronchodilator

Generic and brand names: ipratropium bromide, inhalation; ipratropium bromide, nasal; Atrovent; Atrovent HFA; Atrovent Nasal

What is this medicine used for?

This medicine comes in two forms: a medicine you inhale through your mouth and a nasal spray.

The inhaled form treats breathing problems caused by asthma, bronchitis, or emphysema. It is breathed into your lungs through your mouth.

The nasal spray (in a non-aerosol pump bottle) is used to relieve a runny nose caused by colds or allergies. It does not relieve nasal congestion, sneezing, or postnasal drip (dripping from the back of the nose directly into the throat).

What should my healthcare provider know before I take this medicine?

Do not use this medicine if you are allergic to soy lecithin or related food products such as soybeans and peanuts, or if you are allergic to atropine. Talk to your healthcare provider about this.

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine, or to soy or peanuts
• glaucoma
• an enlarged prostate gland or trouble urinating

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

Use this medicine exactly as your healthcare provider prescribes. Do not use more of it, use it more often, or use it for a longer period than prescribed. Do not stop using this medicine without your provider's approval. Check the label on the medicine for directions about your specific dose. Carefully read the instructions that are included in the medicine package.

The inhaled form comes in the form of a solution to be used in a nebulizer (hand or electric misting device) or in an aerosol inhaler. Both are for inhalation by mouth. The nasal spray is available in a non-aerosol pump bottle for spraying into the nostrils.

Aerosol form (Metered Dose Inhaler/MDI) for lung problems: Use the exact number of sprays per dose as prescribed by your healthcare provider. However, do not use more than 12 sprays (puffs) in 24 hours. Carefully read the instructions that are included in the medicine package. You may want to talk to your healthcare provider about using a spacer (not supplied with this medicine).

If you are not using a spacer, the technique most often recommended is as follows:

1. Shake the metered dose inhaler (MDI) vigorously.
2. Hold the MDI upright so the mouthpiece is at the bottom.
3. The best way to use the MDI is to hold the mouthpiece 1-and-1/2 to 2 inches in front of an open mouth (about 2 to 3 finger widths). Try this technique first. It helps keep medicine from ending up in your mouth, which may cause increased side effects. It also helps medicine to reach your lungs rather than the back of the throat. If the open mouth technique is too difficult, you may also place the MDI mouthpiece directly into your mouth and close your lips snugly around it. Talk with your provider or pharmacist about this.
4. Breathe out normally.
5. Press the MDI down once so it releases a spray of medicine into your mouth while you breathe in slowly. (One spray is called a puff.) Each time you press down, a metered (measured) dose is delivered.
6. Continue breathing in as slowly and deeply as possible.
7. Hold your breath for 5 to 10 seconds, or as long as is comfortable (this gives the medicine time to reach the airways).
8. Breathe out slowly.
9. Take a few normal breaths and then repeat steps 1 through 8 for another inhalation (puff) if required. Take the number of puffs prescribed by your healthcare provider.

Rinse your mouth with water and spit out the rinse right after you use this medicine. This may reduce the risk of thrush (a fungus infection) in your mouth. It may also help reduce aftertaste, dry mouth, and hoarseness.

If you are using other inhaled medicines, ask your healthcare provider or pharmacist which you should use first. Use inhaled medicines 10 minutes apart from each other.

Solution form for lung problems: This medicine comes in small vials that contain the exact dosage to be used with a nebulizer. The solution may be mixed in the nebulizer with albuterol (Proventil or Ventolin) if used within 1 hour. Use a nebulizer with a mouthpiece, not a face mask, to keep from getting the medicine into your eyes. Breathe slowly and evenly until all the medicine has been inhaled (usually 5-15 minutes). Read carefully the information sheet that comes in the medicine package.

Nasal spray for runny nose: The spray bottle requires priming. Push down on the spray pump 7 times before the first use. Gently blow your nose before using this medicine. Insert the tip of the sprayer about 1 inch into your nostril, pointing straight up. Block your other nostril and keep your head upright. Pump and sniff gently at the same time. Try not to sneeze or blow your nose right after using the spray. Use the number of sprays per nostril that your healthcare provider prescribes. Read carefully the information sheet that comes with this medicine.

If you have any questions about how to use this medicine, ask your healthcare provider or your pharmacist to explain.

What if I miss a dose?

Use this medicine regularly as prescribed. If you miss a dose, use it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and use the next one as directed. Do not use double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

An acute overdose of this medicine is not likely to cause life-threatening symptoms. If you think that you or anyone else may have taken too much of this medicine, call the poison control center at 800-222-1222.

What should I watch out for?

This medicine is not intended to treat sudden bronchospasm (severe gasping for breath). Your healthcare provider will prescribe a medicine that you inhale through your mouth for fast relief.

Contact your healthcare provider if your breathing does not improve with use of this medicine.

Getting the aerosol or the solution in your eyes may cause temporary blurred vision, worsening of glaucoma, or eye pain. To keep the medicine out of your eyes, close your mouth around the mouthpiece when using the aerosol or nebulizer.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your healthcare provider right away): Increased trouble breathing, fast heartbeat, chest pain.

Other: Headache, nausea, vomiting, dizziness, dry mouth or throat, hoarseness, cough, blurred vision, nosebleeds.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• anticholinergic medicines such as atropine (Donnatal, Sal-Tropine), clidinium bromide, hyoscyamine (Levbid, Levsin, Levsinex), scopolamine (Transderm-Scop), methantheline (Banthine), methscopolamine (Pamine), propantheline (Pro-Banthine), and tolterodine (Detrol)
• dronabinol (Marinol)

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.

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