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Ipratropium bromide | Anticholinergic


Ipratropium bromide. It is an anticholinergic bronchodilator chemically described as 8-Azoniabicyclo [3.2.1] octane, 3-(3- hydroxy-1-oxo-2-phenylpropoxy)-8-methyl-8-(1-methylethyl)-, bromide, monohydrate, (endo, syn): a synthetic quaternary ammonium compound, chemically related to atropine.
Anticholinergic bronchodilator used in bronchospasm associated with COPD, bronchitis, and emphysema.



Ipratropium bromide is a white to off-white crystalline substance, freely soluble in water and methanol and sparingly soluble in ethanol and insoluble in lipophilic solvents such as ether, chloroform, and fluorocarbons.




Indications:
Anticholinergic bronchodilator used in bronchospasm associated with COPD, bronchitis, and emphysema.

Mechanism of Action

Ipratropium bromide is an anticholinergic (parasympatholytic) agent which, based on animal studies, appears to inhibit vagally mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released at neuromuscular junctions in the lung. Anticholinergics prevent the increases in intracellular concentration of cyclic guanosine monophosphate (cyclic GMP) which are caused by interaction of acetylcholine with the muscarinic receptor on bronchial smooth muscle.
Dosage:

Asthma exacerbation, acute:

- Nebulization: 500 mcg every 20 minutes for 3 doses, then as needed. Note: Should be given in combination with a short-acting beta-adrenergic agonist.
- Metered-dose inhaler: 8 inhalations every 20 minutes as needed for up to 3 hours. Note: Should be given in combination with a short-acting beta-adrenergic agonist.

Bronchospasm associated with COPD:

- Nebulization: 500 mcg (one unit-dose vial) 3-4 times/day with doses 6-8 hours apart.
- Metered-dose inhaler: 2 inhalations 4 times/day, up to 12 inhalations/24 hours. Geriatric Refer to adult dosing. Renal Impairment: No dosage adjustment provided in manufacturer’s labeling (has not been studied). Hepatic Impairment: No dosage adjustment provided in manufacturer’s labeling (has not been studied).

Common side effect:
Respiratory: Bronchitis, COPD exacerbation, sinusitis
Pregnancy Risk Factor: B



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