IPRATROPIUM BROMIDE (Atrovent)
IPRATROPIUM BROMIDE (Atrovent): available as an inhaler, solution for inhalation 0.02%; solution for nebulizer 0.025%. 

Action: Bronchodilator that antagonizes acetylcholine at receptors on bronchial smooth muscle.

Indications and Dosage: May provide additive effects to beta-agonist but has slower onset of action. Is alternative for patients with intolerance for beta2-agonists. Dose delivered by MDI is low. 
Adults and children over age 12: 1-2 inhalations q.i.d. No more than 12 inhalations in 24 hours.
Children 5 to 12: 12 5 to 250 mcg nebulizer solution dissolved in normal saline. Administer by nebulizer q 4 to 6 hours.


Most Common Adverse Reactions: Upper respiratory tract infection, bronchitis, bronchospasm, hypersensitivity reactions.

Interactions: Anticholinergics: increased anticholinergic effects.

Contraindications: Contraindicated in patients with hypersensitivity to drug, atropine, or its derivatives and in those with history of hypersensitivity to soy lecithin or related food products such as soybeans and peanuts.

Nursing Considerations and Patient Education:

  • Temporary blurring of vision could occur if there is leakage around a facemask used for nebulizer treatment.
  • A patient with a severe peanut allergy could potentially have an anaphylactic reaction after using Atrovent.
  • Drug is not effective for rapid treatment of acute bronchospasm.
  • Teach patient to use inhaler correctly.
  • Teach patient to avoid spraying into eyes.
  • Use of a spacer may improve delivery.
  • Wait for 2 minutes between puffs of inhaler.
  • If the patient is also using a steroid inhaler, use the bronchodilator first, then wait 5 minutes before using the steroid.
  • At least once a week, wash the canister with warm water and soap.

References:
Nursing 2001 Drug Handbook, 2001
Physician's Desk Reference, 2001