Ipratropium Bromide (Ipratropium Bromide)
Also sold as: Ipravent, Atrovent, Ipramol (with salbutamol), Duolin (with levosalbutamol), Combipres
Pregnancy
Cat B
Lactation
Safe
Schedule
H
Forms
MDI inhaler 20mcg/actuation +4
Indications
- Maintenance treatment of COPD (first-line bronchodilator)
- Acute severe asthma (adjunct to SABA)
- Acute COPD exacerbations
- Allergic and non-allergic rhinitis (nasal spray)
- Bronchospasm associated with beta-blocker therapy
Adult Dosing
COPD maintenance (MDI)
40–80mcg (2–4 puffs of 20mcg) three to four times daily
QID; onset 15–30 min, peak at 1–2 hours, duration 4–6 hours
Slower onset than salbutamol but additive effect when combined. Use spacer for better lung deposition.
Acute severe asthma (nebulisation, adjunct to salbutamol)
500mcg every 20 minutes for 3 doses, then every 4 hours
Combined nebulisation with salbutamol is most effective
Adding ipratropium to salbutamol nebulisation reduces admission rates in acute severe asthma. Available as combination Ipramol/Duolin.
Acute COPD exacerbation (nebulisation)
500mcg every 4–6 hours
QID to Q6h
May combine with salbutamol 2.5mg in same nebuliser
Rhinitis (nasal spray 0.03%)
2 sprays per nostril BD-TDS
Twice to three times daily
21mcg per spray; for perennial rhinitis and rhinorrhea
Pediatric Dosing
Use with salbutamol for additive bronchodilation in acute asthma. MDI: 20mcg/puff, 1–2 puffs TID-QID with spacer in older children.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any degree of renal impairment | No dose adjustment required — minimal systemic absorption with inhaled route |
Hepatic Adjustment
No dose adjustment required. Negligible hepatic metabolism with inhaled administration.
Pregnancy & Lactation
Pregnancy: Category B
Animal studies show no fetal harm. Limited human data. Inhaled route has very low systemic absorption, making fetal exposure minimal. Generally considered safe when inhaled salbutamol alone is insufficient. Preferred over systemic anticholinergics.
Lactation: Safe
Very low systemic absorption with inhaled use. Unlikely to be present in breast milk in clinically significant amounts. Compatible with breastfeeding.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Other anticholinergic agents (atropine, tiotropium, oxybutynin, tricyclic antidepressants) | Additive anticholinergic toxicity: dry mouth, urinary retention, constipation, tachycardia, blurred vision, confusion | Moderate |
| Salbutamol / Beta-2 agonists | Additive bronchodilation — beneficial combination. Combined nebulisation effective in acute severe asthma and COPD exacerbations. | Minor |
| Haloperidol / Phenothiazines | Additive anticholinergic effects; risk of urinary retention, ileus, hyperthermia | Moderate |
| Amantadine | Additive anticholinergic effects; increased risk of urinary retention and confusion | Moderate |
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Side Effects
Common
- Dry mouth (most common)
- Throat irritation
- Cough
- Headache
- Nausea
- Urinary retention (rare with inhaled doses)
- Constipation
- Tachycardia
Serious / Discontinue If
- Acute angle-closure glaucoma (if nebulised solution contacts eyes — use mouthpiece, not face mask)
- Paradoxical bronchospasm (rare)
- Severe urinary retention (especially in prostatic hypertrophy)
- Hypersensitivity reactions (rare)
Contraindications
- Hypersensitivity to ipratropium bromide or atropine/belladonna alkaloids
- Angle-closure glaucoma (avoid nebulisation with face mask — may cause acute glaucoma)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Ipravent Inhaler | Cipla Ltd | 200 dose ₹185 |
| Atrovent | Boehringer Ingelheim India | 200 dose ₹220 |
| Ipravent Respules | Cipla Ltd | 2.5mL × 10 vials ₹110 |
| Duolin Inhaler | Cipla Ltd | 200 dose ₹195 |
| Ipramol Nebuliser | Cipla Ltd | 2.5mL × 10 vials ₹125 |
Monitoring Required
- Symptom relief (PEFR, FEV1 improvement)
- Intraocular pressure in patients with glaucoma risk
- Urinary symptoms in elderly male patients (prostatic hyperplasia)
- Heart rate (tachycardia with higher doses)
- Saliva production (dry mouth marker of anticholinergic effect)
Patient Counseling Points
- This inhaler takes 15–30 minutes to start working — it is NOT a rescue inhaler for sudden breathlessness.
- For acute attacks, use your salbutamol (short-acting) inhaler first.
- If using a nebuliser, use a mouthpiece rather than a face mask to avoid getting solution in your eyes.
- Do not spray inhaler near your eyes — may cause blurred vision or raise eye pressure.
- Dry mouth is very common; sip water frequently and maintain good oral hygiene.
- Tell your doctor if you have prostate problems or glaucoma before starting this medication.
- Use consistently as prescribed — do not skip doses for COPD maintenance.
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Clinically reviewed by: Dr. Suresh Nair, MD (Pulmonology), AIIMS New Delhi
Last reviewed: 2026-03-15
References
- Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report 2025.
- FDA Prescribing Information: Atrovent HFA (ipratropium bromide). Boehringer Ingelheim.
- Indian Pharmacopoeia Commission. Ipratropium Bromide monograph. IP 2022.
- CIMS India Drug Database 2025 — Ipratropium Bromide
- Rodrigo GJ, Castro-Rodriguez JA. Anticholinergics in the treatment of children and adults with acute asthma. Chest. 2005;128(4):2265–2274.