From the Guidelines
Ipratropium can cause several adverse effects, including dry mouth, throat irritation, and cough. Other potential side effects include headache, dizziness, nausea, and urinary retention [ 1 ]. In rare cases, ipratropium can cause more serious adverse effects, such as paradoxical bronchospasm, which can be life-threatening.
Common Adverse Effects
- Dry mouth
- Throat irritation
- Cough
- Headache
- Dizziness
- Nausea
- Urinary retention
Serious Adverse Effects
- Paradoxical bronchospasm It is essential to use ipratropium as directed, typically 2-4 puffs, 2-4 times a day, and to rinse the mouth after inhalation to minimize the risk of adverse effects [ 1 ]. Patients with a history of glaucoma, urinary retention, or prostate enlargement should use ipratropium with caution [ 1 ]. The most common specific adverse effects of ipratropium were dry mouth, occurring in 10.3% of participants, and urine retention [ 1 ].
Special Considerations
- Use with caution in patients with glaucoma, urinary retention, or prostate enlargement
- Rinse mouth after inhalation to minimize risk of adverse effects
- Use as directed, typically 2-4 puffs, 2-4 times a day
From the FDA Drug Label
ADVERSE REACTIONS Adverse reaction information concerning ipratropium bromide inhalation solution is derived from 12-week active-controlled clinical trials. Additional adverse reactions reported in less than three percent of the patients treated with ipratropium bromide include tachycardia, palpitations, eye pain, urinary retention, urinary tract infection and urticaria Cases of precipitation or worsening of narrow-angle glaucoma, mydriasis, and acute eye pain have been reported. Lower respiratory adverse reactions (bronchitis, dyspnea and bronchospasm) were the most common events leading to discontinuation of ipratropium bromide therapy in the 12-week trials. Headache, mouth dryness and aggravation of COPD symptoms are more common when the total daily dose of ipratropium bromide equals or exceeds 2,000 mcg Allergic-type reactions such as skin-rash, angioedema of tongue, lips and face, urticaria, laryngospasm and anaphylactic reaction have been reported.
The adverse effects of Ipratropium (Atrovent) include:
- Respiratory System Disorders:
- Lower respiratory: bronchitis, dyspnea, bronchospasm, coughing, sputum increased
- Upper respiratory: upper respiratory tract infection, pharyngitis, rhinitis, sinusitis
- Cardiovascular Disorders: hypertension/hypertension aggravated, tachycardia, palpitations
- Central & Peripheral Nervous System: dizziness, insomnia, tremor, nervousness
- Gastrointestinal System Disorders: mouth dryness, nausea, constipation
- Musculo-skeletal System Disorders: arthritis
- Body as a Whole-General Disorders: headache, pain, influenza-like symptoms, back pain, chest pain
- Allergic-type reactions: skin-rash, angioedema of tongue, lips and face, urticaria, laryngospasm, anaphylactic reaction
- Ophthalmic: precipitation or worsening of narrow-angle glaucoma, mydriasis, acute eye pain, eye pain 2
From the Research
Adverse Effects of Ipratropium (Atrovent)
The adverse effects of Ipratropium (Atrovent) are generally mild and include:
- Cough 3
- Nausea 3
- Palpitations 3, 4
- Dry mouth 3, 4
- Nervousness 3
- Gastrointestinal distress 3
- Dizziness 3
- Tremor (associated with beta-agonist administration, not directly with ipratropium) 4
- Pupillary dilatation, blurred vision, and acute glaucoma (can occur from escape of droplets from loosely fitting nebulizer masks) 4
- Supraventricular tachycardias (observed in a 5-year randomized controlled trial of ipratropium bromide) 4
- Paradoxical bronchoconstriction (can occur with inhaled anticholinergics) 4
- Impairment of cognitive function (central effects of anticholinergic drugs) 4
Specific Studies
- A study published in 1988 reported that the adverse effects of ipratropium bromide were mild and included cough, nausea, palpitations, dry mouth, nervousness, gastrointestinal distress, and dizziness 3.
- A study published in 2008 discussed the potential adverse effects of bronchodilators, including ipratropium bromide, in older people, and noted that inhaled anticholinergics may cause dry mouth, pupillary dilatation, blurred vision, and acute glaucoma 4.
- A study published in 1986 reported that ipratropium bromide does not exhibit the well-known toxic effects of atropine, and doses many times those required for maximum therapeutic benefit do not produce any effects on the eye, urinary bladder, heart rate, or mucociliary function 5.
- A study published in 2001 reported that the addition of inhaled ipratropium to inhaled beta2-agonist therapy was effective in the treatment of acute asthma exacerbation in children and adults, and did not report any severe adverse effects attributable to ipratropium 6.
- A study published in 1992 reported that inhaled ipratropium bromide produced significantly less day and night time cough in patients with persistent post-viral infective cough, with overall clinical improvement in 12 cases 7.