What are the indications for Atrovent (Ipratropium)?

From the Guidelines

Atrovent (ipratropium bromide) is primarily indicated for the treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema, as well as for the management of bronchospasm in asthma as an adjunct therapy when other treatments are insufficient. The medication can also be used to treat rhinorrhea (runny nose) associated with allergies or the common cold, in the form of a nasal spray. As an anticholinergic medication, Atrovent works by blocking muscarinic receptors in the airways, which prevents acetylcholine from causing bronchial smooth muscle contraction, leading to bronchodilation and reduced mucus secretion 1. The typical dosage for the inhaler is 2 inhalations (34 mcg each) four times daily, while the nebulizer solution is usually 500 mcg administered 3-4 times daily, and for nasal spray, the usual dose is 2 sprays per nostril 2-3 times daily 1. Atrovent has a relatively slow onset of action (15-30 minutes) compared to beta-agonists but provides sustained bronchodilation for 4-6 hours, making it valuable for maintenance therapy in COPD. Some key points to consider when using Atrovent include:

• It should not be used as first-line therapy for asthma, but rather as an adjunct to other treatments such as short-acting beta-agonists (SABAs) in cases of severe exacerbations 1.
• The addition of ipratropium to SABA therapy has been shown to provide additive benefit in the emergency care setting, but not once the patient is hospitalized 1.
• Atrovent can be used in combination with other medications, such as albuterol, for the treatment of severe exacerbations 1. In terms of specific dosages, the following are recommended:
• For children, 0.25-0.5 mg of ipratropium bromide every 20 minutes for 3 doses, then as needed, via nebulizer solution 1.
• For adults, 0.5 mg of ipratropium bromide every 20 minutes for 3 doses, then as needed, via nebulizer solution 1. It's worth noting that Atrovent has been compared to other treatments, such as leukotriene modifiers and long-acting beta-agonists, in terms of its effectiveness in reducing exacerbations and improving lung function 1. However, the most recent and highest-quality study on this topic is from 2007, which found that ipratropium bromide was effective in reducing exacerbations and improving lung function in patients with COPD 1. Overall, Atrovent is a valuable medication for the treatment of bronchospasm associated with COPD and asthma, and its use should be considered in conjunction with other treatments and under the guidance of a healthcare professional.

From the FDA Drug Label

INDICATIONS AND USAGE Ipratropium bromide inhalation solution administered either alone or with other bronchodilators, especially beta adrenergics, is indicated as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema.

• Indication: The indication for ipratropium bromide (INH), also known as Atrovent, is for the maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including:
  • Chronic bronchitis
  • Emphysema 2

From the Research

Atrovent Indication

Atrovent, also known as ipratropium bromide, is a medication used to treat chronic obstructive pulmonary disease (COPD) and asthma. The following are some key points about the indication of Atrovent:

• Atrovent is used to interrupt vagally mediated bronchoconstriction by inhibiting the cyclic guanosine 3',5'-monophosphate system at parasympathetic nerve endings 3.
• It is used as a bronchodilator therapy in COPD and asthma, as parasympathetic activity is increased in patients with these conditions 4.
• Atrovent is indicated for maintenance therapy in stable chronic bronchitis and emphysema, and may be useful as adjunctive therapy in asthma and in the management of acute exacerbations of chronic bronchitis and asthma 3.
• The medication can be used in combination with other bronchodilating drugs, such as short-acting beta-2 agonists, to improve symptoms and lung function in patients with COPD 5, 6.
• Atrovent may be used as part of a triple therapy regimen, which includes a long-acting beta-2 agonist, a long-acting muscarinic antagonist, and an inhaled corticosteroid, to reduce the rate of COPD exacerbations and improve health-related quality of life 7.

Key Benefits and Risks

Some key benefits and risks of using Atrovent include:

• Benefits:
  • Improves lung function and symptoms in patients with COPD 3, 6.
  • Reduces the requirement for oral steroids 6.
  • May improve health-related quality of life when used as part of a triple therapy regimen 7.
• Risks:
  • May cause adverse effects such as cough, nausea, palpitations, dry mouth, nervousness, gastrointestinal distress, and dizziness 3.
  • May increase the risk of pneumonia as a serious adverse event when used as part of a triple therapy regimen 7.