What are the side effects of ipratropium (ipratropium bromide) inhaler?

Side Effects of Ipratropium Bromide Inhaler

The most common side effect of ipratropium bromide inhaler is dry mouth, occurring in approximately 10% of patients, with other potential adverse effects including urinary retention, throat irritation, and rarely, precipitation of narrow-angle glaucoma. 1

Common Side Effects

Ipratropium bromide is an anticholinergic bronchodilator that works by blocking muscarinic cholinergic receptors, reducing intrinsic vagal tone in the airways. Based on FDA drug labeling, the most frequently reported side effects include:

• Dry mouth (3-10.3% of patients) 1
• Cough (4-6%) 1
• Headache (6-9%) 1
• Nausea (2-4%) 1

Respiratory System Effects

Respiratory-related side effects can occur and may include:

• Bronchitis (14-20% of patients) 1
• Dyspnea (9-16%) 1
• Bronchospasm (2-5%) - paradoxical bronchospasm may occur in some individuals 1
• Upper respiratory tract infection (9-16%) 1
• Increased wheezing in some individuals 2

Anticholinergic Effects

Due to its mechanism of action as an anticholinergic agent, ipratropium can cause:

• Urinary retention (less than 3% of patients) 1
• Eye pain (less than 3%) 1
• Precipitation or worsening of narrow-angle glaucoma (rare but serious) 1
• Mydriasis (pupil dilation) 1
• Acute eye pain 1

Cardiovascular Effects

• Tachycardia (less than 3% of patients) 1
• Palpitations (less than 3%) 1
• Hypertension/aggravated hypertension (0.9-4%) 1

Allergic Reactions

Though uncommon, ipratropium can cause allergic reactions including:

• Skin rash 1
• Angioedema of tongue, lips, and face 1
• Urticaria (less than 3%) 1
• Laryngospasm 1
• Anaphylactic reaction (rare) 1

Important Considerations

1. Onset and Duration: Unlike beta-agonists, ipratropium has a slower onset of action (15-30 minutes) and longer duration (4-6 hours) 3, 4

2. Systemic Absorption: Only about 7% of inhaled ipratropium bromide is systemically absorbed, which limits systemic side effects 2

3. Special Populations: Should be used with caution in patients with:

   • Glaucoma (especially narrow-angle)
   • Prostatic hypertrophy
   • Bladder neck obstruction
   • Urinary retention 4

4. Combination Therapy: When used in combination with beta-agonists, the side effect profile remains similar to monotherapy 1

Practical Recommendations

• Patients should be advised to avoid getting the medication in their eyes to prevent complications like acute eye pain or worsening glaucoma
• Patients with a history of allergies to other drugs or foods may be at higher risk for allergic reactions 1
• Monitoring for dry mouth and urinary symptoms is recommended, especially in elderly patients
• If paradoxical bronchospasm occurs, the medication should be discontinued immediately

Ipratropium bromide is generally well-tolerated, with most adverse effects being mild and transient. Its favorable safety profile makes it particularly useful for patients who experience troublesome side effects from beta-agonists such as tremor or palpitations 3.