From the Guidelines
Ipratropium bromide nasal spray works by blocking muscarinic acetylcholine receptors in the nasal passages, preventing acetylcholine from binding to these receptors on the glands lining the nasal mucosa, thereby inhibiting parasympathetic stimulation and reducing watery secretions from the nasal glands and decreasing nasal mucus production. As an anticholinergic agent, ipratropium bromide is particularly effective for treating rhinorrhea (runny nose) associated with the common cold or allergic and non-allergic rhinitis 1. The medication works locally in the nasal passages with minimal systemic absorption, which explains its favorable safety profile and limited side effects, such as dryness of the nasal membranes 1.
Key Points
- Ipratropium bromide nasal spray is effective in reducing rhinorrhea caused by allergic rhinitis, nonallergic rhinitis, and the common cold 1
- The concomitant use of ipratropium bromide and an intranasal corticosteroid is more effective than administration of either drug alone in the treatment of rhinorrhea without any increased incidence of adverse events 1
- Ipratropium bromide has no adverse effect on physiologic nasal functions, such as sense of smell, ciliary beat frequency, or mucociliary clearance, and has a low incidence of dryness 1
- Standard dosing for adults is typically 2 sprays (42 mcg) per nostril 2-3 times daily, though this may vary based on the specific condition being treated
Mechanism of Action
Ipratropium bromide exerts its effect locally on the nasal mucosa, resulting in a reduction of systemic anticholinergic effects, and does not alter physiologic nasal functions 1. The medication begins working within minutes and its effects typically last 4-6 hours, requiring multiple daily dosing. The use of ipratropium bromide nasal spray is recommended for the treatment of rhinorrhea associated with the common cold or allergic and non-allergic rhinitis, due to its effectiveness and favorable safety profile.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Mechanism of Action Ipratropium bromide is an anticholinergic (parasympatholytic) agent which, based on animal studies, appears to inhibit vagally-mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released at the neuromuscular junctions in the lung In humans, ipratropium bromide has anti-secretory properties and, when applied locally, inhibits secretions from the serous and seromucous glands lining the nasal mucosa The mechanism of action of nasal ipratropium is through its anticholinergic properties, which inhibit the action of acetylcholine and reduce secretions from the nasal mucosa 2.
- Key actions:
- Inhibition of vagally-mediated reflexes
- Antagonism of acetylcholine
- Inhibition of secretions from serous and seromucous glands
- Local application minimizes systemic effects.
From the Research
Mechanism of Action of Nasal Ipratropium
- Ipratropium bromide (IB) reduces secretions in the upper respiratory tract through competitive inhibition of acetylcholine at muscarinic receptors that control rhinorrhea production 3.
- The anticholinergic agent, ipratropium bromide, is useful in the treatment of rhinorrhea associated with perennial allergic rhinitis by reducing nasal hypersecretion without causing excessive dryness or other potential cholinergic side effects 4.
- Ipratropium bromide nasal spray significantly reduces the severity and duration of rhinorrhea in non-allergic rhinitis patients, with a noticeable difference within the first week and remaining consistent throughout the treatment 5.
Efficacy of Nasal Ipratropium
- IB significantly reduced rhinorrhea by an average of 18% over placebo for days 1 and 2 (p = 0.01) in patients with the common cold 3.
- IB produced an average reduction in nasal discharge of 23% over placebo for days 1 and 2 (p = 0.003) when patients with relatively minor rhinorrhea were excluded 3.
- IB nasal spray reduced the mean severity and duration of rhinorrhoea within the first week and throughout the 8 weeks of active treatment compared with placebo (P < 0.05) in patients with perennial non-allergic rhinitis 6.
- IB outperformed the placebo in terms of shortening the symptom's duration/day, as shown by an SMD of 0.35 (95% CI 0.15-0.55) in non-allergic rhinitis patients 5.
Safety and Tolerability of Nasal Ipratropium
- IB was well-tolerated, and was not associated with any significant adverse events in patients with perennial allergic rhinitis 4.
- Nasal adverse events with IB were generally intermittent and brief in non-allergic rhinitis patients 5.
- There were no drug-related serious or systemic anticholinergic adverse events in patients with perennial non-allergic rhinitis 6.