From the Guidelines
Ipratropium bromide is contraindicated in patients with hypersensitivity to ipratropium, atropine, or any derivatives of these compounds. The medication should be avoided in patients with a history of allergic reactions to soya lecithin or related food products like soybean and peanut. Caution is necessary when administering ipratropium to patients with narrow-angle glaucoma, as the medication can potentially worsen this condition by increasing intraocular pressure 1. Patients with prostatic hyperplasia or bladder neck obstruction should use ipratropium cautiously due to its anticholinergic properties that may exacerbate urinary retention. While not absolutely contraindicated, special care should be taken when prescribing ipratropium to patients with myasthenia gravis as it may worsen symptoms. Pregnant women should only use ipratropium if clearly needed, and nursing mothers should consider the potential risks to the infant.
Some key points to consider when prescribing ipratropium include:
- The onset of action of anticholinergic agents is slower than that of β2-agonists, reaching a maximum in 30–90 min and lasting 4–6 h for ipratropium 1
- Anticholinergic agents are more effective in COPD than in asthma
- There are individual differences in response which mean that it is worth switching between β2-agonists and anticholinergics, even if the response to the first drug is poor 1
- No evidence has been found of tolerance to anticholinergic drugs during chronic therapy 1
- The commonest reported side-effect is cough, and early concerns about a decrease in mucociliary clearance have not been substantiated 1
It is essential to weigh the benefits and risks of ipratropium bromide in each patient, considering their individual medical history and current health status. The potential benefits of ipratropium bromide in relieving bronchospasm must be balanced against the potential risks and contraindications. By carefully evaluating each patient's situation and using the medication judiciously, healthcare providers can minimize the risks associated with ipratropium bromide and maximize its therapeutic benefits.
From the FDA Drug Label
CONTRAINDICATIONS Ipratropium bromide is contraindicated in known or suspected cases of hypersensitivity to ipratropium bromide, or to atropine and its derivatives. The contraindications of ipratropium are:
- Hypersensitivity to ipratropium bromide
- Hypersensitivity to atropine and its derivatives 2
From the Research
Contraindications of Ipratropium
- There are no direct contraindications of ipratropium mentioned in the provided studies 3, 4, 5, 6.
- However, the studies suggest that ipratropium should not be used as single-drug therapy in an acute asthmatic exacerbation due to its delayed onset of action 3.
- Additionally, the use of ipratropium bromide has been associated with an increased risk of cardiovascular events, such as heart failure, acute coronary syndrome, and cardiac dysrhythmia, particularly when used within the past 6 months 6.
- The studies also mention that ipratropium may not be suitable for patients with certain medical conditions, such as those with a "non-responsive" state in asthma, where initiation of corticosteroid therapy should not be delayed 4.
- It is also noted that ipratropium may cause adverse effects, such as cough, nausea, palpitations, dry mouth, nervousness, gastrointestinal distress, and dizziness, although these effects are generally mild 3, 4, 5.