Ipratropium

Ipratropium - an antimuscarinic bronchodilator traditionally regarded as more effective in relieving bronchoconstriction associated with COPD.

Uses
Reverse bronchospasm, particularly in COPD

Administration
• Nebuliser: 250–500 μg up to 6 hourly, undiluted (if prolonged delivery time desirable then dilute with sodium chloride 0.9% only)
• For patients with chronic bronchitis and hypercapnia, oxygen in high concentration can be dangerous, and nebulisers should be
driven by air

How not to use ipratropium
For nebuliser: do not dilute in anything other than sodium chloride 0.9% (hypotonic solution may cause bronchospasm). Ipratropium is not a logical choice for patients with thick secretions as ipratropium may make these worse.

Adverse effects
Dry mouth
Tachycardia
Paradoxical bronchospasm (stop giving if suspected)
Acute angle closure glaucoma (avoid escape from mask to patient’s eyes)

Cautions
Prostatic hypertrophy – urinary retention (unless patient’s bladder catheterised)