Atrovent HFA

You should not use this medication if you are allergic to ipratropium or atropine.

Before using this medicine, tell your doctor if you have glaucoma or urination problems.

Ipratropium will not work fast enough to treat an bronchospasm attack that has already begun. Use only a fast acting inhalation medicine to treat an bronchospasm attack.

You should not use this medication if you are allergic to ipratropium or atropine.

To make sure ipratropium is safe for you, tell your doctor if you have:

• narrow-angle glaucoma; or

• an enlarged prostate, bladder obstruction, or urination problems.

FDA pregnancy category B. Ipratropium is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether ipratropium passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Do not give this medicine to a child without medical advice.

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with ipratropium, especially:

• bladder or urinary medicine such as darifenacin, fesoterodine, oxybutynin, tolterodine, or solfenacin;

• other bronchodilators such as tiotropium;

• cold or allergy medicine that contains an antihistamine;

• medication for Parkinson's disease; or

• medication to treat excess stomach acid, stomach ulcer, motion sickness, or irritable bowel syndrome.

This list is not complete. Other drugs may interact with ipratropium, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

• It is used to open the airways in lung diseases where spasm may cause breathing problems.
• This medicine is not to be used to treat intense flare-ups of shortness of breath. Use a rescue inhaler. Talk with the doctor.

• Tell all of your health care providers that you take Atrovent HFA. This includes your doctors, nurses, pharmacists, and dentists.
• Unsafe allergic effects may rarely happen.
• Call your doctor right away if your breathing problems get worse, if your rescue inhaler does not work as well, or if you need to use your rescue inhaler more often.
• Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this medicine while you are pregnant.
• Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

Use Atrovent HFA as ordered by your doctor. Read all information given to you. Follow all instructions closely.

• Follow how to use as you have been told by the doctor or read the package insert.
• Keep out of your eyes.
• To gain the most benefit, do not miss doses.
• Keep using this medicine as you have been told by your doctor or other health care provider, even if you feel well.
• If using more than 1 type of puffer (inhaler), ask the doctor which puffer to use first.
• For breathing in only.
• Prime puffer (inhaler) before first use or if not used for more than 3 days by spraying it 2 times.
• Put the cap back on after you are done using your dose.
• A spacer may be used with the puffer (inhaler) for easy use.
• Have your puffer (inhaler) use checked with your doctor at each visit. Read and follow facts on how to use the puffer. Make sure you use the puffer the right way.

What do I do if I miss a dose?

• Take a missed dose as soon as you think about it.
• If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
• Do not take 2 doses at the same time or extra doses.

• If your symptoms or health problems do not get better or if they become worse, call your doctor.
• Do not share your drugs with others and do not take anyone else's drugs.
• Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
• Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
• Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about this medicine, please talk with your doctor, nurse, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

This information should not be used to decide whether or not to take Atrovent HFA or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to Atrovent HFA. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Review Date: October 4, 2017

  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. Anticholinergics prevent the increases in intracellular concentration of Ca++ which is caused by interaction of acetylcholine with the muscarinic receptors on bronchial smooth muscle.

  Pharmacodynamics

At recommended doses, ipratropium bromide does not produce clinically significant changes in pulse rate or blood pressure.

In studies without a positive control, ipratropium bromide did not alter pupil size, accommodation, or visual acuity.

Controlled clinical studies have demonstrated that ipratropium bromide does not alter either mucociliary clearance or the volume or viscosity of respiratory secretions.

  Pharmacokinetics

Following administration by oral inhalation from a metered dose inhaler, the majority of the delivered dose is deposited in the gastrointestinal tract and, to a lesser extent, in the lung, the intended site of action. Ipratropium bromide is a quaternary amine and hence is not readily absorbed into the systemic circulation either from the surface of the lung or from the gastrointestinal tract as confirmed by blood level and renal excretion studies.

The half-life of elimination is about 2 hours after inhalation or intravenous administration. Ipratropium bromide is minimally bound (0 to 9% in vitro) to plasma albumin and α1-acid glycoprotein. It is partially metabolized to inactive ester hydrolysis products. Following intravenous administration, approximately one-half of the dose is excreted unchanged in the urine.

A pharmacokinetic study with 29 chronic obstructive pulmonary disease (COPD) patients (48-79 years of age) demonstrated that mean peak plasma ipratropium concentrations of 59±20 pg/mL were obtained following a single administration of 4 inhalations of Atrovent HFA (84 mcg). Plasma ipratropium concentrations declined to 24±15 pg/mL by six hours. When these patients were administered 4 inhalations QID (16 inhalations/day=336 mcg) for one week, the mean peak plasma ipratropium concentration increased to 82±39 pg/mL with a trough (6 hour) concentration of 28±12 pg/mL at steady state.

Geriatric Patients

In the pharmacokinetic study with 29 COPD patients, a subset of 14 patients were > 65 years of age. Mean peak plasma ipratropium concentrations of 56±24 pg/mL were obtained following a single administration of 4 inhalations (21 mcg/puff) of Atrovent HFA (84 mcg). When these 14 patients were administered 4 inhalations four times a day (16 inhalations/day) for one week, the mean peak plasma ipratropium concentration only increased to 84±50 pg/mL indicating that the pharmacokinetic behavior of ipratropium bromide in the geriatric population is consistent with younger patients.

Renally Impaired Patients

The pharmacokinetics of Atrovent HFA have not been studied in patients with renal insufficiency.

Hepatically Impaired Patients

The pharmacokinetics of Atrovent HFA have not been studied in patients with hepatic insufficiency.

Drug-Drug Interaction

No specific pharmacokinetic studies were conducted to evaluate potential drug-drug interactions with other medications.

Atrovent HFA is used to prevent episodes of breathing problems (bronchospasms) that are caused by chronic obstructive pulmonary disease (COPD). This includes the conditions chronic bronchitis and emphysema.

You shouldn’t use this drug alone for bronchospasm attacks. You’ll need a different medication that acts more quickly to help you breathe.

Atrovent HFA comes as a pressurized inhalation solution called a metered dose inhaler or MDI. Your doctor or nurse will show you how to use these products.

The standard dose of Atrovent HFA is 2 inhalations taken four times per day. You shouldn’t take more than 12 inhalations in 24 hours.

More common side effects of taking this drug include dry mouth, bitter taste in your mouth, headache, dizziness, bronchitis, worse COPD symptoms, and shortness of breath.

• Acute shortness of breath See Details

• Worsening symptoms See Details

• Urinary problems See Details

What is Atrovent HFA?

This drug is a prescription drug. It’s available as a pressurized inhalation solution known as a metered dose inhaler (MDI).

This drug isn’t available as a generic drug. It’s only available as the brand-name drug Atrovent HFA.

This drug may be used as part of a combination therapy. This means you may need to take it with other medications for chronic obstructive pulmonary disease (COPD).

Why it's used

This drug is used to prevent episodes of breathing problems (bronchospasms) that are caused by chronic obstructive pulmonary disease (COPD). This includes the conditions chronic bronchitis and emphysema.

How it works

This drug belongs to a class of drugs called anticholinergics. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

More Details