Atrovent, 0.25 mg/ml 20 ml

Bronchodilator drug. It blocks m-cholinoreceptors of smooth muscles of tracheobronchial tree (mainly at the level of large and medium bronchi) and suppresses reflex bronchoconstriction. Having structural similarity with acetylcholine molecule, it is its competitive antagonist.

Prevent bronchospasm resulting from inhalation of cigarette smoke, cold air, the action of various drugs, and also eliminates bronchospasm associated with the influence of the vagus nerve.

Inhalation has almost no resorptive action, with only 10% reaching the small bronchi and alveoli, and the remainder being deposited in the throat or oral cavity and swallowed.

In patients with bronchospasmal symptoms associated with COPD (chronic bronchitis and pulmonary emphysema) the drug improves indexes of external respiratory function: BEF1 and mean forced expiratory volume rate FEF25-75% increase by 15% or more already in 15 min after drug administration. Maximal effect is reached 1-2 hours later and lasts in most patients up to 6 hours after ipratropium bromide injection.

In 40% of patients with bronchial asthma a significant improvement in measures of external respiration is noted (SPR1 increased by 15% or more).

Pharmacokinetics

absorption

Absorption of the drug is low. It is practically not absorbed from the gastrointestinal tract.

Distribution

It is poorly soluble in fats and poorly penetrates through biological membranes. Does not cumulate.

Metabolism

The absorbed (small) portion is metabolized to form 8 inactive or weakly active metabolites with anticholinergic effects.

Evolution

Unchanged is excreted through the intestine. Metabolites are excreted in the urine.

Indications

Cough, Bronchitis, Lung inflammation (pneumonia), Chronic obstructive pulmonary disease, Bronchial asthma, Bronchospasm

Bronchial asthma (moderate to mild severity), especially with associated cardiovascular disease.

Chronic obstructive pulmonary disease (chronic obstructive bronchitis, pulmonary emphysema).

Active ingredient

Ipratropium bromide

Composition

Active ingredient:

Ipratropium bromide – 0.25 mg.

Auxiliary substances:

benzalkonium chloride,

dinatrium edetate dihydrate,
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Sodium chloride,

Hydrochloric acid 1n,

purified water.

How to take, the dosage

Inhaled.

Inhalation solution: for adults and children over 12 years old – 0.5 mg (40 drops) 3-4 times a day by nebulizer; for children 6-12 years old – 0.25 mg (20 drops) 3-4 times a day by nebulizer; for children under 6 years old – 0.1-0.25 mg (8-20 drops) 3-4 times a day (under medical supervision).

The recommended dose just before use is diluted with saline to 3-4 ml.

The dose depends on the method of inhalation and the quality of nebulization.

If necessary, repeat inhalation at least 2 hours apart.

Interaction

Potentiates the bronchodilator effect of beta-adrenomimetics and xanthine derivatives. It enhances the cholinolytic effect of other drugs.

Special Instructions

It is not recommended for emergency relief of an attack of suffocation (the bronchodilator effect develops later than in beta-adrenergic stimulants).

Patients with cystic fibrosis have an increased likelihood of developing delayed gastrointestinal motility.

Patients should know how to use Atrovent N aerosol inhalation dosage correctly.

The first time patients use the CFC-free aerosol dosage form, they may notice that the new medication tastes slightly different from the previous form of the drug that contained CFC. When switching from one form of the drug to another, patients should be warned about possible changes in the taste of the drug. Patients should be advised that the drugs are interchangeable and that taste is irrelevant to the safety and effectiveness of the new drug.

The 0.025% inhalation solution contains the preservative benzalkonium chloride and the stabilizer ethylenediaminetetetraacetic acid. There have been reports that these agents, when administered in high doses, may cause bronchospasm in some patients.

The prescribed daily dose should not be exceeded, both with short-term and long-term use.

Patients with angle-closure glaucoma and urinary dysfunction due to benign prostatic hyperplasia should use the drug with caution.

If the drug accidentally gets into the eyes of a patient with closed angle glaucoma, the intraocular pressure may increase.

Pain or discomfort in the eye, blurred vision, and the appearance of a halo and colored spots in front of the eye combined with conjunctival and corneal hyperemia may be symptoms of an attack of narrow angle glaucoma. If any of these symptoms occur, pupil constrictor drops should be prescribed and an ophthalmologist should be seen without delay.

If the patient’s condition worsens or if there is no significant improvement, a physician consultation is necessary to determine a treatment plan. If there is a sudden and rapid increase in dyspnea (difficulty in breathing), it is necessary to see a doctor immediately.

In children, Atrovent N metered dose aerosol should only be prescribed after a physician’s recommendation and under adult supervision.

Contraindications

• High sensitivity to the components.
• Pregnancy (first trimester).
• Children under 6 years.

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Side effects

The most frequent unwanted effects are headache, nausea, dry mouth.

Due to the low systemic absorption of the drug, side effects associated with systemic anticholinergic action, such as tachycardia, palpitations, accommodation disorders, decreased sweat gland secretion, impaired GI motility, urinary retention, are rare and reversible. However, patients with obstructive urinary tract disease have an increased risk of urinary retention.

As with other inhalation therapy, including bronchodilators, coughing is sometimes observed, and paradoxical bronchospasm is less common.

In rare cases, allergic reactions, including urticaria, angioedema, rash, oropharyngeal edema and anaphylaxis may occur.

There have been some reports of ocular complications (dilated pupils, increased intraocular pressure, closed-angle glaucoma, ocular pain) when ipratropium bromide aerosol or ipratropium bromide aerosol combined with beta2-agonists has been in the eye.

Patients should know how to use metered dose aerosol correctly.

Overdose

Symptoms:No specific symptoms of overdose have been identified.

Significant manifestations of systemic anticholinergic effects such as dry mouth, impaired accommodation, increased HR are possible.

Treatment:symptomatic.

Similarities

Ipratropium-Nativ, Atrovent N