Ipratropium belongs to the group of medications called bronchodilators. It is used to treat chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.

It is also used along with other medications to treat asthma attacks.

Ipratropium works by opening the air passages, making breathing easier. This solution is given with the help of compressed air or nebulizers.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

The recommended adult dose of ipratropium inhalation solution is 250 µg to 500 µg. For children (5 to 12 years of age), the recommended dose is 125 µg to 250 µg. The dose may be repeated every 4 to 6 hours as needed.

For regular treatment of breathing difficulties caused by chronic bronchitis or emphysema, the recommended adult dose is 500 µg 3 to 4 times a day. If less than 2 mL of solution is to be nebulized, a sterile, preservative-free saline or another suitable nebulizer solution should be used to make up the total volume to between 2 mL and 5 mL.

Your doctor or pharmacist should tell you how to use this medication properly. Also, follow the instructions found with the medication and with your nebulizer for proper treatment, care, maintenance, and equipment cleaning procedures. It is very important to adjust the face mask, if required, to prevent the mist from getting into your eyes.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important that this medication be used exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Bottles
Each mL of clear, colourless or almost colourless, isotonic solution contains ipratropium bromide 250 µg (0.025%). Nonmedicinal ingredients: edetate disodium, sodium chloride, and benzalkonium chloride.

Unit dose vials
125 µg/mL
Each mL of clear, colourless, isotonic solution contains ipratropium bromide 125 µg (0.0125%). Nonmedicinal ingredients: sodium chloride, hydrochloric acid, nitrogen, sodium hydroxide, and water.

250 µg/mL
Each mL of clear, colourless, isotonic solution contains ipratropium bromide 250 µg (0.025%). Nonmedicinal ingredients: sodium chloride, hydrochloric acid, nitrogen, sodium hydroxide, and water.

Ipratropium inhalation solution should not be used by anyone with an allergy or sensitivity to ipratropium, to atropine-like medications in general, or to any of the ingredients of the medication.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• cold symptoms (e.g., runny nose, stuffy nose, sore throat) 
• constipation
• cough
• diarrhea
• dry mouth
• dizziness
• headache
• hoarseness
• muscle cramps or pain
• nausea
• nervousness
• sweating 
• throat irritation
• trembling
• unpleasant taste
• weakness 
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• changes in blood pressure (e.g., dizziness, fainting, lightheadedness) 
• chest pain 
• difficulty or pain when urinating
• fast or irregular heartbeat
• increased wheezing or tightness in the chest
• shortness of breath 
• skin rash
• symptoms of glaucoma (e.g., new or worsened pressure in the eyes, eye pain, blurred vision, seeing halos or rainbows around images, red eyes) 
• wheezing after inhaling a dose

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
• symptoms of a severe allergic reaction (e.g., sudden wheezing, chest pain or chest tightness; hives; swelling of the eyelids, face, tongue, or throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergy: In rare cases, immediate allergic reactions may occur after using ipratropium inhalation solution, causing hives, swelling around the throat and tongue, rash, and worsening of breathing problems. If this occurs, get emergency medical help at once.

Asthma attack: Do not use ipratropium alone for the relief of an asthma attack since this medication works slower than other types of medications used for asthma attacks. If it is used for an asthma attack, it should be used together with other medications (e.g., salbutamol) that help open up the airways quickly.

Cystic fibrosis: If you have cystic fibrosis, you may be more likely to experience certain side effects such as constipation. Talk to your doctor about how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Driving: Ipratropium inhalation solution may cause blurred vision or dizziness, affecting the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other potentially hazardous tasks until you have determined how this medication affects you.

Eye concerns: Make sure the nebulizer mask fits the user's face properly and that nebulized solution does not escape into the eyes. There have been rare reports of eye complications (e.g., tearing, increased eye pressure, glaucoma, and eye pain) when this medication has been released into the eyes.

If you have glaucoma, talk to your doctor about how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Mixing with other medications: Do not mix ipratropium solution with preservatives (i.e., from the 20 mL multidose bottle) and sodium cromoglycate, as this produces a cloudy solution caused by an interaction between the preservatives and the sodium cromoglycate. If sodium cromoglycate needs to be used, use ipratropium solution without preservatives (the unit dose vials).

Preservatives: Ipratropium solution in the 20 mL multidose bottle contains preservatives (benzalkonium chloride, disodium ethylene diamine tetraacetic acid (EDTA) disodium). It has been reported that these preservatives may cause breathing to get worse for some patients who have very sensitive airways.

The unit dose vials do not contain preservatives.

Urination problems: If you have a medical condition (e.g., prostate problems, urinary retention, or obstruction) that affects your ability to urinate, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Worsening Symptoms: If you experience an increased need to use your "rescue" medication, contact your doctor as soon as possible.

Pregnancy: The safety of using ipratropium during pregnancy has not been established. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor.

Breast-feeding: It is not known if this medication passes into breast milk. If you are breast-feeding and are using ipratropium inhalation solution, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The efficacy and safety of this medication have not been established for children under 5 years of age.

There may be an interaction between ipratropium inhalation solution and any of the following:

• aclidinium
• amantadine
• antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, ketotifen, loratadine, rupatadine)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• atropine
• azelastine
• belladonna
• benztropine
• botulinum toxin-containing products
• cannabis
• clidinium
• darifenacin
• disopyramide
• domperidone
• donepezil
• eluxadoline
• galantamine
• glucagon
• glycopyrrolate
• ipratropium
• ketotifen
• metoclopramide
• mirabegron
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, tranylcypromine)
• muscle relaxants (e.g., cyclobenzaprine, orphenadrine)
• nabilone
• narcotic pain relievers (e.g., codeine, morphine, oxycodone, tramadol)
• oxybutynin
• potassium chloride
• quinidine
• rivastigmine
• scopolamine
• solifenacin
• thiazide diuretics (water pills; e.g., hydrochlorothiazide)
• tiotropium
• tolterodine
• topiramate
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• umeclidinium

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.