Atrovent Inhaler

In this article you can read instructions for use to Atrovent medicinal product. Here you can find customers’ reviews – the drug consumers – as well as medical specialists opinion on Atrovent use in their practice, information about drug usage in bronchial asthma and chronic bronchitis treatment at adults, children, also during pregnancy and breastfeeding, drug composition description.

Atrovent is a bronchodilator medication. It inhibits muscarinic receptors of tracheobronchial tree smooth muscle (mainly on large and medium bronchi level) and inhibits reflex bronchoconstriction. Having structural similarity to acetylcholine molecule, it is its competitive antagonist.

Atrovent prevents bronchospasm resulting from cigarette smoke or cold air inhalation, different drugs effect, and also eliminates bronchospasm associated with vagus nerve influence.

At inhalation it has almost no resorptive effect, while only 10% reaches small bronchi and alveoli, and the remainder is deposited in throat or mouth and swallowed.

At patients with bronchospasm associated with COPD (chronic bronchitis and emphysema), the drug improves respiratory function: FEV1 and mean forced expiratory volume rate FEF 25-75% increase by 15% or more within 15 minutes after drug administration. Maximal effect is achieved after 1 – 2 hours and lasts for most patients for up to 6 hours after ipratropium bromide administration.

In 40% of patients with asthma significant improvement of external breathing parameters (FEV1 increased by 15% or more) is observed.

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Composition

Ipratropium bromide monohydrate auxiliary substances.

Pharmacokinetics

Drug absorption is low. Almost not absorbed from gastrointestinal tract. Poorly dissolved in fats and weakly penetrates biological membranes. Not accumulates in the body. Absorbed (small) part is metabolized forming 8 inactive or poorly active metabolites with anticholinergic action. Cleared through intestines unchanged. Metabolites are excreted with urine.

Indications

Inhalation:

• chronic obstructive pulmonary disease (airflow limitation in these organs), including the elderly people;
• pulmonary emphysema (abnormal enlargement of distal bronchioles airspaces);
• bronchospasms at colds;
• bronchial asthma (except severe cases);
• enhanced sputum production by bronchial mucous;
• bronchospasms during surgery;
• tests on obstructive diseases reversibility (for accurate diagnosis and disease course prognosis assessment);
• in order to prepare airways surface before using aerosol antibiotics, glucocorticosteroids, cromoglicic acid).

Pharmaceutical Form

• Dosed aerosol for inhalation (sometimes mistakenly referred to as spray).
• Solution for inhalation.

Pills or capsules, does not exist.

Instruction for Use and Dosage

Spray

Dosage regimen is defined individually.

Adults and children over 6 years are prescribed 2 inhalations 4 times a day.

Given absence of complete information, Atrovent should be used at children only on prescription and under adults’ supervision.

Necessity for dosage increase may indicate need to revise basic treatment. The total daily dose is not more than 12 inhalations.

For chronic obstructive pulmonary disease exacerbations treatment Atrovent solution for inhalation may be used.

Application

Before using dosed aerosol for the first time, press valve 2 times until aerosol cloud appears.

Every time you use dosed aerosol it is necessary to observe the following rules:

1. Remove protective cap.
2. Make a slow, deep breath.
3. Holding the bottle, grasp the tip with lips.
4. Container should be held upside down.
5. Taking maximally deep breath, at the same time quickly press the bottom of the bottle to release 1st inhalation dose. For a few seconds, hold your breath, then take the tip out of mouth and breathe out slowly. Repeat steps for 2nd inhalation dose.
6. Put protective cap on.
7. If aerosol bottle is not used for more than 3 days before using press valve one time until aerosol cloud appears.

Container contains 200 inhalations. Then, cylinder must be replaced. Despite the fact that some content may remain in cylinder, drug amount released during inhalation is decreased.

The cylinder is opaque, so drug amount in the bottle can be determined as follows: having removed the cap, cylinder is put into container filled with water. Drug amount is determined depending on cylinder position in water.

The tip should be kept clean, if necessary, it can be washed with warm water. After using soap or detergent, the tip should be rinsed thoroughly with water.

Plastic tip is only intended for use with Atrovent dosed aerosol and serves for exact drug dosing. The tip should not be used with any other dosed aerosol. You cannot use Atrovent aerosol with other tips.

Side Effects

• headaches;
• dry mouth;
• gastrointestinal dysmotility (nausea, vomiting, diarrhea, constipation);
• increased pulse rate;
• supraventricular tachycardia;
• ciliary arrhythmia;
• increased heartbeat;
• accommodation disorder;
• urinary retention;
• cough;
• local irritation;
• paradoxical bronchospasm;
• mydriasis;
• accommodation paresis;
• increased intraocular pressure (particularly at patients with angle-closure glaucoma);
• eye pains;
• blurred vision;
• halo and color spots before eyes;
• skin rash;
• urticaria fever;
• Quincke’s disease;
• itching;
• tongue, lips and facial swelling;
• laryngospasm;
• anaphylactic reactions.

Contraindications

• 1 trimester pregnancy (Atrovent spray);
• hypersensitivity to atropine and its derivatives;
• hypersensitivity to ipratropium bromide and other ingredients.

Application at Pregnancy and Lactation Period

Atrovent safety during pregnancy has not been established at humans. Appointing drug during possible or confirmed pregnancy, doctor should take into account ratio of expected benefits of therapy and possible risk to the fetus.

Atrovent is contraindicated during 1 trimester pregnancy. Drug appointment during 2nd and 3rd trimesters is possible only if expected benefits of therapy to the mother overweigh potential risk to the fetus.

The data on Atrovent penetration breast milk are not available. However, given that many drugs are excreted with breast milk, Atrovent should be used with caution by women during lactation period.

Atrovent for Children

Atrovent is used in pediatric practice, strictly following doctor’s advice and further control. The spray is recommended for children from 6 years old, solution for inhalation – 5 years old.

Atrovent is indicated to children to treat bronchial diseases. Property to suppress excessive mucus secretion makes possible its use at «wet» asthma, most common in childhood. No negative effect on cardiovascular system is particularly valuable for use at children with impaired heart function.

The most preferred pharmaceutical form for pediatric practice is solution for inhalation, providing drug penetration into poorly ventilated bronchi areas.

With great caution the drug is prescribed to children with chronic pulmonary diseases (due to possible sputum inspissation and bronchi plugs occurrence), brain injuries, Down’s syndrome, central paralysis syndrome (may increase).

Special Instructions

• It is not recommended to prescribe the drug for emergency relief of asthma attack (since bronchodilator effect develops later than that of beta-agonists).
• At patients with cystic fibrosis risk of gastrointestinal motility slowing increases.
• It is not recommended to excess recommended doses for acute bronchospasm treatment and maintenance therapy. Patients should be informed that if inhalations are not effective enough or there is worsening, they should consult doctor to change treatment plan.
• Atrovent can be used for inhalation combined with Ambroxol (solution for inhalation) and Bromhexine (solution for inhalation).
• Preparation contains an antibacterial preserved benzalkonium chloride and edetate disodium stabilizer, which can cause bronchoconstriction (risk of bronchospasm).
• The drug is available on prescription.
• Patient should be taught to properly use Atrovent.
• Do not allow solution contact with eyes. Patients predisposed to glaucoma should be warned about need to protect eyes from contact with the drug.
• In case of any symptom of angle-closure glaucoma attack (eye pains, discomfort, blurry vision, halo and color spots before eyes, combined with conjunctival and corneal hyperemia) it is necessary to appoint drops, causing pupil constriction, and immediately contact ophthalmologist.
• For inhalation nebulizer with tip for mouth is recommended to use. If you use nebulizer with a mask, mask of proper size should be used.

Drug Interactions

• With simultaneous use, beta2-agonists and xanthine derivatives contribute to Atrovent bronchodilator effect.
• At Atrovent application with antiparkinsonian medications, quinidin, tricyclic antidepressants, drug anticholinergic effect increase.
• At Atrovent application with other anticholinergic drugs additive effect is observed.
• When using Atrovent with inhaled beta2-agonists at patients with angle-closure glaucoma risk of acute glaucoma attack increases.
• Atrovent should not be administered together with disodium cromoglicate solution for inhalation, given possibility of precipitation.

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