Atrovent Nebules

(Ipratropium Bromide)

The active ingredient in Atrovent Nebules is ipratropium bromide, an anticholinergic bronchodilator. Its mechanism of action is through relaxation of the airway muscles, making breathing easier.

Unless combined with a short-acting beta-adrenergic bronchodilator, this medication is not intended for sudden breathing problems (acute exacerbations of asthma) and will not replace your rescue bronchodilator like albuterol sulfate.

Follow all directions given to you by your doctor and read all documents provided, including the full Prescribing Information, FDA-Approved Product Labeling, Instructions for Use, and Medication Guide, before using Atrovent nebules. However, the following is a synopsis of the general guidelines for the use of Atrovent Nebules:

1. These nebules are intended to be taken by inhalation from a nebulizer, and not injected or swallowed.

2. The liquid should be put into the nebulizer machine, with the aerosol inhaled through a face mask or mouthpiece.

3. When using a face mask, use a barrier cream on your face, and wash your face thoroughly after treatment.

4. Do not dilute the nebule content unless advised by a doctor. Use only sterile sodium chloride injection BP for dilution.

5. Ensure the liquid or mist from the machine does not get into your eyes.

6. Always use the nebulizer in a well-ventilated room.

7. Discard any remaining solution in the nebulizer after use.

8. Keep the nebules in the pack until you are ready to use them. Once removed from the foil wrap, use within 3 months. Do not use past the expiry date.

The most common side effects of Atrovent nebules include:

• Throat irritation or sore throat.
• Dry mouth.
• Constipation.
• Back pain.
• Headache.
• Cough.

Some individuals may experience serious side effects while using Atrovent Nebules. These side effects may require immediate medical attention. If you experience any of the following, contact your healthcare provider or seek emergency medical help:

• Serious allergic reactions - rash, hives, swelling of the face, mouth, or tongue, anaphylaxis, and trouble breathing.
• Blurred vision or eye pain.
• Fast or irregular heartbeat.
• Difficult or painful urination (urinary retention).
• Skin rash.

This medication also has the potential to cause an initial worsening of your asthma symptoms (shortness of breath or bronchospasm), requiring you to use your rescue nebules more often, experience nighttime awakenings due to your symptoms, or have acute asthma attacks. Contact your physician if this occurs at any time.

These are not all of the possible side effects of Atrovent Nebules. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Before starting Atrovent nebules, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including whether you have:

• Narrow-angle glaucoma.
• An enlarged prostate.
• Urinary retention or bladder neck obstruction.
• Cystic fibrosis or other lung disease.

• Treatment of a sudden or severe asthma attack (rescue use).
• Allergy or hypersensitivity to ipratropium bromide, the preservative benzalkonium chloride (only in the 20mL bottles), or atropine.

With the first dose of Atrovent Nebules, you should notice improvements in your breathing within 15 minutes. The effects can last up to 8 hours.

When Atrovent Nebules is taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking to avoid any negative drug interactions, including:

• Other anticholinergic drugs such as tiotropium, amitriptyline, quetiapine, dimenhydrinate (Gravol), and many others should not be used in tandem with Atrovent Nebules, as this can increase anticholinergic side effects.
• Inhaled forms of loxapine (Adasuve) are contraindicated with ipratropium bromide, as this may increase the toxicity of loxapine.
• Ipratropium may decrease the efficacy of methacholine.

The unit dose vials are available as 1mL vials (containing 250 mcg/mL) or 2mL vials (containing 250 mcg/mL or 125 mcg/mL).

Atrovent Nebules should be stored at room temperature and protected from extreme heat, cold, or humidity. It should be kept out of reach of children and pets. Once opened, the vials should be used within 48 hours.

Atrovent Nebules is manufactured by Boehringer Ingelheim.

Yes, there are generic versions of Atrovent Nebules available. There is also a generic available for the metered-dose inhaler Atrovent HFA that contains ipratropium bromide.

Barring any serious side effects as listed above, or under the direction of a healthcare provider, this medication should not be discontinued suddenly.

Overall, as this drug is inhaled, it is expected that it does not reach high enough concentrations in the blood to cause harm to a growing fetus.

Ipratropium is not known to cross the placenta and result in harm to a growing fetus.

Talk to your doctor if you are already pregnant or if you have any plans to become pregnant. They will know or recommend what is best for you.

Overall, as this drug is inhaled, it is expected that it does not reach high enough concentrations in the blood to cause harm to a nursing infant.

However, it is not known whether ipratropium is found in breast milk, and careful risk vs benefit considerations should be made before starting this medication during breastfeeding.

Talk to your doctor if you are already breastfeeding or if you have any plans to breastfeed. They will know or recommend what is best for you.