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Antimuscarinic nasal spray (rhinorrhoea) Pregnancy: Use with caution — limited data. Systemic absorption minimal via nasal route.

Ipratropium Bromide 0.03% Nasal Spray (Rinatec)

Brand names: Rinatec

Adult dose

Dose: 2 sprays (42 micrograms) into each nostril 2–3 times daily
Route: Intranasal
Frequency: 2–3 times daily
Max: 8 sprays (168 micrograms) per day
Rhinorrhoea (watery nasal discharge): 2 sprays per nostril 2–3 times daily. Reduces watery secretion from nasal mucosa (antisecretory — not decongestant). Indicated for: perennial non-allergic rhinitis (vasomotor rhinitis), rhinorrhoea of allergic rhinitis not controlled by antihistamines/steroids, gustatory rhinitis (rhinorrhoea triggered by eating). Onset within 15 minutes.

Paediatric dose

Route: Intranasal
Frequency: 2–3 times daily
Max: 168 micrograms/day
6–11 years: 2 sprays per nostril 3 times daily (0.03%). ≥12 years: adult dose. Not licensed under 6 years.

Dose adjustments

Renal

No specific dose adjustment required.

Hepatic

No specific dose adjustment required.

Clinical pearls

  • Specifically targets watery rhinorrhoea — does not treat nasal obstruction or sneezing (unlike antihistamines/steroids)
  • Excellent for gustatory rhinitis (watery runny nose triggered by hot/spicy food) — 2 sprays 30 min before eating
  • Vasomotor rhinitis (non-allergic, non-infectious rhinorrhoea): ipratropium nasal is most effective pharmacological option
  • Onset of action within 15 minutes — reassure patient
  • Elderly patients: caution regarding urinary retention and precipitation of glaucoma

Contraindications

  • Hypersensitivity to ipratropium or atropine
  • Narrow-angle glaucoma (systemic absorption — rare but possible with nasal administration)
  • Bladder outflow obstruction (prostatic hypertrophy)

Side effects

  • Nasal dryness and irritation
  • Epistaxis
  • Headache
  • Dry mouth (anticholinergic)
  • Urinary retention (rare — systemic absorption)
  • Worsening of narrow-angle glaucoma (rare)

Interactions

  • Other antimuscarinics — additive anticholinergic side effects
  • Inhaled ipratropium (tiotropium) — additive anticholinergic burden if used simultaneously

Monitoring

  • Symptom response (rhinorrhoea control)
  • Urinary symptoms in at-risk males

Reference: BNFc; BNF; BSACI Non-Allergic Rhinitis Guidelines; Rinatec SPC. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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