Skip to content
ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Antimuscarinic nasal spray (rhinorrhoea) Pregnancy: UK SPC §4.6: The safety of ipratropium nasal spray during human pregnancy has not been established. The benefits during a confirmed or suspected pregnancy must be weighed against the possible hazards to the unborn child. Preclinical studies showed no embryotoxic or teratogenic effects following inhalation or intranasal application at doses considerably higher than those recommended in man. Breast-feeding: it is not known whether ipratropium bromide is excreted into breast milk; it is unlikely to reach the infant to an important extent, but caution should be exercised in nursing mothers. Fertility: preclinical studies showed no adverse effect on fertility; clinical fertility data are not available.

Ipratropium Bromide 0.03% Nasal Spray (Rinatec)

Brand names: Rinatec

Used in: COPD Asthma

Ipratropium bromide nasal spray (Rinatec) is a topical anticholinergic used specifically to reduce watery rhinorrhoea, including in non-allergic and vasomotor rhinitis.

Adult dose

Dose: Symptomatic relief of rhinorrhoea in allergic and non-allergic rhinitis. Adults: two sprays (42 micrograms) in each nostril (each spray delivers 21 micrograms of ipratropium bromide).
Route: Intranasal (nasal spray)
Frequency: 2-3 times a day
VERBATIM UK SPC §4.2 (IPRATROPIUM BROMIDE 21 MICROGRAMS PER METERED DOSE NASAL SPRAY SOLUTION, PL150110039, Infectopharm / distributed by Consilient Health (UK) Ltd): 'Adults Two sprays (42 micrograms) in each nostril administered 2–3 times a day.' §4.1: 'indicated for the symptomatic relief of rhinorrhoea in allergic and non-allergic rhinitis.' STRENGTH (§2): 20 ml (240 metered doses) pump spray; 'Each valve actuation delivers 70 µl of solution containing 21 micrograms of ipratropium bromide.' The SPC prints no maximum daily dose, so none is given here. PAEDIATRIC (§4.2): 'The use of Ipratropium nasal spray has not been evaluated in children, and therefore is not recommended for use in patients below the age of 12 years'; no figure is printed for 12 years and over, so none is given. PRIMING (§4.2): prime the pump with seven presses before first use; if unused for more than 24 hours re-prime with two sprays; if unused for more than 7 days re-prime with seven sprays. Avoid spraying in or around the eyes; if it happens flush the eye with cold tap water for several minutes. Stop and seek medical advice if there is no improvement or symptoms worsen. This SPC covers this one product; the 0.06% US nasal solution (different strength and indication) is not used.

Dose adjustments

Renal

UK SPC §4.2 gives no renal impairment dose adjustment (no figure printed).

Hepatic

UK SPC §4.2 gives no hepatic impairment dose adjustment (no figure printed).

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via MHRA Products — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to atropine or its derivatives, or to any of the excipients listed in section 6.1

Side effects

  • Most frequent in clinical trials: epistaxis, nasal dryness, headache, throat irritation and nasal discomfort (each common, 1/100 to <1/10)
  • Uncommon: hypersensitivity, anaphylactic reaction, angioedema of tongue, lips and face; dizziness; blurred vision, mydriasis, increased intraocular pressure, glaucoma, eye pain, halo vision, conjunctival hyperaemia, corneal oedema, accommodation disorder
  • Uncommon: supraventricular tachycardia, atrial fibrillation, increased heart rate (palpitations rare); bronchospasm, laryngospasm, pharyngeal oedema, dry throat, dry mouth, nausea, gastrointestinal motility disorder, stomatitis, burning sensation, rash, urinary retention (risk may be increased with pre-existing urinary outflow tract obstruction); urticaria and pruritus rare
  • Immediate hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm, oropharyngeal oedema, anaphylaxis) have been reported in rare cases
  • Benzalkonium chloride preservative may cause irritation of the nasal mucosa

Interactions

  • Antihistamines, decongestants and nasal steroids used for perennial rhinitis: concomitant use does not increase the incidence of nasal or non-nasal side-effects
  • Other anticholinergic medicines, including ipratropium bromide-containing aerosols for oral inhalation: some potential for additive interaction (ipratropium is minimally absorbed systemically)

Monitoring

  • Caution in patients predisposed to or with narrow-angle glaucoma, or with pre-existing urinary outflow tract obstruction (e.g. prostatic hyperplasia or bladder-outflow obstruction)
  • Caution in cystic fibrosis (may be prone to gastrointestinal motility disturbances)
  • Instruct patients in correct administration to avoid contact with the eyes; eye pain or discomfort, blurred vision, visual halos, or coloured images with red eyes may be signs of acute narrow-angle glaucoma - start miotic drops and seek specialist advice immediately
  • Patients should stop and seek medical advice for alternative treatment if there is no improvement or symptoms worsen

Clinical monograph

How it works

As a topical antimuscarinic agent, it blocks acetylcholine at glandular muscarinic receptors in the nasal mucosa, reducing serous secretion and the runny nose, but it does not relieve congestion, sneezing or itch.

Prescribing in practice

  • It targets rhinorrhoea only and will not help nasal blockage, sneezing or itch, so expectations and choice of therapy should reflect this.
  • Use with caution and avoid spraying into the eyes in patients with glaucoma or bladder outflow obstruction, given its anticholinergic action.
  • Local nasal dryness, irritation and epistaxis can occur with regular use.

Monitoring

Monitor symptomatic response (reduction in nasal discharge) and check for local nasal dryness or bleeding at review.

Counselling the patient

  • It helps a runny nose but not a blocked, itchy or sneezy nose.
  • Take care to avoid getting the spray in your eyes.
  • Tell the clinician if you have glaucoma or difficulty passing urine.

Evidence & guidelines

Intranasal ipratropium is recognised as effective for the rhinorrhoea component of allergic and non-allergic rhinitis in UK prescribing references and ARIA guidance.

Reference: BSACI Non-Allergic Rhinitis Guidelines; Rinatec SPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways