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SAMA (short-acting muscarinic antagonist)

Ipratropium bromide

Brand names: Atrovent, Rinatec

A short-acting inhaled antimuscarinic bronchodilator used in COPD and as an adjunct in acute asthma, available by metered-dose inhaler or nebuliser. It produces slower-onset bronchodilation than short-acting beta-2 agonists.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Ipratropium competitively blocks airway muscarinic receptors, reducing vagally mediated bronchoconstriction and mucous secretion to widen the airways.

Prescribing in practice

  • Protect the eyes during nebulisation — nebulised mist reaching the eyes can precipitate acute angle-closure glaucoma, so a mouthpiece or eye protection is advised, especially when combined with a beta-2 agonist.
  • Use with caution in prostatic hyperplasia and bladder outflow obstruction owing to risk of urinary retention.
  • Onset is relatively slow, so it is not the first-choice agent for rapid relief of acute bronchospasm.

Monitoring

Monitor symptomatic response and watch for antimuscarinic effects including dry mouth, urinary retention and any visual disturbance suggestive of acute glaucoma.

Counselling the patient

  • Avoid getting the nebulised mist in your eyes; report eye pain, blurred vision or haloes promptly.
  • Dry mouth is common — sips of water or sugar-free gum can help.

Evidence & guidelines

Ipratropium is a long-established bronchodilator supported by UK guidance for COPD and as nebulised add-on therapy in acute severe asthma.

Reference: BTS/SIGN; NICE NG115; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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