SAMA (short-acting muscarinic antagonist) Pregnancy: Safety during human pregnancy has not been established; the benefits of use during confirmed or suspected pregnancy must be weighed against the possible hazards to the unborn child (nonclinical studies showed no embryotoxic or teratogenic effects). It is not known whether ipratropium bromide is excreted into breast milk, and it is unlikely to reach the infant to an important extent, but caution should be exercised in nursing mothers.

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.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 250-500 micrograms (one 250 microgram/1 ml vial or one 500 microgram/2 ml vial) 3 to 4 times daily; for acute bronchospasm 500 micrograms, with repeated doses until the patient is stable

Route: Inhalation via nebuliser (unit-dose vials; administer via a mouthpiece where possible)

Frequency: 3 to 4 times daily; for acute bronchospasm repeated doses until stable (interval at the physician's discretion)

Max: Do not exceed the recommended daily dose; daily doses exceeding 2 mg in adults and adolescents aged 12 years should only be given under medical supervision

Anticholinergic bronchodilator (SPC: Atrovent 250 UDVs, 1 ml nebuliser solution). Dose is adapted to the individual needs of the patient. In children aged 12 years and under, only Atrovent 250 UDVs 1 ml should be used. Paediatric dosing (fixed by age band, not per kg): children 6-12 years 250 micrograms up to a total daily dose of 1 mg (4 vials); children 0-5 years (acute asthma only) 125-250 micrograms up to a total daily dose of 1 mg (4 vials), given no more frequently than every 6 hours in children under 5 years. May be combined with a short-acting beta2-agonist in the same nebuliser chamber (use promptly; discard unused solution). If dilution is needed to reach a suitable fill volume (usually 2-4 ml) use only sterile sodium chloride 0.9%. Do not administer simultaneously with disodium cromoglycate solutions containing benzalkonium chloride (precipitation may occur). For inhalation only - must not be taken orally or given parenterally. Care must be taken not to allow the solution or mist to enter the eyes. Verify paediatric dosing against a children's formulary.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Known hypersensitivity to atropine or its derivatives (such as the active substance ipratropium bromide)
Hypersensitivity to any other component of the product

Side effects

Headache; dizziness (common)
Throat irritation, cough, dry mouth (common)
Nausea and gastro-intestinal motility disorders including constipation, diarrhoea and vomiting
Ocular effects if the solution or mist reaches the eyes - blurred vision, mydriasis, raised intra-ocular pressure, narrow-angle glaucoma, eye pain (uncommon)
Hypersensitivity and anaphylactic reactions, angioedema; paradoxical bronchospasm; urinary retention (uncommon to rare)

Interactions

Chronic co-administration with other anticholinergic drugs is not recommended (not studied)
Beta-adrenergic drugs and xanthine preparations may produce an additive bronchodilatory effect
The risk of acute glaucoma in patients with a history of narrow-angle glaucoma may be increased when nebulised ipratropium bromide and beta2-agonists are administered simultaneously

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. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways