Ipratropium Bromide

How it works

It antagonises muscarinic acetylcholine receptors in airway smooth muscle, reducing cholinergically mediated bronchoconstriction and bronchial secretions.

Prescribing in practice

• Care is needed to avoid the nebulised mist or spray reaching the eyes, particularly in patients with glaucoma, as acute angle-closure glaucoma can be precipitated.
• Use with caution in prostatic hyperplasia and bladder outflow obstruction owing to its antimuscarinic effects.
• It has a slower onset than short-acting beta-2 agonists and is not the preferred first reliever in acute asthma.

Monitoring

Monitor symptomatic response and inhaler technique, with vigilance for antimuscarinic adverse effects.

Counselling the patient

• When using a nebuliser, use a mouthpiece or protect the eyes to avoid blurred vision and eye pain.
• Report eye pain, halos around lights or a painful red eye urgently.
• Dry mouth is a common effect; sips of water can help.

Evidence & guidelines

Short-acting antimuscarinic bronchodilators are established in COPD and acute asthma management within national guidance.