Drug reference

Ipratropium

Short-acting inhaled antimuscarinic (SAMA) · Bronchodilator

Also known as Ipratropium Bromide, Atrovent

START

COPD MDI 2 puffs QID; acute (asthma/COPD) nebulised 500 mcg with salbutamol, repeat per response

TYPICAL MAX

MDI ~12 puffs/day; nebulised 500 mcg QID (more frequent short-term in acute exacerbation)

STOP IF

Acute angle-closure glaucoma, severe urinary retention, paradoxical bronchospasm

WATCH

Inhaler/nebuliser technique, protect eyes from mist (glaucoma), anticholinergic effects (bladder), not a sole reliever in asthma

CDSCO approvedSchedule HJan AushadhiATC R03BB01

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 15min · bronchodilation onset
PEAK: 1.5h · peak FEV1
t½: 1.6h · absorbed-fraction t½
DURATION: 5h · effect duration

EXCRETION

Minimal systemic; renal/biliary small fraction

route + CYP

INTERACTIONS

1 major

SEVERE in our sources

PREGNANCY

Use if clearly needed — considered acceptable for asthma/COPD; minimal systemic exposure

FDA category + note

Top interactionssee all 4 →

Other AnticholinergicsSevereDatabaseKimi deep-research + Cla

Available in India

9 branded formulations and 1 fixed-dose combination. Look up specific brands in the Drugs workspace.

Jan Aushadhi — generic available at GoI pharmacies

Mechanism

Non-selective muscarinic antagonist blocking acetylcholine-mediated bronchoconstriction (M3) → bronchodilation; quaternary ammonium → minimal systemic absorption; slower onset than SABA, useful add-on.

Indications

COPD maintenance bronchodilation and acute exacerbations (with SABA)Acute severe asthma (adjunct to salbutamol, esp. exacerbations)Rhinorrhoea (nasal spray — allergic/non-allergic rhinitis, common cold)

Dosing

Adult: MDI 2 puffs (17–21 mcg/puff) four times daily (max ~12 puffs/day). Nebulised 250–500 mcg every 6 h (acute: 500 mcg with salbutamol, repeat). Nasal spray per product.
Pediatric: Nebulised 125–250 mcg (per age) for acute asthma with salbutamol (specialist).
Renal adjustment: No adjustment (minimal absorption).
Hepatic adjustment: No adjustment.
Geriatric: No specific adjustment; anticholinergic awareness (eye/bladder).
Max dose: MDI ~12 puffs/day; nebulised 500 mcg QID (acute: more frequent short-term)

Pharmacokinetics

Onset

~15 min

Peak effect

~1–2 h

Duration

~4–6 h

Half-life

~1.6 h (absorbed fraction)

Bioavailability

Low systemic (quaternary; ~2% inhaled)

Protein binding

Minimal

Metabolism

Partial ester hydrolysis (largely inactive)

Excretion

Renal/biliary (small absorbed fraction)

Contraindications

Hypersensitivity to ipratropium/atropine derivatives or soya lecithin (some MDIs)
Caution: narrow-angle glaucoma (avoid eye exposure), bladder-neck obstruction/prostatic hyperplasia