Drug reference
ipratropium bromide
Short-acting muscarinic antagonist (SAMA), anticholinergic · Bronchodilator
Short-acting muscarinic antagonist (SAMA), anticholinergicBronchodilator
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
—
none in our sources
PREGNANCY
—
not curated
Mechanism
Ipratropium bromide is a competitive antagonist of endogenous acetylcholine (ACh) at muscarinic receptors. It inhibits the direct constrictor effect on bronchial smooth muscle mediated via the M3-Gq-PLC-IP3-Ca2+ pathway. It also antagonizes vagally mediated airway tone, resulting in bronchodilation and reduced mucus secretion.
Indications
COPDAcute severe asthma (additive with β2 agonists)Asthma (when control is not adequate with nebulized β2 agonists, or in cases of theophylline problems, or tremor from β2 agonists in elderly patients)Regular prophylactic use for bronchial asthmaAsthmatic bronchitisRhinorrhoea in perennial rhinitis and common coldBronchial asthma (less efficacious than inhaled β2 sympathomimetics)COPD (bronchodilator of choice)Psychogenic asthmaRefractory asthma (nebulized with salbutamol)
Dosing
- Adult
- 40–80 µg by inhalation; 2 puffs 3–4 times daily (metered dose inhaler); 0.4–2 ml nebulized in conjunction with a β2 agonist 2–4 times daily (respirator solution); 1–2 sprays in each nostril 3–4 times a day (nasal spray)
Pharmacokinetics
Onset
Relatively slow
Peak effect
30-60 min
Duration
4–6 hours
Protein binding
Little systemic absorption
Side effects
Common
Bitter tasteDryness of the mouthDryness of mouthScratching sensation in tracheaCoughBad tasteNervousness (reported in 20–30% patients)
Serious
- Precipitation of glaucoma (with nebulized use if via face mask)
- Paradoxical bronchoconstriction (rarely, due to hypotonic nebulizer solution, antibacterial additives, or M2 receptor blockade)
- Urinary retention (occasionally in elderly patients)
Related guidelines
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Sources: KD Tripathi 7e, Goodman & Gilman 14e·Verified: 2026-05-10 · House clinical team