Ipratropium Bromide — NZ Medication Guide

What is Ipratropium Bromide?

Ipratropium Bromide (generic name: ipratropium bromide) is a medication used primarily for relief of bronchospasm in COPD and acute asthma exacerbations. Ipratropium bromide MDI (Atrovent) and nebuliser solution are funded by Pharmac on the Pharmaceutical Schedule for COPD and acute asthma management.

What is Ipratropium Bromide Used For?

Ipratropium Bromide is prescribed by healthcare professionals in New Zealand for the following indications:

• Chronic obstructive pulmonary disease (COPD) — bronchospasm relief
• Acute severe asthma exacerbations (in combination with salbutamol)
• Asthma — when short-acting beta2-agonists are insufficient as monotherapy
• Acute bronchospasm of any cause

How Does Ipratropium Bromide Work?

Ipratropium bromide is an anticholinergic (antimuscarinic) bronchodilator. It blocks muscarinic receptors in bronchial smooth muscle, preventing acetylcholine-induced bronchoconstriction and reducing mucus secretion. Unlike beta2-agonists, ipratropium works predominantly in larger airways and is more effective in COPD than in asthma. Onset is slower (15–30 minutes) but duration longer (4–6 hours) than salbutamol.

How to Take Ipratropium Bromide

For MDI (metered-dose inhaler): use 1–2 puffs (20–40 mcg) up to 4 times daily or as directed. For nebuliser: 250–500 mcg via nebuliser up to 4 times daily in COPD; higher doses may be used under medical supervision in acute exacerbations. Use with a spacer device for MDI to improve lung delivery. Rinse your mouth after each use to reduce dry mouth. Do not exceed prescribed doses.

Common Side Effects

• Dry mouth (very common)
• Cough and throat irritation
• Headache
• Blurred vision if spray enters eyes (avoid eye contact)
• Nausea
• Constipation

Serious Side Effects — Seek Medical Attention

• Acute angle-closure glaucoma — if spray accidentally enters eyes (especially with nebuliser mask)
• Urinary retention — particularly in men with enlarged prostate
• Paradoxical bronchospasm (rare) — worsening of breathing immediately after use
• Tachycardia (rapid heart rate)
• Hypersensitivity reaction — swelling, rash, difficulty breathing

Drug Interactions

• Other anticholinergic medications (tiotropium, oxybutynin, tricyclic antidepressants) — additive anticholinergic effects
• Beta2-agonists (salbutamol) — safe and commonly combined for additive bronchodilation in COPD and acute asthma
• Antihistamines with anticholinergic properties — additive dry mouth, constipation, urinary retention

New Zealand Prescribing Information

In New Zealand, BPAC NZ and the NZ Asthma and Respiratory Foundation recommend ipratropium as an important adjunct bronchodilator in COPD management and in acute severe asthma. The Asthma and Respiratory Foundation NZ treatment guidelines recommend combining ipratropium with salbutamol via nebuliser in acute severe asthma presentations. For COPD, long-acting anticholinergics (tiotropium) have largely replaced ipratropium as the preferred maintenance bronchodilator, but ipratropium remains valuable as an as-needed or combination treatment.

Frequently Asked Questions

How is ipratropium different from salbutamol?

Both are bronchodilators (medicines that open the airways) but they work through different mechanisms. Salbutamol (a beta2-agonist) works faster (within 5 minutes) and is often the first choice for acute relief. Ipratropium (an anticholinergic) takes 15–30 minutes to work but has a longer duration. Ipratropium is particularly effective in COPD, while salbutamol is the primary bronchodilator in asthma. They are often used together in acute asthma exacerbations for a stronger combined effect.

Why should I rinse my mouth after using ipratropium?

Ipratropium can cause dry mouth by reducing saliva production. Rinsing your mouth with water after use helps prevent discomfort and also reduces the small amount that may land in your mouth and throat. This simple habit also reduces the risk of oral infections. Adequate fluid intake throughout the day also helps manage dry mouth symptoms.

References & Further Information

The following New Zealand and international resources were used to inform this page:

• New Zealand Formulary — Ipratropium Bromide
• Pharmac — Funded Medicines Schedule
• BPAC NZ — COPD Management
• Asthma and Respiratory Foundation NZ

Reviewed by a Registered Pharmacist — KiwiMeds New Zealand