Atrovent – composition, action, indications, contraindications, side effects

Proven content

Atrovent is a medical prescription drug. It is an inhaler medication with a bronchodilator effect. The active substance is ipratropium bromide, a derivative of atropine. This substance is an anticholinergic bronchodilator that causes short-term (up to 6 hours) bronchodilation after ingestion. Atrovent is used in diseases accompanied by bronchospasm that makes breathing difficult. What is Atrovent and what is its composition? What’s the action? What are the indications for use and are there any contraindications and side effects of using Atrovent? How to dose it and with what drugs can it interact?

Atrovent – drug characteristics

Atrovent is a drug for anticholinergic activitycausing the bronchodilation, causing the free flow of air in the airways. Anticholinergic drugs are substances that block muscarinic receptors, which result in relaxation of the bronchial smooth muscles, preventing further contractions and reducing the secretion of mucus in the bronchial tree.

The international name of the drug is Ipratropium bromide. The active substance is ipratropium (ipratropium bromide). The drug is sold only in stationary pharmacies upon presentation of a prescription issued by a doctor.

Atrovent comes in the form of a nebuliser solution, where one bottle of the drug contains 20 ml of inhalation fluid. The price of Atrovent without refund is about PLN 15. However, eligible patients are entitled to a refund. In the case of people with cystic fibrosis, bronchopulmonary dysplasia, ciliary dyskinesia, chronic obstructive pulmonary disease, eosinophilic bronchitis and asthma, the reimbursement price is PLN 8,40. For patients aged 75 or more and pregnant women, this drug is reimbursed 100% and is free of charge.

There are no special precautions for storage. Keep Atrovent out of the sight and reach of children at 15 ° C – 25 ° C. The drug should not be used after the expiry date which is stated on the label and on the box. Before using Atrovent, read the package leaflet or consult a doctor or pharmacist, as any drug used improperly is life or health threatening.

The responsible entity is Boehringer Ingelheim International GmbH in Germany and the manufacturer of Atrovent is Instituto de Angeli S. rl in Italy.

For more detailed information about Atrovent, please contact the representative of the Marketing Authorization Holder: Poland Boehringer Ingelheim Sp. z o. o. located in Warsaw.

The Boehringer Ingelheim Group was founded in 1885 and remains the property of the Boehringer family continuously, with its headquarters in Ingelheim, Germany. The company is one of the world’s 20 leading pharmaceutical companies and operates through 146 subsidiaries. The representative office of Boehringer Ingelheim Pharma GmbH started working in Warsaw in 1990. In 1993, the company Boehringer Ingelheim Sp. z o. o. and a pharmaceutical wholesaler. Boehringer Ingelheim conducts research and development, production and sale of innovative medicinal products with high therapeutic value for use in human and veterinary medicine.

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Atrovent – composition and mode of operation

The active substance in Atrovent is ipratropium bromide, which has a cholinolytic (anticholinergic) effect.

1 ml of Atrovent solution (20 drops) contains 261 micrograms of ipratropium bromide as ipratropium bromide monohydrate, equivalent to 250 micrograms of ipratropium bromide anhydrous.

The active substance in Atrovent has an antispastic effect by expanding the bronchial tubes and preventing them from spasming. Atrovent works by blocking the activation of cholinergic receptors (M3 muscarinic receptors), which are found in the smooth muscle of the bronchi. M3 cholinergic receptors are activated by acetylcholine (released after stimulation of the vagus nerve), which causes the bronchial smooth muscle to contract. Atrovent works by blocking the receptors by the medicine, blocking the effect of acetylcholine on airway smooth muscle.

This preparation causes bronchodilation and improves lung ventilation, thanks to which the patient feels relief and disappears shortness of breath caused by contraction of the muscles of the respiratory tract. The first effects of lung function improvement occur within 15 minutes of drug administration and last an average of 4-6 hours.

In addition to the active ingredient, Atrovent contains 0,01 g / 100 ml of benzalkonium chloride as a preservative, sodium edetate as a stabilizer, sodium chloride, hydrochloric acid and purified water.

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Atrovent – indications for the use of the drug

Atrovent is a medication indicated for the treatment of bronchospasm in chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema, and in bronchial asthma. It is given to dilate the bronchi and make it easier for the patient to breathe.

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Atrovent- contraindications to the use of the drug

Atrovent is a drug available only on prescription and the doctor decides on its implementation for treatment, individually assessing the risk of using the drug in the patient.

Although there may be indications for the use of this preparation, it may not always be taken by the patient.

Primary contraindication to the use of Atrovent is hypersensitive, i.e. allergic to atropine and its derivatives, such as tiotropium or oxitropium or any of the ingredients. The use of the preparation by people with hypersensitivity to the ingredients of the preparation may cause an immediate reaction, including angioedema (difficulty breathing or swallowing, swelling of the tongue, lips, face), hives or rash, bronchospasm and anaphylaxis. Speech by the above-mentioned symptoms requires immediate discontinuation of the preparation and consultation with a doctor.

Certain diseases and other circumstances may constitute a contraindication to the use or an indication for a change in the dosage of the preparation. In some situations it may be necessary to carry out certain check-ups.

Particular caution when using the drug Atrovent should be kept in the case of people:

1. with angle-closure glaucoma, after getting into the eye, the preparation may cause pupil dilation, increase in intraocular pressure, angle-closure glaucoma, eye pain;
2. with urination disorders (narrowing of the bladder neck, enlargement of the prostate gland);
3. patients with cystic fibrosis, as they may be more prone to gastrointestinal motility disorders.

Due to limited data on the use of the drug in children, Atrovent should be used in this age group under close medical supervision.

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Atrovent – side effects

Atrovent can cause side effects and side effects that may not necessarily be experienced by everyone who uses this medicine. It is important to report any suspected adverse reactions after authorization of the medicinal product so that the benefit / risk balance of the medicinal product can be monitored.

The general classification of the frequency of adverse body reactions (ADRs) is based on the following principles: very common (≥1 / 10), common (≥1 / 100 to <1/10), uncommon (≥1 / 1 to <000/1), rare ( ≥100 / 1 to <10 / 000), very rare (<1 / 1), not known (cannot be estimated from the available data).

Most of the side effects of Atrovent are related to the anticholinergic properties of the product. This preparation, like all inhalation drugs, may cause local irritation symptoms.

The most commonly reported side effects reported in clinical trials were headache, throat irritation, cough, dry mouth, gastrointestinal motility disorders (including constipation, diarrhea and vomiting), nausea and dizziness.

Atrovent may cause the following side effects:

1. common side effects after taking the drug (more than 1 in 100 but less than 1 in 10 patients): pain, dizziness, throat irritation, cough, dry mouth, nausea, gastrointestinal motility disorders;
2. not very common side effects after taking the drug (more than 1 in 1000 but less than 1 in 100 patients): rapidly progressing, life-threatening allergic reactions (anaphylactic reactions), hypersensitivity, angioedema (sudden swelling of the skin or mucous membranes that may cause difficulty in breathing), palpitations supraventricular tachycardia (excessively rapid heart rate), narrowing of the airways, inhalation-induced (paradoxical) narrowing of the airways, laryngospasm (sudden contractions of the vocal cords which may affect breathing and speech), swelling of the throat (swelling of the upper part of the throat), blurred vision, pupil dilation, increased intraocular pressure, glaucoma, eye pain, visual halo, conjunctival hyperaemia, corneal edema (swelling of the protective layer of the eye), dry throat, diarrhea, constipation, vomiting, stomatitis, cavity swelling oral, urinary retention, rash, itching;
3. rare side effects after using the drug (more than 1 in 10 but less than 000 in 1 patients): atrial fibrillation (very fast, irregular heartbeat), increased heart rate, disturbance in accommodation (visual acuity), hives.

In the event of any of the above symptoms or other not mentioned above symptoms, inform your doctor or pharmacist. It allows continued monitoring of the benefit / risk balance of Atrovent.

Atrovent – dosage and method of application

Atrovent is a drug in the form of inhalation fluid from a nebuliser. The fluid should only be inhaled and should not be taken orally.

Dosage of Atrovent should be adapted to the individual needs of the patient. The use of the drug requires constant medical care, therefore the patient should be advised to contact the doctor in order to establish a new treatment plan in the event of no significant improvement or when the patient’s condition deteriorates.

Always take Atrovent exactly as your doctor or pharmacist has told you. If in doubt, consult your doctor or pharmacist.

Unless otherwise prescribed by the doctor, the following dosage is recommended: 20 drops, i.e. equal to about 1 ml of the preparation. 1 drop is equal to 0,0125 mg of anhydrous ipratropium bromide. For maintenance treatment in adults and adolescents from 14 years of age (including the elderly), the recommended dose of Atrovent is 2 ml (40 drops) taken 3 to 4 times a day.

Due to the limited amount of information on the use of the preparation in children under 14, it is recommended to:

1. children from 6 to 14. years of age, dose: 1 ml (20 drops) administered 3-4 times a day under the supervision of a doctor,
2. children up to 6 years of age, dose: 0,4–1 ml (8–20 drops) administered 3-4 times a day under medical supervision.

The recommended doses should not be exceeded, as it does not affect the effectiveness of the drug and may be harmful to health or life.

The administration of the preparation in a daily dose of more than 2 mg (160 drops) in adults and children over 14 years of age and 1 mg (80 drops) in children up to 14 years of age should be under strict medical supervision.

As Atrovent is a drug intended for inhalation use only, it must not be used orally or intravenously. The recommended dose of the drug should be diluted with 0,9% sodium chloride solution (must not be diluted with distilled water) to a volume of 3-4 ml and inhaled until the solution is completely consumed.

The solution should be prepared immediately before each use and any unused diluted solution should be discarded. The inhalation time or dosage may depend on the inhalation method and the quality of the nebulizer.

Different types of nebulizers differ in their construction. Atrovent can be administered using any type of nebuliser available on the market. Follow the instructions for the type of nebuliser.

If an oxygen wall installation is available, use a flow of 6-8 liters per minute.

Atrovent can be used together with inhalations of drugs that facilitate the secretion and thinning of mucus (eg Mucosolvan inhalation fluid from a nebuliser). However, simultaneous use of Atrovent and disodium cromoglycate in the same nebuliser is not recommended as precipitation may occur.

If you have any doubts about the dosage or method of using Atrovent, or if you notice any disturbing symptoms, please consult your doctor or pharmacist.

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Atrovent – overdose or missed dose

The use of Atrovent should be under the close supervision of a physician who will determine the dosage individually to the patient’s needs. It is important to always get a prescription in time and buy a new preparation before using the previous one, so that the treatment with the drug is not interrupted.

If you stop using Atrovent may make breathing difficult again or may worsen. It is forbidden to stop using the drug on your own and the doctor will recommend the duration of the treatment and decide when to stop using Atrovent.

In case of using more than the recommended dose of the drug, consult your doctor or pharmacist. Considering the wide therapeutic range and the local administration of the medicinal product, no serious symptoms of anticholinergic activity are expected.

An overdose of the drug may only result in the development of mild systemic symptoms such as dry mouth, accommodation disorders and increased heart rate.

If you miss a dose on a regular basis, take it as soon as possible, but do not take a double dose to make up for the forgotten dose. In case of any doubts regarding the use of the drug, consult a physician or a pharmacist.

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Atrovent – interactions with other drugs and substances

Atrovent is a drug that, when taken with other drugs at the same time, can negatively affect your health. Inform your doctor about all medications you have recently taken, even those sold without a prescription.

Atrovent should not be used with other drugs with anticholinergic properties. Β-adrenergic preparations and xanthine preparations may potentiate the bronchodilating effect.

Concomitant nebulised administration of ipratropium bromide and β-mimetics may increase the risk of acute glaucoma in patients with a history of narrow-angle glaucoma.

The preparation and disodium cromoglycan should not be used simultaneously (in the same nebulizer), as this may cause precipitation.

Atrovent can be used together with inhalations of drugs that facilitate the secretion and thinning of mucus (eg Mucosolvan inhalation fluid from a nebuliser). Before starting treatment with this medicine, any doubts should be clarified with your doctor or pharmacist.

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Atrovent – pregnancy and breastfeeding

The use of any drug during pregnancy or breastfeeding requires prior consultation in order to clarify all the potential risks and benefits associated with the use of the drug.

Safety of Atrovent in pregnancy has not been established. Before prescribing the drug by your doctor, you should inform about pregnancy or planning. The physician will decide whether the expected benefits clearly outweigh the possible risks to the fetus.

In preclinical studies, Atrovent has not been shown to be embryotoxic or teratogenic at doses well in excess of those recommended for human use. Moreover, it is not known whether the drug is excreted in human milk.

Quaternary lipid-insoluble cations are excreted in human milk, however, it seems unlikely that Atrovent, after inhaled use, would be secreted into the infant in a significant amount.

Nevertheless, caution should be exercised when administering Atrovent to women who are breast-feeding, or who are pregnant or planning a pregnancy.

Also in preclinical studies with ipratropium bromide, no negative effects on fertility were shown. It should be remembered before taking Atrovent that only a doctor can assess the risk-benefit ratio, so consult your doctor when taking the drug.

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