Atrovent Nebuliser Solution (U.D.V.)

People with COPD who have been shown to benefit from regular use of high doses of ipratropium are also sometimes prescribed nebules to be used on a regular basis in a nebuliser at home.

How does it work?

• Atrovent inhaler and Atrovent UDVs both contain the active ingredient ipratropium bromide, which is a type of medicine called an antimuscarinic bronchodilator. Ipratropium nebuliser solution is also available without a brand name, ie as the generic medicine. Ipratropium works by opening the airways to make it easier to breathe.
• In conditions where there is narrowing of the airways, such as asthma or chronic obstructive pulmonary disease (COPD, eg emphysema and chronic bronchitis), it is difficult for air to get in and out of the lungs.
• Ipratropium works in the lungs, where it blocks receptors called muscarinic receptors that are found on the muscle surrounding the airways. A natural chemical called acetylcholine normally acts on these receptors, causing the muscle in the airways to contract and the airways to narrow.
• Ipratropium blocks the muscarinic receptors in the lungs and therefore stops the action of acetylcholine on them. This allows the muscle around the airways to relax and the airways to open. This makes it easier for people with asthma or COPD to breathe.
• Ipratropium is inhaled into the lungs using either an inhaler or a nebuliser. Inhaling the medicine allows it to act directly in the lungs where it is needed most. It also reduces the potential for side effects occurring in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if it is taken by mouth.

How do I use Atrovent inhaler?

• Follow this link for general instructions on how to use a metered dose inhaler such as Atrovent inhaler. You should also make sure you read the information leaflet provided with your inhaler, as this will give detailed instructions on how to use and look after your inhaler.
• If you find it difficult to use the Atrovent inhaler because you have problems pressing down the canister at the same time as breathing in, the AeroChamber Plus spacer device can be used with this inhaler to make it easier. Ask your pharmacist for more information and advice.
• The dose of Atrovent inhaler prescribed by your doctor will depend on your age and the severity of your lung condition. It is important to follow the instructions given by your doctor. These should also be printed on the dispensing label that your pharmacist has put on the packet.
• Adults usually need to use one or two puffs three to four times a day, but some people may need to use up to four puffs at a time.
• Children aged 6 to 12 years usually need to use one or two puffs three times a day, and children under six years usually need one puff three times a day.
• If you forget to take a dose take it as soon as you remember, unless it is nearly time for your next dose. If this is the case, leave out the forgotten dose and just take your next dose as usual. Do not take a double dose to make up for a missed dose.
• Do not exceed the dose of ipratropium that your doctor has prescribed you to use.

Use with caution in

• People who have difficulty passing urine, for example men with an enlarged prostate gland (prostatic hypertrophy) or people with an obstruction of the bladder.
• Glaucoma and people susceptible to narrow-angle glaucoma.
• Cystic fibrosis.

Not to be used in

• People who are allergic to ipratropium bromide or related medicines, eg atropine.
• This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• The manufacturer states that this medicine should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the developing baby. However, it is important that asthma is well controlled in pregnant women. Wherever possible, asthma medications should be taken by inhaler, as this minimises the amount of medicine that enters the bloodstream and crosses the placenta. It is important to get medical advice from your doctor on how to control your asthma during pregnancy, but in general, inhaled medicines can be taken as normal during pregnancy.
• It is not known if this medicine passes into breast milk. It should be used with caution in nursing mothers, and only if the benefits to the mother outweigh any risks to the nursing infant. However, in general, asthma inhalers can be used as normal during breastfeeding, because the amount of medicine that passes into the breast milk after using an inhaler is negligable and unlikely to harm the baby. Seek further medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Common

• Headache.
• Dizziness.
• Dry mouth.
• Cough.
• Throat irritation.
• Feeling sick.

Uncommon 

• Blurred vision.
• Dilated pupils.
• Red eyes.
• Increased pressure in the eye or glaucoma (see warning section above).
• Awareness of your heartbeat (palpitations).
• Unexpected narrowing of the airways (paradoxical bronchospasm - see warnign section above).
• Dry or swollen throat.
• Constipation or diarrhoea.
• Vomiting.
• Rash or itching.
• Difficulty passing urine (urinary retention).
• Allergic reaction, such as swelling of the face, lips and tongue (angioedema).

Rare

• Difficulty focusing.
• Increased heart rate (tachycardia).
• A type of irregular heartbeat called atrial fibrillation.
• Nettle-type rash (hives or urticaria).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before using any new medicines while using this one, to make sure that the combination is safe.

This medicine has not been studied in combination with other antimuscarinic medicines such as those below, and these are therefore not recommended while you are using this medicine:

• aclidinium
• glycopyrronium
• oxitropium
• tiotropium.

If you experience a dry mouth as a side effect of this medicine you may find that medicines that are designed to dissolve and be absorbed from under the tongue, eg sublingual glyceryl trinitrate (GTN) tablets for angina, become less effective. This is because the tablets do not dissolve properly in a dry mouth. To resolve this, drink a mouthful of water before taking sublingual tablets.

If you have any more questions please ask your Pharmacist.

Remember to keep all medicines out of reach of children
Please Note: We have made every effort to ensure that the content of this information sheet is correct at time of publish, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.

References:

https://www.medicines.org.uk/emc/medicine/14332

https://www.drugs.com/atrovent.html

http://www.rxlist.com/atrovent-hfa-drug.htm

http://www.medicinenet.com/ipratropium_bromide_inhaler/article.htm

http://www.netdoctor.co.uk/medicines/allergy-and-asthma/a6252/atrovent-ipratropium-bromide/