In addition, Atrovent® inhalation aerosol is contraindicated in patients with hypersensitivity to soya lecithin or related food products (eg, soybean and peanut). Note: Other formulations may include these components; refer to product-specific labeling.

Inhalation aerosol and inhalation solution:

>10%: Bronchitis (10% to 23%), upper respiratory tract infection (13%)

1% to 10%:

Cardiovascular: Palpitation

Central nervous system: Dizziness (2% to 3%)

Dermatologic: Rash (1%)

Gastrointestinal: Nausea, xerostomia, stomach upset, dry mucous membranes

Renal: Urinary tract infection

Respiratory: Nasal congestion, dyspnea (10%), sputum increased (1%), bronchospasm (2%), pharyngitis (3%), rhinitis (2%), sinusitis (5%)

Miscellaneous: Flu-like syndrome

<1%: Anaphylactic reaction, angioedema, atrial fibrillation, bitter taste, blurred vision, constipation, hypersensitivity reactions, insomnia, laryngospasm, mucosal ulcers, nervousness, rash, stomatitis, supraventricular tachycardia, tremor, urinary retention, urticaria

Nasal spray: Respiratory: Epistaxis (8%), nasal dryness (5%), nausea (2%)

Onset of action: Bronchodilation: 1-3 minutes

Peak effect: 1.5-2 hours

Duration: 4 hours

Absorption: Negligible

Distribution: Inhalation: 15% of dose reaches lower airways

Nebulization:

Infants and Children 12 years: 125-250 mcg 3 times/day

Children >12 years and Adults: 500 mcg (one unit-dose vial) 3-4 times/day with doses 6-8 hours apart

Oral inhalation: MDI:

Children 3-12 years: 1-2 inhalations 3 times/day, up to 6 inhalations/24 hours

Children >12 years and Adults: 2 inhalations 4 times/day, up to 12 inhalations/24 hours

Intranasal: Nasal spray:

Symptomatic relief of rhinorrhea associated with the common cold (safety and efficacy of use beyond 4 days in patients with the common cold have not been established):

Children 5-11 years: 0.06%: 2 sprays in each nostril 3 times/day

Children 5 years and Adults: 0.06%: 2 sprays in each nostril 3-4 times/day

Symptomatic relief of rhinorrhea associated with allergic/nonallergic rhinitis: Children 6 years and Adults: 0.03%: 2 sprays in each nostril 2-3 times/day

Atrovent®: Shake inhaler before each use; rinsing mouth after each use decreases dry mouth side effect

Atrovent® HFA: Prime inhaler by releasing 2 test sprays into the air. If the inhaler has not been used for >3 days, reprime.

Inhaler: Follow instructions for use accompanying the product. Close eyes when administering ipratropium; blurred vision may result if sprayed into eyes. Effects are enhanced by holding breath 10 seconds after inhalation; wait at least 1 full minute between inhalations.

Nebulizer: Wash hands before and after treatment. Wash and dry nebulizer after each treatment. Twist open the top of one unit dose vial and squeeze the contents into the nebulizer reservoir. Connect the nebulizer reservoir to the mouthpiece or face mask. Connect nebulizer to compressor. Sit in a comfortable, upright position. Place mouthpiece in your mouth or put on the face mask and turn on the compressor. If a face mask is used, avoid leakage around the mask (temporary blurring of vision, worsening of narrow-angle glaucoma, or eye pain may occur if mist gets into eyes). Breathe calmly and deeply until no more mist is formed in the nebulizer (about 5 minutes). At this point, treatment is finished.

Solution for nebulization, as bromide: 0.02% (2.5 mL)

Solution for oral inhalation, as bromide (Atrovent®): 18 mcg/actuation (14 g) [contains soya lecithin and chlorofluorocarbons]

Solution for oral inhalation. as bromide (Atrovent® HFA): 17 mcg/actuation (12.9 g)

Solution, intranasal spray, as bromide (Atrovent®): 0.03% (30 mL); 0.06% (15 mL)

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Schuh S, Johnson DW, Callahan S, et al, "Efficacy of Frequent Nebulized Ipratropium Added to Frequent High-Dose Albuterol Therapy in Severe Childhood Asthma,"J Pediatr, 1995, 126(4):639-45.

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