Indications & Uses
Ipramid is indicated for:
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
Nebuliser Solution, for adults (including elderly patients) and children over 12 years: 250-500 micrograms (that is, 1 ml or 2 ml) of ipratropium bromide nebuliser solution 3 to 4 times daily. For acute bronchospasm, 500 micrograms/2 ml is used. It is best not to go beyond the recommended daily dose during either acute or maintenance treatment, and daily doses above 2 mg in adults and children over 12 should only be given under medical supervision. For children aged 6 to 12 years: 250 micrograms (1 ml), up to a total daily dose of 1 mg (4 ml), with the interval between doses left to the physician's judgment. For children aged 0 to 5 years (for acute asthma only): 125-250 micrograms (0.5 ml to 1 ml), up to a total daily dose of 1 mg (4 ml). In children under 5 years, ipratropium should not be given more often than every 6 hours; doses may be repeated until the patient is stable, with the interval again left to the physician's judgment. Ipratropium nebuliser solution can be mixed with a short-acting beta 2-agonist in the same nebulizer chamber; once mixed, it should be used promptly and any leftover solution discarded. It can be given through most commercially available nebulizing devices, and the solution may need diluting, usually to a final volume of 2-4 ml, to suit the particular nebulizer; if dilution is needed, only sterile sodium chloride 0.9% solution should be used. This unit-dose solution is meant for inhalation through a nebulizer only and must not be swallowed or injected. Inhaler, for adults: the usual dose is 1-2 puffs (20 gm per spray) three or four times daily. A single dose of up to 80 gm (4 puffs) may be needed for best effect early in treatment, and further puffs may be taken as required, but total inhalations should not go beyond 12 in 24 hours. For children aged 6 to 12 years: usually 1-2 puffs, two to three times daily. Below 6 years: usually 1 puff (20 gm) three times daily. An adult should supervise use of the inhaler to make sure it is taken correctly. For elderly patients, there is no specific dosing information available, though clinical trials have included patients over 65 years without any adverse reactions particular to this age group being reported.
Side Effects
Nebuliser Solution: Common: Headache, Dizziness, Cough, Inhalation induced bronchospasm, Dryness of mouth, Vomiting. Uncommon: Urticaria, Tachycardia, Skin rash, Pruritus. Rare: Anaphylactic reaction, Eye pain, Mydriasis, Intraocular pressure increased, Palpitations, Atrial fibrillation, Nausea. Inhaler: Potentially life-threatening effects- Idiosyncratic reactions to Iprex are rare. Severe adverse effects due to the inhibition of muscarinic receptors and ganglion blockade are theoretically possible but unlikely with the metered-dose aerosol. Severe/Irreversible adverse effects- No effects of this kind is reported. Symptomatic adverse effects- Regular use of Iprex can lead to a dry mouth through inhibition of salivary low. Observed during clinical practice- The most common adverse reactions reported are dryness of the oropharynx (5%); cough, exacerbation of symptoms, & irritation from aerosol (3%); headache (2%); nausea, dizziness, blurred vision/difficulty in accommodation & drying of secretions (1%). Less frequently reported adverse reactions to include tachycardia, nervousness, paresthesias, drowsiness, coordination difficulty, itching, hives, flushing, alopecia, constipation, tremor & mucosal ulceration. Case of precipitation or worsening of narrow-angle glaucoma, acute eye pain & hypotension have been reported. Allergic-type reactions such as skin rash, angioedema of the tongue, lips & face, urticaria (including giant urticaria), laryngospasm and anaphylactic reactions have been also reported; with positive rechallenges in some cases. Iprex does not produce adverse effects on mucociliary clearance, in contrast to atropine and other muscarinic antagonists. There is no evidence that in the therapeutic dose range, Iprex has any adverse effect on bronchial secretion.
Cautions & Contraindications
Warnings & Precautions
Nebuliser Solution: Use of the nebuliser solution should be subject to close medical supervision during initial dosing. Caution is advocated in the use of anticholinergic agents in patients with narrow-angle glaucoma, or with prostatic hyperplasia or bladder-outflow obstruction or cystic fibrosis. Immediate hypersensitivity reactions have been demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, oropharyngeal edema and anaphylaxis. There have been isolated reports of ocular complications (i.e. mydriasis, increased intraocular pressure, narrow-angle glaucoma, eye pain) when aerosolized Iprex has come into contact with the eyes during nebulizer therapy. Patients must be instructed in the correct administration of the Iprex Nebuliser Solution. Care must be taken not to allow the solution or mist to enter the eyes. It is recommended that the nebuliser solution is administered via a mouthpiece. If a mouthpiece is not available and a nebuliser mask is used, it must fit properly. Inhaler: Patients should be advised that temporary blurring of vision, precipitation or worsening of narrow-angle glaucoma, or eye pain may result if the aerosol is sprayed into the eyes. If the recommended dosage does not provide relief, or if symptoms become worse, patients should seek immediate medical attention. While taking Iprex inhalation aerosol, other inhaled drugs should not be used unless prescribed. Iprex inhalation aerosol is not indicated for the initial treatment of acute episodes of bronchospasm where a rapid response is required; drugs with a faster onset may be preferable as initial therapy in this situation. Immediate hypersensitivity reactions may occur after administration of Iprex, as demonstrated by rare cases of urticaria, angio-oedema, rash, bronchospasm and oropharyngeal oedema.
Contraindications
Nebuliser Solution: Known hypersensitivity to atropine or its derivatives, or to any other component of the product.Inhaler: Known hypersensitivity to Ipratropium, Atropine or its derivative. Also contraindicated in patients with a history of hypersensitivity to soya lecithin or related food products such as soybean, lecithin and peanut.