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Indications & Uses
Ipramid is indicated for:
Pharmacology
Ipratropium Bromide is a quaternary ammonium compound that works as an anticholinergic. It appears to block vagal reflexes by opposing the action of acetylcholine, the chemical messenger released from the vagus nerve. As an anticholinergic, it stops acetylcholine from acting on muscarinic receptors in the smooth muscle of the airways, which prevents the resulting rise in intracellular cyclic guanosine monophosphate (cyclic GMP).
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 side effects include headache, dizziness, cough, bronchospasm caused by inhalation, dry mouth, and vomiting. Uncommon side effects include urticaria, a fast heartbeat (tachycardia), skin rash, and itching (pruritus). Rare side effects include anaphylactic reaction, eye pain, dilated pupils (mydriasis), increased intraocular pressure, palpitations, atrial fibrillation, and nausea. Inhaler Potentially life-threatening effects are rare. Idiosyncratic reactions to Iprex (an unusual reaction specific to the individual) are uncommon. Severe effects caused by blocking muscarinic receptors and ganglia are theoretically possible but unlikely with the metered-dose aerosol. No severe or irreversible adverse effects have been reported. Regular use of Iprex can cause dry mouth, because it reduces saliva production by blocking the salivary glands. Observed during clinical practice The most common reactions are dryness of the oropharynx (5%), cough, worsening of symptoms, and irritation from the aerosol (3%), and headache (2%). Nausea, dizziness, blurred vision or difficulty focusing, and drying of secretions each occur in about 1% of people. Less often, people report a fast heartbeat (tachycardia), nervousness, tingling sensations (paresthesias), drowsiness, poor coordination, itching, hives, flushing, hair loss (alopecia), constipation, tremor, and ulceration of the mucous membranes. There have been cases where narrow-angle glaucoma was triggered or got worse, along with acute eye pain and low blood pressure (hypotension). Allergic-type reactions have also been reported, including skin rash, swelling (angioedema) of the tongue, lips and face, urticaria (including giant urticaria), laryngospasm, and anaphylactic reactions. In some cases, these reactions came back when the medicine was given again. Unlike atropine and other muscarinic antagonists, Iprex does not affect mucociliary clearance. At the therapeutic dose range, there is no evidence that 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
For the nebuliser solution, do not use it if you have a known allergy (hypersensitivity) to atropine or any of its derivatives, or to any other ingredient in the product. For the inhaler, do not use it if you have a known allergy to ipratropium, atropine or any of its derivatives. It is also not for people who have had an allergic reaction to soya lecithin or related foods such as soybean, lecithin and peanut.
Pregnancy & Breastfeeding
The safety of Ipratropium Nebulizer Solution in pregnancy has not been established. Doctors have to weigh the benefits of using Ipratropium Nebuliser Solution during pregnancy against the possible hazards to the fetus. It is not known whether ipratropium bromide passes into breast milk, so care is needed when Ipratropium Nebulizer Solution is given to mothers who are breastfeeding.
⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
Overdose
Overdose from inhaling Ipratropium Bromide is unlikely, because very little of the medicine is absorbed into the body after an aerosol dose. An inhaled dose of 5 mg causes a faster heart rate and palpitation. When single doses of Ipratropium Bromide 30 mg were taken by mouth, they caused anticholinergic side effects, but these were not severe enough to need specific reversal.
⚠️ In an emergency call 999 or go to the nearest hospital emergency department.
Storage
Ipratropium Bromide solution has no preservative in it, so use a fresh ampoule for every dose. Open the ampoule just before you give the dose, and throw away any solution left in it. Don't store it above 25°C, and keep the ampoule in its outer carton.
Drug Interactions
Common questions about Ipramid 250 mcg/ml
What is Ipramid 250 mcg/ml Nebuliser Solution?
Ipramid 250 mcg/ml Nebuliser Solution is a medicine that contains Ipratropium Bromide. It is made by Beximco Pharmaceuticals Ltd. It belongs to the Anticholinergic bronchodilators group of medicines.
What is Ipramid used for?
Ipramid is used for: Asthma, Chronic Obstructive Pulmonary Disease, Bronchitis.
What are the side effects of Ipramid?
Nebuliser Solution Common side effects include headache, dizziness, cough, bronchospasm caused by inhalation, dry mouth, and vomiting. Uncommon side effects include urticaria, a fast heartbeat (tachycardia), skin rash, and itching (pruritus).
Can I take Ipramid during pregnancy or while breastfeeding?
The safety of Ipratropium Nebulizer Solution in pregnancy has not been established. Doctors have to weigh the benefits of using Ipratropium Nebuliser Solution during pregnancy against the possible hazards to the fetus. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
What happens if I take too much Ipramid?
Overdose from inhaling Ipratropium Bromide is unlikely, because very little of the medicine is absorbed into the body after an aerosol dose. An inhaled dose of 5 mg causes a faster heart rate and palpitation. In an emergency call 999 or go to the nearest hospital emergency department.
How should I store Ipramid?
Ipratropium Bromide solution has no preservative in it, so use a fresh ampoule for every dose. Open the ampoule just before you give the dose, and throw away any solution left in it.
Can I take other medicines with Ipramid?
Some medicines can interact with Ipratropium Bromide, for example: Salbutamol + Ipratropium. Tell your doctor or pharmacist about every medicine you take.
Do I need a prescription for Ipramid?
Ipramid is a prescription (Rx) medicine. Take it as your doctor advises.