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Ipratropium bromide

AEMPS

Short-acting muscarinic antagonist for inhalation (SAMA)

ATC code: R03BB01

Brand names: Atrovent HFA, Atrovent

Updated · Methodology

Indications

A

Acute bronchospasm

First line

Nebulised ipratropium combined with SABA (salbutamol) is the standard of care for severe asthma exacerbation and COPD exacerbation in the emergency room. 2024 and GEMA 5.4 recommend adding ipratropium in severe asthma exacerbations in adults and children: it provides additional FEV1 gain and reduces hospitalisation. 2024 lists SAMA+SABA as the combination for acute COPD exacerbation.

Sources

  1. AEMPS: Ficha técnica de Bromuro de ipratropio (Atrovent) (2023)
  2. Cochrane Database of Systematic Reviews: Long-acting muscarinic antagonists (LAMA) added to inhaled corticosteroids (ICS) versus addition of long-acting beta2-agonists (LABA) for adults with asthma (2015)
  3. Cochrane Database of Systematic Reviews: Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children (2013)
  4. GINA: Global Strategy for Asthma Management and Prevention (2024)
  5. GOLD: Global Strategy for Diagnosis, Management and Prevention of COPD (2024)
  6. GEMA: Guia Espanola para el Manejo del Asma (GEMA 5.4) (2024)

ICD-10: J98.0 · ICD-11: CA23.2

B

Chronic obstructive pulmonary disease

Second line

Ipratropium as COPD maintenance is outdated. 2024 and GesEPOC 2024 put LAMAs (tiotropium, aclidinium, umeclidinium, glycopyrronium) as first line: once-daily, better tolerated, superior exacerbation reduction. Ipratropium 3–4 times daily remains an option only when a LAMA cannot be prescribed (cost, availability, intolerance). Continuing it because «mother used to take it» or «it is cheaper» without reviewing symptom control reflects an outdated approach.

Symptomatic therapy and exacerbation relief in COPD.

Sources

  1. AEMPS: Ficha técnica de Bromuro de ipratropio (Atrovent) (2023)
  2. GOLD: Global Strategy for Diagnosis, Management and Prevention of COPD (2024)

ICD-10: J44 · ICD-11: CA22

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

F

Athletic endurance

Not recommended

Ipratropium is offered as a «mild bronchodilator for training» without a diagnosis of asthma or COPD. In healthy people inhalation produces no meaningful FEV1 gain or performance improvement. WADA does not prohibit the drug, but chronic anticholinergic exposure in young adults – dry mouth, impaired thermoregulation during exercise – is unjustified. If ipratropium is suggested for «better breathing during training» without obstructive disease, consider seeking a second opinion.

Sources

  1. AEMPS: Ficha técnica de Bromuro de ipratropio (Atrovent) (2023)
F

Common cold

Not recommended

Ipratropium is sold as nasal drops (Atrovent Nasal) for «rhinorrhea in colds» – marketing by symptom, not aetiology. Quality RCTs in acute infectious rhinitis show no clinically meaningful benefit: rhinorrhea shortens by 1–2 days without impact on cold duration or complication risk. AEMPS keeps intranasal ipratropium only for vasomotor rhinitis. If intranasal ipratropium is suggested «for a cold», consider seeking a second opinion.

Sources

  1. AEMPS: Ficha técnica de Bromuro de ipratropio (Atrovent) (2023)

ICD-10: J00 · ICD-11: CA00

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Quaternary ammonium derivative of atropine, poorly penetrates biological membranes – produces almost no systemic anticholinergic effects when inhaled. Competitively blocks muscarinic M1–M3 receptors of bronchial smooth muscle, reduces vagal tone, relaxes bronchi and suppresses mucus secretion. Onset 15–30 minutes, peak 1–2 hours, duration 4–6 hours. Given 3–4 times daily via MDI or nebuliser.

Safety

Contraindications

  • Hypersensitivity to ipratropium, atropine or derivatives
  • Angle-closure glaucoma (relative)
  • Symptomatic prostatic hyperplasia with urinary retention (relative)

Serious adverse effects

  • Paradoxical bronchospasm
  • Acute angle-closure glaucoma if the drug reaches the eye
  • Acute urinary retention
  • Anaphylactic reactions

Common adverse effects

  • Dry mouth
  • Throat irritation
  • Cough
  • Headache
  • Bitter taste

Pregnancy: can you take Ipratropium bromide?

AEMPS summary of product characteristics (section 4.6): preclinical studies showed no risk, but the safety of ipratropium bromide in pregnancy has not been established. The usual precautions for medicines in pregnancy therefore apply, especially during the first 3 months.

Breastfeeding: can you take Ipratropium bromide?

Compatible. Hale L2. Inhaled systemic absorption is minimal; only minimal amounts reach milk.

Calculate RIDFull profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

pMDI: 2 puffs of 20 mcg (40 mcg total) up to 4 times daily. Nebulizer: 0.5 mg every 4–6 hours in saline. Onset 15–30 minutes, peak at 1–2 hours. In COPD exacerbation, the nebulized dose may be repeated every 20 minutes during the first hour under monitoring.

Device compatibility

Via pMDI in children and elderly, use a spacer. Via nebulizer, use a jet (compressor) or mesh nebulizer. Ipratropium solution is compatible with most nebulizer types, including ultrasonic — unlike ICS suspensions. In closed-angle glaucoma or unstable hemodynamics, the solution must not be aerosolized near the eyes without protection — accidental ocular contact causes mydriasis and may trigger an acute glaucoma attack.
Label mentions2 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

  • Minorsimpaticomiméticosclass named in the label
    «BROMURO DE IPRATROPIO ALDO-UNIÓN 500 microgramos se puede administrar conjuntamente con otros fármacos comúnmente utilizados en el tratamiento de la enfermedad pulmonar obstructiva crónica y la…»

    AEMPS, section 4.5 · Open on CIMA

  • corticosteroidsclass named in the label
    «Drug Interactions: Ipratropium bromide has been shown to be a safe and effective bronchodilator when used in conjunction with beta adrenergic bronchodilators. Ipratropium bromide has also been used…»

    FDA, section 7 · Open on DailyMed

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Frequently asked

What is Ipratropium bromide used for?

Ipratropium bromide is evaluated for the following indications with varying evidence strength: Acute bronchospasm (evidence tier A), Chronic obstructive pulmonary disease (evidence tier B), Common cold (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Ipratropium bromide?

Common side effects of Ipratropium bromide (≥ 1 in 100): Dry mouth, Throat irritation, Cough, Headache, Bitter taste. See the Safety section for uncommon and serious reactions.

Is Ipratropium bromide safe during pregnancy?

AEMPS summary of product characteristics (section 4.6): preclinical studies showed no risk, but the safety of ipratropium bromide in pregnancy has not been established. The usual precautions for medicines in pregnancy therefore apply, especially during the first 3 months.

Is Ipratropium bromide compatible with breastfeeding?

Compatible. Hale L2. Inhaled systemic absorption is minimal; only minimal amounts reach milk.

Who should not take Ipratropium bromide?

Ipratropium bromide is contraindicated in: Hypersensitivity to ipratropium, atropine or derivatives; Angle-closure glaucoma (relative); Symptomatic prostatic hyperplasia with urinary retention (relative). Full list in the Safety section.

Official sources

Direct links to regulator labels. Open in a new tab.

Other drugs in this group

Mometasone, Montelukast, Roflumilast, Salbutamol (Albuterol), Salmeterol + Fluticasone, Aclidinium, Budesonide/formoterol, Salmeterol