Short-acting muscarinic antagonist for inhalation (SAMA)
ATC code: R03BB01 (Ipratropium bromide)
Brand names
Atrovent HFA, Atrovent
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.
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.
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Ipratropium as COPD maintenance is outdated. 2024 and GesEPOC 2024 put LAMAs (tiotropium, aclidinium, umeclidinium, glycopyrronium) as first line: once-daily, better tolerated, superior exacerbation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 Continuing it because «mother used to take it» or «it is cheaper» without reviewing symptom control reflects an outdated approach.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.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
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.
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.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Direct links to regulator labels. Open in a new tab.
FDA Category B. Inhaled systemic absorption is minimal. AEMPS and GEMA 5.4 allow use in asthma and COPD exacerbations during pregnancy without trimester restrictions.
Compatible. Hale L2. Inhaled systemic absorption is minimal; only minimal amounts reach milk.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
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.
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.
FDA category B. FDA Category B. Inhaled systemic absorption is minimal. AEMPS and GEMA 5.4 allow use in asthma and COPD exacerbations during pregnancy without trimester restrictions.
Compatible. Hale L2. Inhaled systemic absorption is minimal; only minimal amounts reach milk.
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.