Atrovent inhaler (ipratropium bromide) is an anticholinergic bronchodilator used in the ongoing treatment of bronchospasm in conditions such as emphysema, bronchitis, asthma, and chronic obstructive pulmonary disease (COPD).

The medication works by relaxing and dilating airways in the lungs. It also minimizes mucus secretion, making it easier to breathe. It is typically prescribed as a long-term treatment, used daily regardless of symptoms. In this application it may reduce the frequency and severity of exacerbations.

Atrovent inhalers are also sometimes used as rescue inhalers, to quickly alleviate shortness of breath and wheezing, but some patients find they don't work as quickly as more widely-used rescue inhalers, such as albuterol. The reason some patients find it effective as a rescue inhaler while others do not are unclear; it may be worth a try to see if it works for a given individual, but a proven rescue inhaler should be kept on-hand until effects are clear.

In both applications Atrovent inhalers provide a number of benefits:

• Alleviates impaired breathing due to bronchospasm
• Convenient, easy-to-use inhaler
• Metered dosing makes it easy to know when to refill
• Provides long-term benefit
• Can be used in conjunction with other therapies for greater control

Atrovent inhaler's active ingredient, ipratropium bromide, is also sometimes combined with other bronchodilators in a single inhaler, such as Combivent. These combination products are typically used for long-term management when a single product is insufficient, though there are exceptions.

Getting the Most from Atrovent Inhalers

As mentioned above, Atrovent inhalers are intended for long-term management and use as a rescue inhaler is not approved in many parts of the world. However, it is often prescribed as such in off-label use; off-label use is fully legal, it will just be difficult to find authoritative information about use in off-label applications as regulatory agencies have not approved it for those applications.

To reduce the frequency and severity of bronchospasm exacerbations the medication needs to be used regularly long-term:

• Administer 2 inhalations 4 times per day, at evenly-spaced intervals.
• Continue daily treatment even if no symptoms are present.

As a rescue inhaler:

• Administer 1 or 2 inhalations as needed.
• Do not exceed 12 inhalations in a 24 hour period.

Before first use, or if the Atrovent inhaler has not been used for three or more days, the inhaler will need to be primed. To prime it, simply spray it twice into the air. The inhaler should cleaned on a weekly basis as well. More detailed instructions on priming and cleaning can be found on the insert included with each product.

Atrovent inhalers are metered; a full inhaler will display a green dose indicator. When fewer than 40 doses remain this indicator will turn red. This is a convenient reminder to refill the prescription to ensure an adequate supply is always on-hand. The inhaler may appear to continue working after the meter is down to zero, but it may not be delivering full a dose of medication.

Possible Side Effects

Very rarely some individuals have an allergic reaction to Atrovent inhalers, which warrants emergency medical attention. Symptoms include difficulty breathing, swelling of the face or throat, hives on the skin, and very rapid or erratic heartbeat. These symptoms usually develop very quickly after first use.

Common side effects associated with Atrovent inhalers are typically mild and not cause for concern unless severe enough to be disruptive. If using the inhaler daily for long-term management, side effects will often stop occurring altogether as the body adjusts to treatment. Most commonly experienced are:

• Headache
• Mild dizziness
• Mild nausea
• Tremor
• Dry mouth, dry cough
• Mild throat irritation
• Mild flu-like symptoms

Other side effects are possible; consult a doctor or pharmacist with any concerns.

Because the medication in Atrovent inhalers is delivered directly to the lungs, relatively little is absorbed into the bloodstream. However, enough is present that it can cause potential complications when mixed with other medications. Discuss risks with a doctor if also taking:

• Urinary or bladder medications
• Antihistamines, found in cold or allergy medications
• Other bronchodilators
• Parkinson's disease medications
• Medications intended to treat irritable bowel syndrome, vertigo, gastric ulcer, or heartburn

Not all potential drug interactions are negative; taking Atrovent inhalers in combination with beta-adrenergic agonists increases the overall efficacy.

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Atrovent Nasal Spray (ipratropium bromide) is used to minimize rhinorrhea, more commonly called a runny nose, from allergies or from having a cold. Atrovent Nasal Spray can be used in patients age 5 and up.

Effects are felt 15 to 30 minutes after administration, and last about 6 hours. It is used three or four times per day, and use should not extend past 3 consecutive weeks.

When to Use---and Not Use---Atrovent Nasal Spray

This medication is effective but very specific in what it treats. When a patient is experiencing allergies or has a cold, the nasal mucous membranes may produce excess mucus in an attempt to keep the antagonizing agents from penetrating further into the body. Many people associate allergies with pollen or animal dander, but they can be caused by a range of particulates in the air or environment:

• Pollen
• Animal dander
• Dust
• Latex
• Soy
• Detergents
• Other particulates

Allergies are fairly common, and everyone gets a cold now and then. Atrovent Nasal Spray will alleviate a runny nose in these cases.

What Atrovent Nasal Spray does not help with includes:

• Congested (stuffy) nose
• Coughing
• Sneezing

Nor will it help with runny nose from other causes:

• Opioid withdrawal
• Genetic disorders
• Nasal tumors
• Head trauma
• Hormonal changes
• Cluster headaches

In other words, when used as intended, Atrovent Nasal Spray is quite effective at minimizing or eliminating a runny nose. Used for other purposes, it is unlikely to provide significant benefit.

Dosage & Administration

Atrovent Nasal Spray comes in a plastic vial with an applicator built in to the top. The vial is held upright, applicator inserted into the nostril, and the applicator is depressed to administer a dose. More detailed instructions are included with each vial.

Vials may need to be primed prior to first use or if not used for more than 24 hours. Holding the vial away from the eyes, depress the applicator several times---it may take 7 to 10 sprays before a uniform mist is expelled. Once primed, the medication is ready to use.

To treat runny nose from a cold:

• Patients age 12 and up should administer 2 sprays in each nostril 3 or 4 times per day.
• Patients age 5 to 11 should administer 2 sprays in each nostril 3 times per day.
• Use should not exceed 4 consecutive days.

To treat runny nose from allergies:

• Patients age 5 and up should administer 2 sprays in each nostril 4 times per day.
• Use should not exceed 3 weeks.

Dosage may vary to some extent by patient; one or three sprays may be advised, for example, though deviations from the above are unusual.

Possible Side Effects

Side effects from Atrovent Nasal Spray are uncommon and usually mild. Most frequently reported include:

• Headache
• Dry mouth
• Dry nose
• Mild nosebleed
• Sore throat
• Mild vision blurring

Rarely more serious side effects occur, which call for medical attention:

• Seeing halos or other hallucinations
• Severe blurred vision
• Other vision changes
• Severe nosebleed
• Difficult and/or painful urination

Other medications may interact with Atrovent Nasal Spray, though this is somewhat unlikely given the administration method directly to the nasal passages. Other nasally-administered medications may be a concern. To be on the safe side, double-check with a doctor or pharmacist before mixing treatments.

Atrovent Nasal Spray is unlikely to be harmful to unborn or nursing babies.