Allergic/nonallergic rhinitis, perennial: Children ≥6 years and Adolescents: 0.03% (21 mcg/spray) solution: Intranasal: 2 sprays (42 mcg) per nostril 2 to 3 times daily; total daily dose range: 168 to 252 mcg/day
Allergic rhinitis, seasonal: 0.06% (42 mcg/spray) solution: Intranasal:
Children 2 to <5 years: Limited data available: 1 spray (42 mcg) per nostril 3 times daily for 14 days (Ref); maximum daily dose: 252 mcg/day
Children ≥5 years and Adolescents: 2 sprays (84 mcg) per nostril 4 times daily; maximum daily dose: 672 mcg/day; use beyond 3 weeks has not been established
Colds (symptomatic relief of rhinorrhea): Note: Use beyond 4 days has not been established. 0.06% (42 mcg/spray) solution: Intranasal:
Children 2 to <5 years: Limited data available: 2 sprays (84 mcg) per nostril 3 times daily; maximum daily dose: 504 mcg/day (Ref)
Children 5 to 11 years: 2 sprays (84 mcg) per nostril 3 times daily; maximum daily dose: 504 mcg/day
Children ≥12 years and Adolescents: 2 sprays (84 mcg) per nostril 3 to 4 times daily; total daily dose range: 504 to 672 mcg/day
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use with caution.
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use with caution.
(For additional information see "Ipratropium (nasal): Drug information")
Allergic/nonallergic rhinitis, perennial: Intranasal (0.03% solution): Two sprays (21 mcg/spray) in each nostril 2 or 3 times daily (total dose: 168 to 252 mcg/day).
Allergic rhinitis, seasonal: Intranasal (0.06% solution): Two sprays (42 mcg/spray) in each nostril 4 times daily (total dose: 672 mcg/day); use beyond 3 weeks has not been established.
Colds (symptomatic relief of rhinorrhea): Intranasal (0.06% solution): Two sprays (42 mcg/spray) in each nostril 3 or 4 times daily (total dose: 504 to 672 mcg/day); use beyond 4 days has not been established.
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use with caution.
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use with caution.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Central nervous system: Headache (4% to 10%)
Gastrointestinal: Dysgeusia (≤4%), xerostomia (1% to 4%), diarrhea (2%), nausea (2%)
Respiratory: Upper respiratory tract infection (5% to 10%), epistaxis (6% to 9%), pharyngitis (≤8%), dry nose (≤5%), nasal mucosa irritation (2%), nasal congestion (1%)
<2%, postmarketing, and/or case reports: Anaphylaxis, angioedema, blurred vision, burning sensation of the nose, conjunctivitis, cough, dizziness, eye irritation, hoarseness, increased thirst, laryngospasm, palpitations, skin rash, tachycardia, tinnitus, urticaria
Hypersensitivity to ipratropium, atropine (and its derivatives), or any component of the formulation
Concerns related to adverse effects:
• CNS effects: May cause dizziness, accommodation disorder, mydriasis and blurred vision; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery or driving).
• Hypersensitivity reactions: Immediate hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm, oropharyngeal edema, and anaphylaxis) have been reported. Discontinue use immediately if allergic or anaphylactoid/anaphylactic reactions occur.
Disease-related concerns:
• Glaucoma: Use with caution in patients with narrow-angle glaucoma.
• Hepatic impairment: Use with caution in patients with hepatic impairment.
• Prostatic hyperplasia/bladder neck obstruction: Use with caution in patients with prostatic hyperplasia or bladder neck obstruction.
• Renal impairment: Use with caution in patients with renal impairment.
Other warnings/precautions:
• Appropriate use: Avoid direct contact with eye. Temporary blurred vision, precipitating or worsening of narrow-angle glaucoma, mydriasis, increased intraocular pressure, acute eye pain, visual halos or colored images secondary to conjunctival and/or corneal congestion may occur. The 0.03% and 0.06% solutions do not relieve nasal congestion, sneezing, or postnasal drip associated with allergic or nonallergic perennial rhinitis or the common cold.
Atrovent 0.03% (21 mcg/spray) nasal solution 30 mL bottles contain 345 sprays, and the 0.06% (42 mcg/spray) 15 mL bottles contain 165 sprays.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Nasal, as bromide:
Generic: 0.03% (30 mL); 0.06% (15 mL)
Yes
Solution (Ipratropium Bromide Nasal)
0.03% (per mL): $1.52 - $3.72
0.06% (per mL): $3.04 - $6.38
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Nasal, as bromide:
Generic: 0.03% (30 mL); 0.06% (15 mL)
Intranasal: Administer by the intranasal route only. Avoid spraying into or around the eyes. Blow nose gently to clear nostrils before use. Prior to initial use, prime pump by releasing 7 test sprays into the air away from the face. If not used for >24 hours, reprime pump by releasing 2 test sprays into the air; if not used for >7 days, reprime by releasing 7 test sprays into the air.
Administer by the intranasal route only. Avoid spraying into or around the eyes. Blow nose gently to clear nostrils before use. Prior to initial use, prime pump by releasing 7 test sprays into the air. If the inhaler has not been used for >24 hours, reprime by releasing 2 test sprays into the air. If the inhaler has not been used for more than 7 days, reprime by releasing 7 test sprays into the air.
Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C and 25°C (59°F and 77°F). Avoid freezing.
0.03% Nasal spray: Symptomatic relief of rhinorrhea associated with allergic and nonallergic perennial rhinitis (FDA approved in ages ≥6 years and adults)
0.06% Nasal spray: Symptomatic relief of rhinorrhea associated with the common cold and seasonal allergic rhinitis (FDA approved in ages ≥5 years and adults)
Atrovent may be confused with Alupent, Serevent
Ipratropium may be confused with tiotropium
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Agents with Clinically Relevant Anticholinergic Effects: Ipratropium (Nasal) may enhance the anticholinergic effect of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor therapy
Adverse events have not been observed in animal reproduction studies.
Local application to nasal mucosa inhibits serous and seromucous gland secretions.
Onset of action: 15 minutes
Absorption: <20%
Protein binding: Up to 9% (albumin)
Metabolism: To inactive metabolites via ester hydrolysis
Excretion:
Allergic rhinitis: Urine (as unchanged drug): Pediatrics: Up to 11.1%; Adults: Up to 5.6%
Common cold: Urine (as unchanged drug): Pediatrics: Up to 7.8%; Adults: Up to 8.1%
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