Ipratropium Oral Inhalation (patient information)

# Why this medication is prescribed
Ipratropium oral inhalation is used to prevent wheezing, difficulty breathing, chest tightness, and coughing in people with chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways) such as chronic bronchitis (swelling of the air passages that lead to the lungs) and emphysema (damage to the air sacs in the lungs). Ipratropium is in a class of medications called bronchodilators. It works by relaxing and opening the air passages to the lungs to make breathing easier.

# How this medication should be used
Ipratropium comes as a solution (liquid) to inhale by mouth using a nebulizer (machine that turns medication into a mist that can be inhaled) and as an aerosol to inhale by mouth using an inhaler. The nebulizer solution is usually used three or four times a day, once every 68 hours. The aerosol is usually used four times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use ipratropium exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Talk to your doctor about what you should do if you experience symptoms such as wheezing, difficulty breathing, or chest tightness. Your doctor will probably give you a different inhaler that acts more quickly than ipratropium to relieve these symptoms. Your doctor may also tell you to use additional puffs of ipratropium along with other medications to treat these symptoms. Follow these directions carefully and be sure you know when you should use each of your inhalers. Do not use extra puffs of ipratropium unless your doctor tells you that you should. Never use more than 12 puffs of ipratropium inhalation aerosol in a 24-hour period.
Call your doctor if your symptoms worsen or if you feel that ipratropium inhalation no longer controls your symptoms. Also call your doctor if you were told to use extra doses of ipratropium and you find that you need to use more doses than usual.
If you are using the inhaler, your medication will come in canisters. Each canister of ipratropium aerosol is designed to provide 200 inhalations. After the labeled number of inhalations has been used, later inhalations may not contain the correct amount of medication. You should keep track of the number of inhalations you have used. You can divide the number of inhalations in your inhaler by the number of inhalations you use each day to find out how many days your inhaler will last. Throw away the canister after you have used the labeled number of inhalations even if it still contains some liquid and continues to release a spray when it is pressed. Do not float the canister in water to see if it still contains medication.
Be careful not to get ipratropium into your eyes. If you are using the inhaler, keep your eyes closed when you use the medication. If you are using the nebulizer solution, you should use a nebulizer with a mouthpiece instead of a face mask. If you must use a face mask, ask your doctor how you can prevent the medication from leaking. If you get ipratropium in your eyes, you may develop narrow angle glaucoma (a serious eye condition that may cause loss of vision). If you already have narrow angle glaucoma, your condition may worsen. You may experience widened pupils (black circles in the center of the eyes), eye pain or redness, blurred vision, and vision changes such as seeing halos around lights. Call your doctor if you get ipratropium into your eyes or if you develop these symptoms.
The inhaler that comes with ipratropium aerosol is designed for use only with a canister of ipratropium. Never use it to inhale any other medication, and do not use any other inhaler to inhale ipratropium.
Do not use your ipratropium inhaler when you are near a flame or source of heat. The inhaler may explode if it is exposed to very high temperatures.
Before you use ipratropium inhalation for the first time, read the written instructions that come with it. Ask your doctor, pharmacist, or respiratory therapist to show you how to use the inhaler or nebulizer. Practice using the inhaler or nebulizer while he or she watches.
To use the inhaler, follow these steps:
- Hold the inhaler with the clear end pointing upward. Place the metal canister inside the clear end of the inhaler. Be sure that it is fully and firmly in place and that the canister is at room temperature.
- Remove the protective dust cap from the end of the mouthpiece. If the dust cap was not placed on the mouthpiece, check the mouthpiece for dirt or other objects
- If you are using the inhaler for the first time or if you have not used the inhaler in 3 days, prime it by pressing down on the canister to release two sprays into the air, away from your face. Be careful not to spray medication into your eyes while you are priming the inhaler.
- Breathe out as completely as possible through your mouth.
- Hold the inhaler between your thumb and your next two fingers with the mouthpiece on the bottom, facing you. Place the open end of the mouthpiece into your mouth. Close your lips tightly around the mouthpiece. Close your eyes.
- Breathe in slowly and deeply through the mouthpiece. At the same time, press down firmly on the canister.
- Hold your breath for 10 seconds. Then remove the inhaler, and breathe out slowly.
- If you were told to use two puffs, wait at least 15 seconds and then repeat steps 47.
- Replace the protective cap on the inhaler.
To inhale the solution using a nebulizer, follow these steps;
- Twist off the top of one vial of ipratropium solution and squeeze all of the liquid into the nebulizer reservoir.
- Connect the nebulizer reservoir to the mouthpiece or face mask.
- Connect the nebulizer to the compressor.
- Place the mouthpiece in your mouth or put on the face mask. Sit in an upright, comfortable position and turn on the compressor.
- Breathe in calmly, deeply, and evenly for about 515 minutes until mist stops forming in the nebulizer chamber.
Clean your inhaler or nebulizer regularly. Follow the manufacturer's directions carefully and ask your doctor or pharmacist if you have any questions about cleaning your inhaler or nebulizer.

# Other uses for this medicine
Ipratropium is also sometimes used to treat the symptoms of asthma. Talk to your doctor about the risks of using this medication for your condition

# Special precautions
Before using ipratropium inhalation:
- tell your doctor and pharmacist if you are allergic to ipratropium, atropine (Atropen), or any other medications.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antihistamines; or medications for irritable bowel disease, motion sickness, Parkinson's disease, ulcers, or urinary problems. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- if you are using any other inhaled medications, ask your doctor if you should use these medications a certain amount of time before or after you use ipratropium inhalation. If you are using a nebulizer, ask your doctor if you can mix any of your other medications with ipratropium in the nebulizer.
- tell your doctor if you have or have ever had glaucoma, urinary problems or a prostate (a male reproductive organ) condition.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using ipratropium, call your doctor.
- if you will be having surgery, including dental surgery, tell the doctor or dentist that you are using ipratropium.
- you should know that ipratropium inhalation sometimes causes wheezing and difficulty breathing immediately after it is inhaled. If this happens, call your doctor right away. Do not use ipratropium inhalation again unless your doctor tells you that you should.

# Special dietary instructions
Unless your doctor tells you otherwise, continue your normal diet.

# What to do if you forget a dose
Use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.

# Side effects

## Minor side effects
Ipratropium may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- dizziness
- nausea
- heartburn
- constipation
- dry mouth
- difficulty urinating
- pain when urinating
- frequent need to urinate
- back pain

## Severe side effects
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
- rash
- hives
- itching
- swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs
- hoarseness
- difficulty breathing or swallowing
- fast or pounding heartbeat
- chest pain
Ipratropium may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

# Storage conditions needed for this medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store unused vials of the solution in the foil pack until you are ready to use them. Store the medication at room temperature and away from excess heat and moisture (not in the bathroom). Talk to your pharmacist about the proper disposal of medication that is outdated or no longer needed. Do not puncture the aerosol canister, and do not discard it in an incinerator or fire.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

# Other information
Keep all appointments with your doctor.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Atrovent