Ipravent (Ipratropium Bromide)
Also sold as: Ipravent, Atrovent, Duolin (with salbutamol), Iprasal, Combivent (salbutamol+ipratropium)
Pregnancy
Cat B
Lactation
Safe
Schedule
H
Forms
MDI 20 mcg/actuation +2
Indications
- Acute severe asthma (added to salbutamol in emergency — proven mortality benefit)
- COPD exacerbation (acute)
- COPD maintenance (short-acting, less preferred over tiotropium)
- Allergic rhinitis (nasal spray)
Adult Dosing
Acute severe asthma (A&E)
500 mcg (2 mL) via nebuliser every 4-6 hours combined with salbutamol
Add ipratropium to salbutamol in moderate-severe acute asthma — improves FEV1 and reduces hospitalisation
COPD exacerbation
500 mcg nebulised every 4-6 hours OR 40 mcg MDI (2 puffs) QID
Acute phase 5-7 days
MDI maintenance (COPD)
20-40 mcg (1-2 puffs) TDS-QID
Pediatric Dosing
CRITICAL in acute severe asthma — reduces need for systemic steroids and improves hospitalisation rates
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any | No adjustment; negligible systemic absorption via inhalation |
Hepatic Adjustment
No adjustment required
Pregnancy & Lactation
Pregnancy: Category B
Generally safe; inhaled route minimises systemic exposure. Used in acute asthma in pregnancy.
Lactation: Safe
Minimal systemic absorption via inhalation; compatible with breastfeeding.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Other anticholinergics (tiotropium, atropine) | Additive anticholinergic effects — avoid concurrent LAMA | Moderate |
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Side Effects
Common
- Dry mouth
- Bitter taste
- Cough
- Headache
- Blurred vision (if aerosol contacts eye)
- Urinary hesitancy
Serious / Discontinue If
- Acute angle-closure glaucoma (if inhaler mist enters eye)
- Paradoxical bronchospasm (rare)
- Urinary retention (BPH patients)
Contraindications
- Atropine or ipratropium hypersensitivity
- Peanut allergy (some MDI formulations contain soya lecithin)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Ipravent 500 mcg Respule | Cipla | 5 respules ₹52 |
| Atrovent MDI 20 mcg | Boehringer Ingelheim | 200 puffs ₹285 |
| Duolin Respule (Ipra+Salb) | Cipla | 5 respules ₹72 |
| Iprasal 500 mcg | Sun Pharma | 5 respules ₹48 |
Monitoring Required
- Peak expiratory flow (PEF) or SpO2 in acute asthma
- Urinary symptoms in elderly males
- Eye symptoms
Patient Counseling Points
- ACUTE ASTHMA: given at hospital/clinic via nebuliser along with salbutamol — do NOT attempt at home unsupervised
- MDI: shake well before use, exhale fully, seal lips around mouthpiece
- Avoid aerosol contacting eyes — angle inhaler away from face
- BPH patients: report any difficulty passing urine
- Duolin (combination): provides dual bronchodilation for COPD acute flares
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Clinically reviewed by: Dr. Kavitha Rao, MD (Pulmonology), Consultant
Last reviewed: 2026-04-01
References
- BNF — Ipratropium
- GINA Asthma Emergency Guidelines 2024
- GOLD COPD 2025
- IAP Acute Asthma Guidelines