Ipratropium
- Class: Short-acting anticholinergic
- Used for: COPD and asthma
- Say it: ip-ruh-TROH-pee-um
- Forms: inhaler, nebulizer, nasal spray
IPRATROPIUM carries ATROPINE inside its name — it blocks the same nerve, but inhaled into the lung instead of injected.
Both block muscarinic receptors. Keep the nebuliser mask off the eyes: ipratropium reaching the eye can trigger acute angle-closure glaucoma.
Airways narrow two ways — muscle contraction and cholinergic nerve tone. Albuterol works on the first, ipratropium blocks the second. In COPD, where vagal tone dominates, blocking the nerve matters more.
Side effects
Common: dry mouth, cough, bitter taste
Serious: angle-closure glaucoma, urinary retention
Typical dose
20–40 micrograms four times daily inhaled; 500 micrograms nebulised
Up to four times daily and no more — it is not dosed as needed. Use a mouthpiece rather than a mask where possible.
Check yourself
How does ipratropium widen the airway differently from albuterol?
- It blocks muscarinic receptors, removing cholinergic nerve tone
- It stimulates beta-2 receptors more strongly
- It reduces airway inflammation
- It thins the mucus directly
Show answer
A. It blocks muscarinic receptors, removing cholinergic nerve tone
Albuterol stimulates relaxation; ipratropium removes a constricting signal. Because the two mechanisms are independent, giving both achieves more than doubling either — the basis of combined nebulisers in COPD.
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