Pulmonary - Anti-cholinergic agents (Inhaled)

ipratropium (Atrovent ®) tiotropium (Spiriva ®)

ipratropium (Atrovent ®):

INDICATIONS AND USAGE ATROVENT (ipratropium bromide) is indicated as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema. Mechanism of Action Ipratropium bromide is an anticholinergic (parasympatholytic) agent which, based on animal studies, appears to inhibit vagally mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released from the vagus nerve. Anticholinergics prevent the increases in intracellular concentration of cyclic guanosine monophosphate (cyclic GMP) which are caused by interaction of acetylcholine with the muscarinic receptor on bronchial smooth muscle. Dosing (Adults):  (usual): Nebulization: 500 mcg (one vial) 3-4 times/day with doses 6-8 hours apart. Metered dose inhaler: 2 puffs 4 times/day - up to 12 puffs /24 hours. Supplied: Nebulization (soln): 0.02% (2.5 ml). MDI: 18 mcg/actuation. ATROVENT HFA Inhalation Aerosol is supplied in a 12.9 g pressurized stainless steel canister as a metered-dose inhaler with a white mouthpiece that has a clear, colorless sleeve and a green protective cap (NDC 0597-0087-17). The ATROVENT HFA Inhalation Aerosol canister is to be used only with the accompanying ATROVENT HFA Inhalation Aerosol mouthpiece. This mouthpiece should not be used with other aerosol medications. Similarly, the canister should not be used with other mouthpieces. Each actuation of ATROVENT HFA Inhalation Aerosol delivers 21 mcg of ipratropium bromide from the valve and 17 mcg from the mouthpiece. Each 12.9 gram canister provides sufficient medication for 200 actuations. The canister should be discarded after the labeled number of actuations has been used. The amount of medication in each actuation cannot be assured after this point, even though the canister is not completely empty.

tiotropium (Spiriva ®):

Use Maintenance treatment of bronchospasm associated with COPD (bronchitis and emphysema) Mechanism of Action Blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation Dosing: Oral inhalation: Adults: Contents of 1 capsule (18 mcg) inhaled once daily using HandiHaler® device Supplied: Powder for oral inhalation [capsule]: 18 mcg/capsule [contains lactose; packaged in 6s or 30s with HandiHaler® device]

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Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph.  GlobalRPh Inc.