# Ipratropium bromide
**Ipratropium bromide** (8-isopropyl-noratropine-methobromide) is a synthetic quaternary ammonium congener of atropine used as an inhaled anticholinergic bronchodilator, chiefly in the maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD) and as add-on therapy in acute asthma exacerbations.[1](https://www.nejm.org/doi/10.1056/NEJM198808253190806) • [2](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884) It was the first anticholinergic agent approved for use as a bronchodilator.[1](https://www.nejm.org/doi/10.1056/NEJM198808253190806)
| Key fact | Detail |
|---|---|
| Chemical class | Synthetic quaternary ammonium congener of atropine (8-isopropyl-noratropine-methobromide)[1](https://www.nejm.org/doi/10.1056/NEJM198808253190806) |
| Mechanism | Inhibits vagally mediated reflexes by antagonizing acetylcholine released from the vagus nerve[3](https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=7159cf05-da58-4eb9-9e6d-a7f24eec5f46) |
| Time course | Maximum effect after 15–90 minutes; duration of action 3–6 hours[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC2692120/) |
| Introduced | Developed and introduced in 1974; Atrovent marketed by Boehringer Ingelheim in 1986, with U.S. FDA approval of the metered-dose inhaler on 12/29/1986[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC2692120/) • [5](https://pmc.ncbi.nlm.nih.gov/articles/PMC5278812/) • [6](https://pmc.ncbi.nlm.nih.gov/articles/PMC10328096/) |
| Standard inhaler dose | ATROVENT HFA delivers 17 mcg per actuation from the mouthpiece; two inhalations four times daily, not exceeding 12 inhalations in 24 hours[2](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884) |
| Common side effects | Dry mouth, nausea, headache; warnings for urinary retention, narrow-angle glaucoma, and paradoxical bronchospasm[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC2692120/) • [2](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884) |
| Combination product | Combivent, a fixed albuterol/ipratropium metered-dose inhaler, approved in 1996[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC5278812/) |
## Pharmacology
Ipratropium bromide antagonizes the action of acetylcholine, the transmitter released from the vagus nerve, and thereby inhibits vagally mediated bronchoconstrictor reflexes.[3](https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=7159cf05-da58-4eb9-9e6d-a7f24eec5f46) Its quaternary ammonium structure is central to its clinical profile: the drug is poorly absorbed, which allows local anticholinergic effects in the lung while avoiding the systemic side effects that limited atropine.[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC2692120/) Bronchodilation begins within minutes to about an hour and a half, with a maximum effect 15–90 minutes after inhalation and a duration of 3–6 hours, so the drug is taken several times a day.[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC2692120/)
Because of this short action, ipratropium is a short-acting muscarinic antagonist (SAMA), in contrast to the once-daily long-acting agent tiotropium, which was developed later for COPD.[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC2692120/)
## History
Anticholinergic plant alkaloids such as atropine had been used for respiratory disease for centuries, including as smoked Datura preparations for asthma from the early 19th century.[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC2692120/) Ipratropium bromide was introduced in 1974 as the first anticholinergic designed for inhalation, delivering anticholinergic activity to the lung without atropine's systemic effects.[1](https://www.nejm.org/doi/10.1056/NEJM198808253190806) • [4](https://pmc.ncbi.nlm.nih.gov/articles/PMC2692120/) [Boehringer Ingelheim](https://www.edgepedia.org/boehringer-ingelheim) launched it as Atrovent in 1986, and the U.S. FDA approved the chlorofluorocarbon metered-dose inhaler on December 29, 1986.[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC5278812/) • [6](https://pmc.ncbi.nlm.nih.gov/articles/PMC10328096/) The fixed combination of albuterol with ipratropium (Combivent) followed in 1996.[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC5278812/) The current HFA propellant formulation, ATROVENT HFA, received initial U.S. approval in 2004.[2](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884)
## Use in COPD
ATROVENT HFA is indicated for the maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and emphysema; the usual dose is two inhalations four times a day, with no more than 12 inhalations in 24 hours.[2](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884) It is not indicated for the initial treatment of acute bronchospasm where a rapid-response rescue inhaler is needed.[2](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884)
**How it compares with alternatives.** A Cochrane review of eleven randomized trials in 3,912 people with stable COPD found small benefits of ipratropium over a short-acting beta-2 agonist on lung function and quality of life, and combination therapy improved post-bronchodilator lung function, but the authors concluded the evidence does not support routine first-line use of ipratropium alone or the combination over an initial short-acting beta-2 agonist.[7](https://www.cochrane.org/evidence/CD001387_ipratropium-bromide-versus-short-acting-beta-2-agonists-stable-chronic-obstructive-pulmonary-disease) Against long-acting beta-2 agonists, salmeterol produced greater improvements in lung function, while combination therapy improved health-related quality of life.[8](https://www.cochrane.org/evidence/CD006101_ipratropium-bromide-versus-long-acting-beta-2-agonists-stable-chronic-obstructive-pulmonary-disease) In acute exacerbations of COPD, trials comparing ipratropium with short-acting beta-2 agonists showed no significant difference in short-term or 24-hour ease of breathing.[9](https://www.cochrane.org/evidence/CD003900_anticholinergic-bronchodilators-versus-beta2-sympathomimetic-agents-acute-exacerbations-chronic)
The once-daily long-acting muscarinic antagonist tiotropium has largely superseded ipratropium for stable COPD. In a Cochrane review of two trials with 1,073 participants, tiotropium produced a greater trough FEV1 (mean difference 109 mL, 95% CI 81 to 137), fewer exacerbations and hospital admissions, better quality of life, and fewer serious adverse events (odds ratio 0.5, 95% CI 0.34 to 0.73), with no significant difference in mortality.[10](https://www.cochrane.org/evidence/CD009552_tiotropium-versus-ipratropium-bromide-management-copd)
## Use in asthma
In acute asthma exacerbations, ipratropium bromide provides additive benefit when given with a short-acting beta-2 agonist in moderate-to-severe attacks, according to the U.S. Expert Panel Report 3 asthma guidelines.[11](https://www.ncbi.nlm.nih.gov/books/NBK7233/) A 2025 systematic review of 24 randomized trials in 3,238 children found that nebulized ipratropium added to standard first-line treatment lowered the hospitalization rate (risk ratio 0.76, 95% CI 0.64 to 0.90) and improved asthma severity scores, with no serious adverse events reported; when all inhaled and nebulized forms were pooled, the hospitalization benefit was no longer evident.[12](https://pubmed.ncbi.nlm.nih.gov/41224524/) An earlier meta-analysis in adults similarly concluded that adding ipratropium to beta-agonist therapy provided physiological evidence of benefit without added risk of adverse effects.[13](https://pubmed.ncbi.nlm.nih.gov/10381989/)
## Intranasal use
A 0.06% ipratropium bromide nasal solution delivered by metered pump spray releases 42 mcg per spray (70 mcL) and is prescribed for nasal symptoms.[14](https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ee0ac556-8a23-4d5c-a5da-881c1fc6a339&version=6) A Cochrane review of intranasal ipratropium for the common cold concluded that the existing evidence, though with methodological limitations, suggests it is likely effective in reducing rhinorrhea (runny nose).[15](https://pmc.ncbi.nlm.nih.gov/articles/PMC6492479/) Trials of inhaled anticholinergics have also examined airway secretions directly: a 28-day regimen of 200 mcg every 8 hours left sputum weight, viscosity, and mucociliary clearance unchanged apart from increased peripheral aerosol penetration, with occasional dry mouth as the main side effect.[16](https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2026.1790151/pdf)
## Safety
The most common adverse reactions in 12-week placebo-controlled trials of ATROVENT HFA, each occurring in more than 5% of patients, were bronchitis, COPD exacerbation, dyspnea, and headache.[2](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884) As an anticholinergic, the drug carries labeled warnings for urinary retention in men with prostatic hyperplasia or bladder-neck obstruction, for precipitation or worsening of narrow-angle glaucoma, and for paradoxical bronchospasm, which can be life threatening and requires stopping the drug.[2](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884) [Hypersensitivity](https://www.edgepedia.org/hypersensitivity) reactions including urticaria, angioedema, laryngospasm, and anaphylaxis have been reported, and coadministration with other anticholinergic-containing drugs is discouraged because effects may add.[2](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884) In a 5-year placebo-controlled trial, hospitalizations for supraventricular tachycardia or atrial fibrillation occurred at an incidence of 0.5% in COPD patients receiving ATROVENT CFC.[2](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884) Ipratropium is negligibly absorbed after oral inhalation, and published literature over several decades has not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes.[2](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884)
## References
1. [Nicholas J. Gross (1988). Ipratropium Bromide. New England Journal of Medicine 319:486-494.](https://www.nejm.org/doi/10.1056/NEJM198808253190806)
2. [ATROVENT HFA (ipratropium bromide) inhalation aerosol, DailyMed label](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=170e98ef-5560-4068-be7d-e649068eb884)
3. [IPRATROPIUM BROMIDE solution, DailyMed label](https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=7159cf05-da58-4eb9-9e6d-a7f24eec5f46)
4. [The development of anticholinergics in the management of COPD, PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC2692120/)
5. [The History of Therapeutic Aerosols: A Chronological Review, PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC5278812/)
6. [Patents and regulatory exclusivities on inhalers for asthma and COPD, 1986-2020, PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC10328096/)
7. [Ipratropium bromide versus short acting beta-2 agonists for stable COPD, Cochrane](https://www.cochrane.org/evidence/CD001387_ipratropium-bromide-versus-short-acting-beta-2-agonists-stable-chronic-obstructive-pulmonary-disease)
8. [Ipratropium bromide versus long-acting beta-2 agonists for stable COPD, Cochrane](https://www.cochrane.org/evidence/CD006101_ipratropium-bromide-versus-long-acting-beta-2-agonists-stable-chronic-obstructive-pulmonary-disease)
9. [Anticholinergic bronchodilators versus beta2-sympathomimetic agents for acute exacerbations of COPD, Cochrane](https://www.cochrane.org/evidence/CD003900_anticholinergic-bronchodilators-versus-beta2-sympathomimetic-agents-acute-exacerbations-chronic)
10. [Tiotropium versus ipratropium bromide in the management of COPD, Cochrane](https://www.cochrane.org/evidence/CD009552_tiotropium-versus-ipratropium-bromide-management-copd)
11. [Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, NCBI Bookshelf](https://www.ncbi.nlm.nih.gov/books/NBK7233/)
12. [Use of inhaled/nebulised ipratropium bromide in acute asthma exacerbations: systematic review and meta-analysis, PubMed](https://pubmed.ncbi.nlm.nih.gov/41224524/)
13. [The role of ipratropium bromide in the emergency management of acute asthma exacerbation: a meta-analysis, PubMed](https://pubmed.ncbi.nlm.nih.gov/10381989/)
14. [IPRATROPIUM BROMIDE nasal spray, metered, DailyMed label](https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ee0ac556-8a23-4d5c-a5da-881c1fc6a339&version=6)
15. [Intranasal ipratropium bromide for the common cold, Cochrane review, PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC6492479/)
16. [Effect of inhaled anticholinergics on bronchial secretions: a systematic review, Frontiers in Physiology](https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2026.1790151/pdf)
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*Topic: Encyclopedia › Life and health › Human health and medicine › Medicines and therapeutics › Gastrointestinal and respiratory drugs*
*Initially written Sep 17, 2026 · Reviewed: Sep 30, 2026; Oct 21, 2026 · Edited: Sep 30, 2026; Oct 21, 2026 · Last review: Oct 21, 2026*
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License: Edgepedia Community License 1.0, https://www.edgepedia.org/edgepedia/license