"Atrovent" for lung diseases: application and real reviews. Atrovent powder, aerosol and solution for inhalation

The drug Atrovent is the newest representative of medications related to m-anticholinergic blockers. The product is of artificial origin. Used to block bronchial spasms that develop during chronic diseases of the respiratory system and the negative effects of the vagus nerve. Atrovent helps improve the quality of basic breathing. When used, the quality of sputum increases. The positive result is noticeable almost immediately after using the medicine and lasts quite a long time.

Release form and composition

Atrovent's active ingredient is ipratropium bromide. Supplemented with various components.

Pharmacology:

• Atrovent aerosol for inhalation. Viscous suspension. 10 milliliters for 20 doses, a little less - 300. There are 20 micrograms of useful component per particle. Packaged in specialized bottles.
• Atrovent solution for inhalation. Similar viscous component, from 20 to 100 ml. 1 ml - 250 mcg of ipratorium. Packaging - a reservoir of opaque texture.
• Powder in capsules for inhalation
• Each box contains one hundred capsules, 200 mcg of active particles.
• Atrovent for treating the respiratory sinuses. Suspension, bottled in adapted droppers. Pharmacology: ten to thirty milliliters. Per dosed portion - 20 mcg of impatorium.

Indications for use

Atrovent is recommended to relieve symptoms of bronchial diseases. Children are characterized by the appearance of wet asthma. This drug has the ability to reduce increased sputum production, therefore it is recommended for use. It is of particular value in the treatment of young patients with cardiac dysfunction, since it does not have a negative effect on the organ.

For adults

Prescribed in case of development of diseases:

• Inflammation of the respiratory system, which is chronic, causing a restriction in the flow of air;
• Pulmonary emphysema (increased space between bronchioles, in a pathological state);
• Frequent colds that cause spasms;
• Bronchial asthma (mild form);
• Increased sputum content;
• Consequences of surgical intervention causing bronchial contractions;
• Diagnostic method for determining obstructive disease;
• Preparation of respiratory tract tissues for the use of antibiotics and acids;

Contraindications

The safety and low absorption of the active substances of the drug into the blood is ensured by a small list of contraindications. These include:

• Intolerance to the active and auxiliary ingredients included in the drug;
• Initial stage of pregnancy;
• Development of pathological diseases of the bronchi and lungs in patients under 6 years of age (limitation of aerosol use);
• Acute impairment of lung function in children (exclusion of solution);

In strict individuality, Atrovent is prescribed in the presence of closed-angle glaucoma, inflammation of the prostate, malfunction of the urinary system, young mothers during lactation, and patients of preschool age.

Directions for use and dosage for inhalation

The use of Atrovent for inhalation is regulated by a doctor, recording the progression of the disease. Treatment is carried out directly as prescribed to avoid unwanted side effects.

The dosage is entirely individual for each child. Supervision by a qualified specialist is required.

In the presence of an asthmatic condition in patients under 12 years of age, inhalation measures are prescribed for complex treatment at intervals of six hours.

To relieve symptoms of chronic bronchial obstructive disease, a solution is used. The procedure requires 10-20 drops added to the inhaler. Do inhalations as needed. For children, 1 mg of medication is enough.

For adults

There are 2 procedures - 4 times. Dosage 2 mg.

A nebulizer is used, into which an amount of medication diluted with saline solution is placed according to the instructions. The result is about 4 ml of the finished solution. The suspension is prepared immediately before use. If a situation arises where direct use is impossible, it is necessary to place the solution in the refrigerator for no more than 24 hours. For further use, the prepared composition should be heated to 20 degrees.

How to breed

Patient's age Dosage for one procedure (number of drops per ml of saline solution)

• from 0 to 6 years 8-20 k. per 2-3 ml.
• from 6 to 12 years 20 k. per 2-3 ml.
• after 12 years 40 k. per 1-2 ml.

The regulations depend on the amount of solution in the nebulizer. The prepared medicine cannot be reused.

To use the inhaler, you need to turn it over, make several test injections into the air, pressing the canister twice. Then exhale deeply, place the mouthpiece between your lips, inhale while simultaneously pressing the bottom of the can. Continue inhaling until the solution is completely gone, stop breathing and remove the mouthpiece, slowly release the air. Then close the can with the cap. If the inhaler has not been used for a long time, the initial stage should be repeated.

Side effects

The following may be observed:

• Signs of allergies (impaired breathing rate, swelling of the face, mouth, throat, rash and constant itching of the skin, lips, mouth);
• Dysfunction of the digestive tract (metabolism, intestinal obstruction, discomfort in the tongue, signs of poisoning);
• Increased frequency of contraction of the heart muscle, increased heart rate;
• Lethargy, irritability, acute headache, trembling of arms and legs, thirst;
• Deterioration of vision, burning sensation, increased eye pressure, pain symptoms;
• Increased mucus viscosity, increased cough, uncontrolled bronchospasm;
• Drying of the nasal mucosa;
• Urinary disorders.

Use during pregnancy and breastfeeding

The use of Atrovert is contraindicated in the early stages of pregnancy. For the remaining period, it is prescribed if a negative effect on the fetus is excluded, but a positive result for the expectant mother. The negative impact of the drug components on the composition of milk has not been proven. With this method of treatment, the possibility of the active substance of the drug reaching the baby is excluded. However, breastfeeding should be treated carefully.

After half an hour, after taking Atrovent, changes in the patient’s condition are observed. If there is no improvement, a visit to the doctor is recommended. Independent dosage regulation is not recommended. Patients with eye inflammation should not allow the medicine to come into contact with the mucous membrane of the eye. The powder should only be diluted with saline solution.

Analogs

Similar medications offered in different pharmacological forms are available as needed. Analogues: ipravent, ipratropium Steri-Neb, spiriva, troventol, truvent.

Storage conditions and periods

Store in a warm place, protected from children, and use no later than five years.

Conditions for dispensing from pharmacies

You can purchase the medicine over-the-counter.

Registration number: P N043363/01-010312
Trade (proprietary) name: Atrovent® N
International nonproprietary name:
Ipratropium bromide

Dosage form
Aerosol for inhalation dosed

Compound:
1 inhalation dose contains the active substance: ipratropium bromide monohydrate 0.021 mg (21 mcg), which corresponds to ipratropium bromide anhydrous 0.020 mg (20 mcg).
Excipients:
ethanol absolute 8.415 mg,
purified water 0.281 mg, citric acid 0.002 mg,
tetrafluoroethane (HFA134a, propellant) 47.381 mg

Description
A clear, colorless liquid, free of suspended particles, placed under pressure in a one-piece stainless steel container equipped with a metering valve with a plastic stem.

Pharmacological group: m-anticholinergic
ATX code: R03BB01

Pharmacological properties

Bronchodilator. Blocks m-cholinergic receptors of the smooth muscles of the tracheobronchial tree and suppresses reflex bronchoconstriction. Having structural similarity to the acetylcholine molecule, it is its competitive antagonist. Anticholinergics prevent an increase in the intracellular concentration of calcium ions, which occurs due to the interaction of acetylcholine with muscarinic receptors located in the smooth muscles of the bronchi.
The release of calcium ions occurs with the help of secondary messengers (mediators), which include ITP (inositol triphosphate) and DAG (diacylglycerol). Effectively prevents the narrowing of the bronchi that occurs as a result of inhalation of cigarette smoke, cold air, the action of various bronchospasms, and also inhibits bronchospasm associated with the influence of the vagus nerves. When used inhalation, it has virtually no resorptive effect. Bronchodilation occurring after inhalation of ATROVENT® N (ipratropium bromide) is mainly a consequence of the local and specific effect of the drug on the lungs, and not the result of its systemic effect.
In controlled 85-90 day studies conducted in patients with bronchospasm due to chronic obstructive pulmonary disease, chronic bronchitis and emphysema, significant improvement in lung function was observed within 15 minutes, peaked at 1-2 hours and was maintained for 4-6 hours. hours.
In patients with bronchial asthma, a significant improvement in external respiratory function is observed in 51% of patients.

Pharmacokinetics
The therapeutic effect of ATROVENT® N is a consequence of its local action in the respiratory tract. The development of bronchodilation does not parallel pharmacokinetic parameters.
After inhalation, 10-30% of the administered dose of the drug usually enters the lungs (depending on the dosage form and method of inhalation). Most of the dose is swallowed and enters the gastrointestinal tract.
Part of the drug dose entering the lungs quickly reaches the systemic bloodstream (within a few minutes).
Cumulative renal excretion (over 24 hours) of the parent compound is approximately 46% of the intravenous dose, less than 1% of the oral dose, and approximately 3-13% of the inhalation dose. Based on these data, the total systemic bioavailability of ipratropium bromide administered orally and inhaled is calculated to be 2% and 7-28%, respectively.
Clinical parameters describing the distribution of ipratropium bromide were calculated based on its plasma concentrations after intravenous administration. A rapid two-phase decrease in plasma concentration is observed. The apparent volume of distribution during steady state (Css) is approximately 176 L (≈ 2.4 L/kg). The drug binds to plasma proteins to a minimal extent (less than 20%). Ipratropium bromide, which is a quaternary amine, does not penetrate the blood-brain barrier. The half-life during the terminal phase is approximately 1.6 hours.
The total clearance of ipratropium bromide is 2.3 l/min, and the renal clearance is 0.9 l/min. After intravenous administration, approximately 60% of the dose is metabolized by oxidation, mainly in the liver.
Cumulative renal excretion (over 6 days) of the isotope-labeled dose (including parent compound and all metabolites) was 72.1% after intravenous administration, 9.3% after oral administration, and 3.2% after inhalation administration. The total isotope-labeled dose excreted through the intestine was 6.3% after intravenous administration, 88.5% after oral administration, and 69.4% after inhalation administration. Thus, excretion of the isotope-labeled dose after intravenous administration occurs primarily through the kidneys. The half-life of the parent compound and metabolites is 3.6 hours. the main metabolites excreted in the urine bind weakly to muscarinic receptors and are considered inactive.

Indications

Chronic obstructive pulmonary disease (chronic obstructive bronchitis, pulmonary emphysema); bronchial asthma (mild to moderate severity), especially with concomitant diseases of the cardiovascular system.

Contraindications

Hypersensitivity to atropine and its derivatives; hypersensitivity to ipratropium bromide or other components of the drug; pregnancy (first trimester); the drug is contraindicated in patients who have previously had an allergy to soy or peanuts. In such patients, other dosage forms of ATROVENT® N (inhalation solutions) that do not contain soy lecithin can be used.
With caution - angle-closure glaucoma, urinary tract obstruction (prostatic hyperplasia); lactation period, children's age (up to 6 years).

Pregnancy and lactation

The safety of Atrovent® N during pregnancy in humans has not been established. When prescribing the drug during a possible or confirmed pregnancy, the ratio of the expected benefit of the drug and the possible risk to the fetus should be taken into account. In preclinical studies, no embryotoxic or teratogenic effects of the drug were detected when administered in inhalation and intranasal doses significantly exceeding the recommended dose for humans. There are no data on the penetration of Atrovent® N into breast milk. Although insoluble quaternary cations pass into breast milk, Atrovent® N is unlikely to have a significant effect when administered inhaled. However, since many drugs are excreted in breast milk, Atrovent® N should be prescribed with caution to women during lactation.

Directions for use and doses

Dosing should be done individually. During treatment, patients must be under medical supervision. The recommended daily dose should not be exceeded during either acute or maintenance therapy.
If treatment does not lead to significant improvement or the patient’s condition worsens, a doctor’s consultation is necessary to develop a new treatment plan. If shortness of breath (difficulty breathing) suddenly or rapidly worsens, consult your doctor immediately. The following dosages are recommended (unless another dosage regimen is prescribed):

2 inhalation doses (injection) 4 times a day. Since the need for increasing doses indicates the possible need for additional treatment methods, as a rule, more than 12 inhalation doses should not be used per day.
For the treatment of sudden exacerbations of chronic obstructive pulmonary disease, ATROVENT® inhalation solution may be indicated.
In children, metered-dose aerosol ATROVENTA® N should be used only after consulting a doctor and under adult supervision (due to insufficient information).

Using a metered aerosol
Correct application is essential for successful therapy.
-
Before using the inhaler for the first time, press the bottom of the canister 2 times
- the following rules must be observed:
1. Remove the protective cap.
2. Take a deep breath.
3. Hold the inhaler as shown in Fig. 2 and wrap your lips tightly around the mouthpiece.
The arrow and the bottom of the cylinder should be directed upward.
(Fig. 2)
4. Take as deep a breath as possible and at the same time sharply press the bottom of the cylinder. This will release one inhalation dose. Hold your breath for a few seconds, then remove the mouthpiece from your mouth and exhale. Repeat the same steps to receive the second inhalation dose.
5. After using the inhaler, put on the protective cap.
6. If the metered dose aerosol inhaler has not been used for three days, press the valve once before using it.
The container is not transparent, so it is impossible to determine by eye when it becomes empty. The inhaler contains 200 inhalation doses. After all doses have been used, the container may contain a small amount of liquid. However, in such cases the inhaler must be replaced, as it may contain an insufficient amount of the drug.
The amount of drug in your inhaler can be checked in the following way:
(Fig. 3)
- Shake the container, this will show whether there is any liquid left in it.
- Another way. Remove the plastic mouthpiece from the balloon and place the balloon in a container of water. The contents of the cylinder can be estimated depending on its position in the water (Fig. 3).
Clean your inhaler at least once a week. It is important to keep the mouthpiece of your inhaler clean to prevent any drug from getting into it, which could block the release of the aerosol.
When cleaning, first remove the protective cap and remove the canister from the inhaler. Run a stream of warm water through the inhaler, making sure to remove the drug and/or visible dirt.
(Fig. 4)
After cleaning, shake and let it air dry without using heat. Once the mouthpiece is dry, insert the canister into the inhaler and put on the protective cap.
(Fig. 5)

WARNINGS:
The plastic mouthpiece was designed specifically for the use of ATROVENT® N aerosol, and serves for precise dosing of this drug. This mouthpiece should not be used with other metered dose aerosols. ATROVENT® N metered dose aerosol should also not be used with other mouthpieces. The aerosol in the container is under pressure. The cylinder must not be opened or stored at temperatures above 50°C.

Side effects

Many of the listed undesirable effects may be due to the anticholinergic properties of ATROVENT® N.
ATROVENT® N, like any inhalation therapy, may cause local irritation. Adverse reactions to the drug were determined based on data obtained in clinical trials and during pharmacological surveillance of the use of the drug after its registration.
The most common side effects reported in clinical studies were headache, pharyngeal irritation, cough, dry mouth, gastrointestinal motility disorders (including constipation, diarrhea and vomiting), nausea and dizziness.

Hypersensitivity
- anaphylactic reaction

Headache
- dizziness

Blurred vision
- mydriasis
- increased intraocular pressure
- glaucoma
- Pain in the eyes
- appearance of a halo around objects
- hyperemia of the conjunctiva
- corneal edema
- violation of accommodation

Feeling of heartbeat
- supraventricular tachycardia
- atrial fibrillation
- increased heart rate

Throat irritation
- cough
- bronchospasm
- paradoxical bronchospasm
- laryngospasm
- swelling of the pharynx
- dry throat

Dry mouth
- nausea
- impaired motility of the gastrointestinal tract
- diarrhea
- constipation
- vomit
- stomatitis
- swelling of the oral cavity

Rash
- itching
- angioedema
- urticaria

Urinary retention

Interactions with other drugs

Beta2-adrenergic agents and xanthine derivatives may enhance the bronchodilator effect of the drug.
The anticholinergic effect is enhanced by antiparkinsonian drugs, quinidine, and tricyclic antidepressants. When used simultaneously with other anticholinergic drugs, an additive effect occurs.

special instructions

People with cystic fibrosis are at increased risk of developing slowed gastrointestinal motility.
Immediate hypersensitivity reactions may occur following use of ATROVENT® N, as indicated by rare cases of rash, urticaria, angioedema, oropharyngeal edema, bronchospasm and anaphylaxis. ATROVENT® N should be used with caution in patients predisposed to acute-angle glaucoma or in patients with concomitant urinary tract obstruction (for example, prostatic hyperplasia or bladder neck obstruction). Care should be taken to prevent aerosol from getting into the eyes. Since the metered aerosol is applied through a mouthpiece and the use of the aerosol is controlled by the hands, there is little risk of contact with the eyes.

Effects on the ability to drive vehicles and use machinery
The effects of the drug on the ability to drive vehicles and use machinery have not been specifically studied. However, patients should be advised that during treatment with ATROVENT® N they may experience undesirable sensations such as dizziness, accommodation disturbances, mydriasis and blurred vision. Therefore, caution should be recommended when driving vehicles or using machinery. If patients experience the above unwanted sensations, they should refrain from potentially dangerous activities such as driving a car or operating machinery.

Overdose

No specific overdose symptoms were identified. Given the breadth of therapeutic action and the local method of application of ATROVENT® N, the occurrence of any serious anticholinergic symptoms is unlikely. Minor manifestations of systemic anticholinergic action are possible, such as dry mouth, accommodation paresis, increased heart rate. Treatment is symptomatic.

Release form
Aerosol for inhalation dosed 20 mcg/dose.
10 ml (200 doses) in a stainless steel can with a dosing valve and a mouthpiece with a protective cap with the company logo.
The can with instructions for use is placed in a cardboard box.

Storage conditions
Store at a temperature not exceeding 25°C, protected from light.
Keep out of the reach of children.

Best before date
36 months.
Do not use the drug after the expiration date indicated on the package.

Conditions for dispensing from pharmacies
By doctor's prescription

Name and address of the legal entity in whose name the registration certificate was issued
Boehringer Ingelheim International GmbH,
Binger Strasse 173, 55216, Ingelheim am Rhein, Germany
Manufacturer
Boehringer Ingelheim Pharma GmbH & Co. KG",
Germany, 55216 Ingelheim am Rhein, Bingerstrasse 173

Atrovent is a bronchodilator that blocks m-cholinergic receptors. The medicine is a synthetic drug and is usually used to prevent the occurrence of bronchospasm in bronchial asthma.

Once in the respiratory tract, it helps to relax the smooth muscles of the bronchi, causing them to expand. In addition, the drug has the ability to reduce the production of mucous secretions without affecting the quality of sputum discharge.

In patients with bronchospasm associated with chronic obstructive pulmonary disease (chronic bronchitis and emphysema), it improves indicators of external respiratory function: forced expiratory volume in the first second (FEV1) and the average forced expiratory volumetric flow rate of 25-75% increases by 15% or more already 15 minutes after administration of the drug, the maximum effect is observed 1-2 hours after ipratropium bromide enters the body and persists for 6 hours.

In people with bronchospasm that occurs against the background of emphysema and chronic bronchitis, Atrovent improves external respiratory function.

In controlled 85-90 day studies conducted in patients with bronchospasm due to chronic obstructive pulmonary disease, chronic bronchitis and emphysema, significant improvement in lung function was observed within 15 minutes, peaked at 1-2 hours and was maintained for 4-6 hours. hours.

In patients with bronchial asthma, a significant improvement in external respiratory function is observed in 51% of patients.

The active ingredient is Ipratropium bromide, which is a quaternary amine and does not penetrate the blood-brain barrier. The half-life during the terminal phase is approximately 1.6 hours. The total clearance of ipratropium bromide is 2.3 l/min, and the renal clearance is 0.9 l/min.

The drug is available in two forms:

1. Colorless solution for inhalation, 1 ml of the drug contains 250 mcg of anhydrous ipratropium bromide. Excipients: disodium edetate dihydrate, benzalkonium chloride, hydrochloric acid, sodium chloride and purified water. In glass dropper bottles of 20 ml;
2. Atrovent metered-dose aerosol for inhalation - 1 dose contains 20 mcg of ipratropium bromide monohydrate. 10 ml (200 doses) in stainless steel cans with a mouthpiece and a dosing valve.

Indications for use

What does Atrovent help with? The drug is prescribed in the following cases:

• Chronic obstructive pulmonary disease (chronic obstructive bronchitis, pulmonary emphysema);
• Bronchial asthma (mild to moderate severity), especially with concomitant diseases of the cardiovascular system.

Instructions for use of Atrovent, dosages

In each specific situation, the doctor selects the dosage regimen individually, based on the fact that 1 drop of the drug contains 0.0125 mg of anhydrous ipratropium bromide, and 1 ml is 20 drops.

Under no circumstances should you exceed the prescribed daily dose. During the entire course of treatment, the patient must be monitored by a doctor.

If there is no improvement or the patient’s health deteriorates, an urgent consultation with the attending physician is necessary, who will suggest new treatment methods. If you experience shortness of breath or difficulty breathing, you should consult a specialist.

Standard dosages:

• For maintenance treatment, adults (including elderly patients) and children over 12 years of age are prescribed 2 ml (40 drops) 3 to 4 times a day. The maximum daily dose is 8 ml (2 mg).
• Children aged 6 to 12 years: 1 ml (20 drops) 3 – 4 times a day. The maximum daily dose is 4 ml (1 mg).
• Children under 6 years of age: 0.4 – 1 ml (8 – 20 drops) 3 – 4 times a day. The maximum daily dose is 4 ml (1 mg).

For the treatment of acute bronchospasm, adults (including elderly patients) and children over 12 years of age are prescribed 2 ml of Atrovent (40 drops). Repeated appointments are possible until the patient's condition stabilizes.

Children aged 6 to 12 years: 1 ml (20 drops); children under 6 years of age: 0.4 – 1 ml (8 – 20 drops).

Instructions for use of Atrovent: the recommended dose should be diluted with 0.9% sodium chloride solution until the volume of the drug reaches 3 - 4 ml, pour into a nebulizer and inhale. The drug should be diluted with 0.9% sodium chloride solution each time immediately before use. The solution remaining after inhalation is poured out.

The dosage regimen will depend on the type of nebulizer, as well as the method of inhalation. By consuming the volume of the diluted drug, you can control the duration of inhalation.

Atrovent can be used using various commercially available nebulizers. When using a centralized oxygen system, the solution is best used at a flow rate of 6-8 l/min.

It is important to be careful when using Atrovent simultaneously with tricyclic antidepressants, beta2-agonists, antiparkinsonian drugs, xanthine derivatives, quinidine and other anticholinergic drugs.

Side effects

Prescription of Atrovent may be accompanied by the following side effects:

• Causes dry mouth, headache and gastrointestinal motility disorders;
• Supraventricular tachycardia, increased heart rate, impaired accommodation, atrial fibrillation, palpitations, urinary retention;
• Local irritation and cough, less often – paradoxical bronchospasm;
• Dilation of the pupil and increase in intraocular pressure - when Atrovent gets into the eyes;
• Skin rash, laryngospasm, urticaria, itching, swelling of the tongue and face, Quincke's edema, anaphylactic reactions.

If the drug accidentally gets into the eyes of a patient with angle-closure glaucoma, intraocular pressure may increase.

Contraindications

Atrovent is contraindicated in the following cases:

• hypersensitivity to atropine derivatives and itself, as well as to any other components of the drug.

Pregnant women in the first trimester and children under six years of age should not be prescribed Antrovent treatment.

Overdose

Atrovent has a local bronchodilator effect without penetrating into the blood. Therefore, the likelihood of an overdose is low, and specific symptoms have not been identified.

In some cases, dry mouth or increased heart rate were noted, but their manifestations are minor and are primarily associated with side effects from the use of the drug.

Treatment is symptomatic.

Atrovent analogues, price in pharmacies

If necessary, you can replace Atrovent with an analogue of the active substance - these are the following drugs:

1. Ipravent;
2. Atrovetn N;
3. Ipratropium bromide monohydrate;
4. Ipratropium Steri-Neb.

Similar drugs:

• Afonilum;
• Asthmopent;
• Berotek;
• Budesonide;
• Ventolin;
• Histaglobin;
• Dexamethasone;
• Prednisolone;
• Salbutamol;

When choosing analogues, it is important to understand that the instructions for use of Atrovent, the price and reviews of drugs with similar effects do not apply. It is important to consult a doctor and not change the drug yourself.

Price in Moscow pharmacies: Atrovent solution 0.25 mg/ml 20 ml – 217 rubles, inhalation aerosol 200 doses 10 ml – 365 – 373 rubles.

Store at room temperature, away from sources of heat, moisture, and direct exposure to sunlight, at a temperature not exceeding 25C. Shelf life – 5 years. Dispensed from pharmacies with a doctor's prescription.

The drug is effective and safe, it is approved for use in both children and adults. But before use, it is important to carefully read the instructions for use to prevent possible troubles.

Compound

The solution for inhalation contains the active substance ipratropium bromide, as well as a complex of auxiliary components - purified water, hydrochloric acid and others.

Release form

The drug is available in the following varieties:

• Aerosol Atrovent N for inhalation - 10 ml and 15 ml containing 200 and 300 doses, respectively. In 1 dose - 20 mcg of active substance.
• Solution for inhalation in volumes of 20 ml, 40 ml and 100 ml. 1 ml of solution contains 250 mcg of active substance.
• Powder in capsules for inhalation. One package of the drug contains 100 capsules with the medicinal substance. 1 capsule contains 200 mcg of active substance.

Effect of the drug

Atrovent is a bronchodilator that blocks m-cholinergic receptors in the bronchial muscles (this action mainly occurs at the level of large bronchi) and inhibits bronchoconstriction that occurs against the background of a reflex reaction.

Thanks to this, Atrovent solution for inhalation prevents the development of bronchospasm, which can occur when inhaling cigarette smoke or cold air, due to the influence of various medications and household substances. In addition, the drug effectively prevents the development of bronchospasm that occurs under the influence of the vagus nerve.

In persons suffering from bronchospasms resulting from chronic obstructive pulmonary disease (COPD), external respiration data improve 15 minutes after using Atrovent. A high therapeutic effect usually occurs 60-120 minutes after the required dose of the drug enters the respiratory system and in the vast majority of patients lasts 6 hours.

When using the drug inhaled, there is practically no resorptive effect, while only 10% of its volume reaches the smallest bronchi and alveoli, the rest settles in the oropharynx and is swallowed along with saliva.

Indications for use

Atrovent N and inhalation aerosol are indicated for the following conditions:

• COPD with and without emphysema;
• bronchial asthma, except for the advanced stage;
• bronchial asthma with concomitant heart pathologies;
• bronchospasm caused by infectious and inflammatory diseases;
• bronchospasm resulting from surgical interventions;
• diagnostic procedure to determine the reversibility of bronchial obstruction;
• preparatory stage for the introduction of aerosol drugs.

Contraindications

It is contraindicated to prescribe Atrovent for inhalation:

• with individual hypersensitivity of the body to ipratropium bromide;
• in the first trimester of pregnancy;
• for pathological conditions of the bronchopulmonary system in children under 5 years of age.

The drug is used with caution in persons suffering from angle-closure glaucoma, disorders of the urinary system, and during lactation.

Instructions

The dosage of Atrovent is selected by the attending physician on an individual basis. The specialist takes into account the patient’s condition, the severity of the pathology, and the body’s tolerance of the active component of the drug. During treatment, the doctor must monitor the patient.

The use of Atrovent for inhalation, according to the instructions, requires careful handling of the medicine. For example, accidental contact of the active substance with the mucous membrane of the organs of vision can cause temporary deterioration in visual function, discomfort and pain in the eyes.

Aerosol for inhalation

Dosage for children over 6 years of age and adults - 2 doses of the drug 4 times a day.

Before using a new aerosol can, it is recommended to press the valve several times until the first aerosol cloud appears.

Algorithm of actions:

• remove the cap from the drug;
• take a deep breath;
• Turn the bottle upside down and wrap your mouth around the tip;
• while inhaling, press the bottom of the balloon once before injecting a dose of the drug;
• hold your breath for a moment;
• remove the tip from your mouth, slowly exhale;
• After a minute, repeat the manipulation.

If all doses of the aerosol have been used, but there is still liquid in the balloon, it is not recommended to use it further - you need to purchase a new drug. This is due to the fact that the concentration of the active substance becomes significantly lower over time.

The tip of the balloon must be kept clean. It is not advisable to use any detergents to clean it; you can simply rinse it with clean water.

Solution for inhalation

It should be taken into account that 1 drop of the drug contains 0.125 ipratropium bromide.

Standard dosage of Atrovent inhalation solution, according to the instructions for use:

• children over 12 years old and adults - 2 ml 4 times a day (0.5 mg of active substance per procedure), maximum daily dose - 8 ml of solution;
• children 6-12 years old - 1 ml of solution (0.25 mg) 4 times a day, maximum daily dose - 4 ml of solution;
• children under 6 years old - 0.4-1 ml (0.1-0.25 mg) up to 4 times a day, maximum daily dose - 4 ml.

Before inhalation, a single volume of Atrovent must be diluted with 0.9% saline solution to a volume of 4 ml and the resulting product must be poured into. The duration of the procedure directly depends on the consumption of the solution.

Atrovent solution can be used in most nebulizers.

Powder in capsules for inhalation

To use this form of release of the drug, you need a specific inhaler device, which supports gradual inhalation of Atrovent’s medicinal particles through the patient’s breathing.

The capsule with the powder is placed into the device, a puncture is made and the product begins to inhale. In this case, the inhalation should be as deep and sharp as possible, and the exhalation should be slow. After inhaling, you need to hold your breath for a short time, remove the inhaler from the mouth and exhale slowly.

Repeat the manipulation until the medicinal powder inside the capsule is completely consumed. It is recommended to carry out up to 4 inhalations per day.

Side effects of Atrovent

The instructions for use indicate the following undesirable consequences that may occur while using the drug Atrovent:

• The most common side effects are dry mouth, migraine, gastrointestinal motility disorders (nausea, stool disorders, flatulence).
• Side effects that occur in response to the anticholinergic effect of the drug are palpitations, tachycardia, atrial fibrillation, accommodation disorders, acute urinary retention (occurs extremely rarely and has an independent reversible effect when the drug is discontinued).
• On the part of the respiratory system, it is possible to develop an irritating cough, local irritation of the upper respiratory tract, and less often - a paradoxical form of bronchospasm.
• Some patients may experience pupil dilation, accommodation paresis and an increase in intraocular pressure if the drug accidentally penetrates the mucous membrane of the eyes (this usually happens in people suffering from angle-closure glaucoma). In this case, patients may complain of blurred vision, discomfort and even pain in the eyes, the appearance of colored spots or a halo in the visible field of vision against the background of hyperemia of the conjunctiva and corneal area of ​​the eyes.
• Allergic reactions to Atrovent are possible in the form of rashes on the skin, angioedema of the face, lips, tongue, laryngospasm, and less commonly, anaphylactic shock.

Which dosage form is better to choose?

When choosing a dosage form, it is important to know about all the pros and cons of the drug. There is no consensus on which is better - solution, capsules or aerosol.

There are conditions under which the drug can be used, the age and condition of the patient, circumstances in which one or another form of medication will be preferable. Let's look at this in more detail.

Advantages of the inhalation solution, which is used for the nebulizer:

• a single option for transporting the active substance of the drug to the alveoli of the lung tissue;
• a single treatment option for children over 5 years of age and certain elderly patients;
• during the operation of the nebulizer, the therapeutic agent is sprayed into microparticles, the size of which is approximately 5 microns;
• there is no freon in the solution;
• during the procedure, you can use Atrovent solution in combination with other medications;
• there is a possibility of use in a centralized oxygen supply system.

Advantages of Atrovent aerosol:

• one injection of the drug contains the required therapeutic dose of the active substance;
• compact, easy to take with you;
• the fastest way to administer the drug, not dependent on any conditions.

Advantages of powder in Atrovent capsules:

• does not have an irritating effect on the mucous membrane of the respiratory tract;
• does not accumulate in the body;
• quick effect (after 15 minutes, 40% of patients feel normal);
• preparing the airways for the administration of other medications.

Features of the use of Atrovent in childhood

In childhood, the drug Atrovent is used strictly as prescribed by a doctor, with mandatory monitoring of the course of treatment on his part. Aerosol Atrovent, according to the instructions, can be prescribed for the treatment of children over 6 years of age, solution for inhalation - from the age of five.

The main indication for the use of this drug in childhood is bronchial diseases. Atrovent's ability to have a depressing effect on excessive sputum secretion makes it possible to use it for the treatment of wet bronchial asthma, most often found in pediatrics.

Since the drug does not have a negative effect on the cardiovascular system, its use becomes relevant in young patients suffering from functional disorders of the heart.

The preferred form of Atrovent for treatment in childhood is an inhalation solution, thanks to which the ingredients of the drug penetrate deep into the insufficiently ventilated tissues of the bronchopulmonary system.

The drug can be prescribed with caution to children suffering from chronic pathologies of the bronchi and lungs, due to the increased risk of thickening of mucus and sputum with subsequent formation of blockages in the lumen of the bronchi, as well as to young patients with Down syndrome, cerebral palsy, and brain damage.

Features of use in pregnant women

The safety of prescribing Atrovent for inhalation during pregnancy has not been fully clarified.

A direct contraindication to the use of Atrovent is the first trimester of pregnancy. The use of the drug in the second and third trimesters is possible provided that the expected therapeutic effect for the mother is higher than the potential risk for the unborn child.

There is no reliable data on whether the active substance of Atrovent passes into breast milk. Despite the fact that lipid-insoluble cations are found in breast milk, it is difficult to prove that Atrovent, when used in inhalation, can have a significant pathogenic effect. But, despite this, the drug should be prescribed during lactation in exceptional cases.

Analogs

Atrovent has several analogues.

Spiriva is a drug with bronchodilator and anticholinergic effects, blocks m-cholinergic receptors. The active ingredient is tiotropium bromide. The drug is available in capsules with powder for inhalation. Prescribed for COPD with and without emphysema, bronchial asthma.

Ipravent is a bronchodilator and m-cholinergic receptor blocker. The active ingredient is tiotropium bromide. The drug is available in the form of an aerosol, solution for inhalation and capsules with powder for inhalation. Prescribed for COPD and bronchial asthma.

Interaction of the drug with other drugs

When prescribing Atrovent, the specialist must warn the patient about the interaction of the drug with other pharmacological substances that can affect the activity and safety of the drug. This precaution is due to the enhancement or suppression of the therapeutic effect of Atrovent when used simultaneously with other medications.

Atrovent inhalation solution enhances the effect of beta-adrenergic stimulants (Berotec).

When prescribed with anticholinergic drugs (Taren, Cyclodol), an additive effect develops, that is, if you add up the effect of the resulting mixture, it will be equal to the sum of the effects of its individual pharmacological components.

The anticholinergic effect (reduction of sputum production) can be significantly enhanced when using drugs aimed against Parkinson's disease and depression.

Simultaneous use of Atrovent with beta-2-adrenergic agonists used in the form of inhalations (Salbutamol, Fenoterol) in persons suffering from angle-closure glaucoma increases the likelihood of an attack.

The majority of patients who have used Atrovent for therapeutic and prophylactic purposes respond positively to the drug. It is noted that the drug is highly effective both during treatment and when used as maintenance therapy.

Many patients tolerate this drug well and experience virtually no unwanted effects while using it. If necessary, you can replace Atrovent for inhalation with analogue drugs that are based on other active substances with a similar spectrum of action.

Useful video about nebulizers

Compound

1 dose contains ipratropium bromide monohydrate 21 mcg (0.021 mg), which corresponds to 20 mcg (0.020 mg) ipratropium bromide.
Excipients: anhydrous citric acid, purified water, absolute ethanol, propellant - tetrafluoroethane (HFA 134a).

pharmachologic effect

Ipratropium bromide is a quaternary ammonium derivative and has anticholinergic (parasympatholytic) properties. Preclinical studies have shown that it inhibits reflexes mediated by the vagus nerve by counteracting the effect of acetylcholine, a neurotransmitter released from this nerve. Anticholinergics prevent the increase in intracellular Ca++ concentration, which is caused by the interaction of acetylcholine with the muscarinic receptor of bronchial smooth muscle. The release of Ca++ is mediated by a second signaling system consisting of IPG (inositol triphosphate) and DAG (diacylglycerol). Bronchodilation that occurs after inhalation of ATROVENT N is local and specific to the lungs, and is not systemic.
Preclinical and clinical data suggest that ATROVENT N does not have a negative effect on mucus secretion in the respiratory tract, mucociliary clearance and gas exchange.
According to the results of studies involving patients with bronchospasm caused by chronic obstructive pulmonary diseases (chronic bronchitis and emphysema), there was a significant improvement in lung function within 15 minutes, a peak was reached in 1-2 hours and persisted for up to 4-6 hours.
In patients with bronchial asthma, significant improvements in lung function (forced expiratory volume FEV-i increased by 15%) were observed in 51%

Pharmacokinetics

The therapeutic effect of ATROVENT N is created by local action on the respiratory tract. Therefore, the bronchodilator effect and distribution of the drug in the body do not develop in parallel. Absorption is low. After inhalation, 10 to 30% of the dose, depending on the dosage form and method of inhalation, is mainly deposited in the lungs. Most of the dose is swallowed and passes through the gastrointestinal tract. A portion of the dose deposited in the lungs quickly enters the circulatory system. After inhaled administration of ipratropium bromide, the cumulative renal excretion over 24 hours is approximately 10%. Based on the data presented, the total systemic bioavailability of an inhaled dose of ipratropium bromide ranges from 7 to 28%. The ingested portion of the dose of ipratropium bromide does not have a significant effect on the systemic exposure of the drug.
Kinetic parameters describing the distribution of ipratropium were calculated from plasma concentrations after intravenous administration. A rapid two-phase decrease in plasma concentrations is observed. The apparent volume of distribution at steady state (Vdss) is approximately 176 L (“2.4 L/kg). The drug minimally (less than 20%) binds to blood plasma proteins. The quaternary amine ipratropium does not cross the blood-brain barrier.
The half-life of the final elimination phase is approximately 1.6 hours. The total clearance of ipratropium is 2.3 l/min, renal clearance is 0.9 l/min.
In an excretion balance study, the cumulative renal excretion (6 days) of radioactivity associated with the drug (including the parent compound and all metabolites) was 9.3% after oral administration and 3.2% after inhalation. The total radioactivity excreted in feces was 88.5% after oral administration and 69.4% after inhalation. The half-life of drug-associated radioactivity (parent compound and metabolites) is 3.6 hours. The main metabolites excreted in urine bind poorly to muscarinic receptors and are ineffective.

Indications for use

ATROVENT N is indicated for the prevention and treatment of shortness of breath with:
- chronic obstructive pulmonary disease (COPD);
- bronchial asthma of mild or moderate severity in adults and children, if betag-adrenergic drugs are not indicated, or in addition to betag-adrenergic drugs during an acute attack of asthma.

Contraindications

ATROVENT N should not be taken by patients with hypersensitivity to atropine or its derivatives, as well as to other components of the drug.

With caution - angle-closure glaucoma, urinary tract obstruction (prostatic hyperplasia, bladder neck obstruction); children's age (up to 6 years).

Pregnancy and lactation

Despite the fact that the teratogenic effect of the drug has not been identified, ATROVENT N during pregnancy and especially in the first trimester and during lactation can be prescribed by a doctor only after assessing the expected benefit of prescribing the drug for the mother and the possible risk to the fetus.

In addition, the risk of insufficient treatment should be taken into account.

There is no experience with the use of the drug by women before pregnancy and during lactation.

Preclinical studies using ipratrypium bromide have not demonstrated adverse effects on fertility. The effect of ipratropium bromide on human fertility has not been established.

Directions for use and doses

The dosage regimen is selected individually. Patients must be under medical supervision during treatment. The recommended daily dose should not be exceeded for either acute or maintenance treatment.
If treatment does not lead to significant improvement, or if the patient's condition worsens, it is necessary to consult a doctor to prescribe a new treatment regimen. If you experience acute or rapidly worsening shortness of breath, consult your doctor immediately.
Unless otherwise prescribed by a doctor, the following dosage regimen is recommended for cmapiz adults and children: treatment: 1-2 inhalation doses
several times a day. Average daily dose: 1-2 inhalation doses 3-4 times a day.
The need to increase the dose may indicate the need to reconsider the basic treatment. The total daily dose should not exceed 12 inhalations.
ATROVENT inhalation solution can be used to treat exacerbations of chronic obstructive pulmonary diseases.
Due to insufficient information, ATROVENT N for children should be used only as prescribed by a doctor and under adult supervision.
Recommendations for use
Please read the directions for use carefully.
To get the maximum effect, you must use the inhaler correctly.
Before using for the first time, press the bottom of the can twice.

Side effect

Many of the following side effects can be attributed to the anticholinergic properties of ATROVENT N. Like any drug. \ the drug used by inhalation, ATROVENT N, can cause local; \ irritation.

The most commonly reported side effects include headache, throat irritation, cough, dry mouth, gastrointestinal dysmotility (including constipation, diarrhea and vomiting), nausea and dizziness.

The incidence of side effects is indicated as: very often (>1/10); often (from >1/100 to<1/10); нечасто (от >1/1000 to<1/100); редко (от >1/10000 to<1/1000); очень редко (<1/10000).

From the immune system: rarely - anaphylactic reactions, hypersensitivity.

From the nervous system: often - headache, dizziness.

From the organ of vision: infrequently - blurred vision, mydriasis, increased intraocular pressure, glaucoma, pain in the eye, the appearance of a halo before the eyes, conjunctival hyperemia, corneal edema; rarely - disturbance of accommodation.

From the cardiovascular system: infrequently - palpitations, supraventricular tachycardia; rarely - atrial fibrillation, increased heart rate.

From the respiratory system: often - cough, throat irritation; uncommon - paradoxical bronchospasm, bronchospasm, laryngospasm, laryngeal edema, dry throat.

From the gastrointestinal tract: often - dry mouth, impaired motility of the gastrointestinal tract, nausea; uncommon - constipation, diarrhea, abdominal pain, vomiting, stomatitis, swelling of the oral mucosa.

From the skin and subcutaneous tissues: infrequently - rash, itching, angioedema; rarely - urticaria.

Co sides of the kidneys and urinary tract: infrequently - urinary retention.

Overdose

No specific symptoms of overdose have been identified. Given the breadth of therapeutic action and the local route of administration of ATROVENT N, the occurrence of any serious anticholinergic symptoms is unlikely. Minor manifestations of systemic anticholinergic action are possible, such as dry mouth, accommodation paresis, increased heart rate. Treatment is symptomatic.

Interaction with other drugs

Betag-adrenergic agents and xanthine derivatives may enhance the bronchodilator effect of the drug.

Other anticholinergic drugs, such as those containing pirenzepine, may increase the effect of ATROVENT and its side effects.

Features of application

Impact on the ability to drive a car and operate machinery
Studies on the effect of the drug on the ability to drive a car and operate machinery have not been conducted. However, patients should experience side effects during treatment with ATROVENT N, such as dizziness, disturbance of accommodation, mydriasis and blurred vision. Therefore, it is recommended to exercise caution when driving and operating machinery. If patients experience the above side effects, they should avoid such potentially dangerous activities as driving a car or using machinery.