Ipravent

Ipravent is an anti-asthma medication that is administered by inhalation.

Its active ingredient is ipratropium bromide, which is a competitive antagonist of the acetylcholine neurotransmitter. Ipratropium bromide is a 4-ammonium ligand with cholinolytic (parasympatholytic) effects. The drug slows down vagal reflex actions by antagonistically interacting with acetylcholine (a neurotransmitter that ensures the movement of neural impulses in the vagus nerve). [ 1 ]

Indications Ipravent

It is used in long-term therapy of reverse bronchial spasm caused by chronic bronchial asthma or chronic obstructive disorders.

Release form

The drug is released in the form of an inhalation (metered-dose) aerosol (volume - 200 portions per 1 container). The box contains 1 such container with a spray tip and a metering valve.

Pharmacodynamics

Ipratropium bromide blocks the action of muscarinic endings of smooth muscles of the tracheobronchial trunk, and also inhibits the process of reflex bronchial constriction. Cholinolytic substances prevent an increase in intracellular indices of the element cGMP, which develops during the interaction of acetylcholine and muscarinic endings of smooth muscles.

The drug prevents acetylcholine-related stimulation directed at sensory fibers in the vagus nerve under the influence of various factors. This property of the drug is noted both before the onset of exposure to negative factors and in the case of an already existing process. As a result, the drug demonstrates intense bronchodilator and prophylactic activity. [ 2 ]

Ipravent weakens the excretory function of the bronchial glands and nasal mucosa. [ 3 ]

In individuals with bronchial spasm caused by chronic pulmonary obstruction (pulmonary emphysema or chronic bronchitis), the use of ipratropium bromide leads to a significant improvement in pulmonary function 15 minutes after administration of the drug.

The maximum bronchodilating effect of the drug develops after 1 hour after administration and lasts for 5-6 hours (on average). Bronchodilation after inhalation of ipratropium bromide is mainly associated with the local specific activity of the drug.

No negative effects of ipratropium bromide on mucus secretion within the respiratory tract, gas exchange and mucociliary clearance were observed.

Pharmacokinetics

The medicinal effect of the drug develops when a local effect is manifested in relation to the respiratory tract. The bioavailability values when taking the drug orally are only about 2%.

The half-life of the elimination phase is approximately 1.6 hours. The systemic clearance of the active ingredient is 2.3 L per minute. About 40% of the clearance is 0.9 L per minute, and another 60% is non-renal (mainly hepatometabolic). The main metabolic elements determined in the urine are weakly synthesized with muscarinic endings.

Excretion of unchanged active ingredient through the kidneys is equal to 4.4-13.1% of the dose when inhaled orally.

Less than 20% of the drug is synthesized with protein. The active element does not accumulate; the drug does not cross the BBB.

Dosing and administration

Persons over 12 years of age and adults should take 40 mcg (1 inhalation procedure) 3-4 times a day. Sometimes, to achieve the highest effect in an adult, at the initial stage of therapy, the dose can be increased to 80 mcg (2 inhalations) with 3-4 times a day.

Children aged 6-12 years are given 1 inhalation (40 mcg) 3 times a day. A child may use the aerosol only under adult supervision and with a doctor's prescription.

If there is no medicinal effect from the administration of the drug or the clinical condition worsens, or if the effectiveness of the dosage used is significantly reduced, it is necessary to consult a physician regarding further actions. If dyspnea suddenly appears, it is necessary to urgently consult a doctor.

The duration of the treatment cycle is determined by the severity of the disease and is selected individually. A spacer is used for inhalations.

Shake the container and press the dosing valve 1-2 times before using the aerosol.

• Application for children

The 40 mcg dosage should not be used in children under 6 years of age.

Use Ipravent during pregnancy

There is no information regarding the safety of Ipravent during pregnancy. The drug is not prescribed in the 1st trimester. In the 2nd and 3rd trimesters, it can be used only in situations where the probable benefit to the woman is more expected than the risks of complications for the fetus.

Ipratropium bromide can be excreted in breast milk, which is why it is not used during breastfeeding.

Contraindications

Among the contraindications:

• obstructive form of cardiomyopathy of hypertrophic nature;
• tachyarrhythmia;
• severe intolerance to atropine-like elements and other components of the drug.

Side effects Ipravent

Main side effects:

• disorders associated with digestive activity: taste disorders, vomiting, xerostomia, gastrointestinal motility disorders (constipation or diarrhea) and nausea;
• problems with the cardiovascular system: extrasystole or palpitations. Rarely, atrial fibrillation or supraventricular tachycardia is observed;
• disorders affecting the respiratory tract: increased viscosity of sputum, pain and irritation in the throat, laryngospasm, cough and paradoxical bronchial spasm;
• lesions in the nervous system: skeletal muscle tremors, headaches, nervousness and dizziness;
• epidermal symptoms: itching, epidermal rash and weakening of the secretory function of sweat glands;
• visual impairment: if the drug gets into the eyes, accommodation disorders, conjunctivitis, blurred vision and pain in the eye area may occur, as well as dilation of the pupils and an increase in the level of intraocular pressure (in people with closed-angle glaucoma);
• manifestations of allergy: MEE, anaphylaxis, urticaria and Quincke's edema in the area of the lips with tongue and face;
• urinary disorders: impaired urination (especially in people with prostate hyperplasia) or its retention.

Overdose

Cases of poisoning that have been identified include reversible accommodation disorder, increased heart rate and xerostomia.

Interactions with other drugs

In case of combination with Ipravent, there is an increase in the bronchodilatory activity of xanthine derivatives (for example, theophylline) and β-adrenomimetics; in addition, the effect of substances demonstrating an anticholinergic effect may be potentiated.

Combination with β-adrenergic agonists, xanthine derivatives (for example, theophylline) and anticholinergic substances that penetrate the circulatory system may potentiate the side effects of the drug.

Use together with antiparkinsonian drugs, tricyclics and quinidine leads to an increase in the anticholinergic properties of the drug.

Storage conditions

Ipravent should be stored in a place closed to children. Temperature values are no more than 30 °C. The medicine should not be frozen.

Shelf life

Ipravent may be used within 24 months from the date of sale of the medicinal substance.

Analogues

The drug's analogues are Zicomb, Berodual with Freeway Combi, Duolin with Otrivin Extra, and Ipradual with Ximelin Extra.