Difference between revisions of "Ipratropium"

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Latest revision as of 15:49, 27 September 2010

Ipratropium
Systematic (IUPAC) name
File:Ipratropium.svg
[8-methyl-8-(1-methylethyl)- 8-azoniabicyclo[3.2.1] oct-3-yl] 3-hydroxy-2-phenyl-propanoate
Clinical data
Pregnancy category	US: B (No risk in non-human studies)
Routes of administration	Inhalation
Legal status
Legal status	UK: POM (Prescription only)
Pharmacokinetic data
Protein binding	0 to 9% in vitro
Metabolism	Hepatic
Biological half-life	2 hours

Identifiers
CAS Number	60205-81-4
ATC code	R01AX03 (WHO) R03BB01
PubChem	CID 43232
IUPHAR/BPS	325
DrugBank	APRD00537
Chemical data
Formula	C₂₀H₃₀NO₃
Molar mass	332.457 g/mol[[Script error: No such module "String".]]
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Ipratropium (Atrovent, Apovent, Aerovent) is an anticholinergic drug.^[1] It blocks the muscarinic cholinergic receptors in the smooth muscles of the bronchi in the lungs. This opens the bronchi, and provides relief in chronic obstructive pulmonary disease and acute asthma.

1 Uses
2 Pharmacology
3 Side effects
4 See also
5 References

Uses

It is administered by inhalation for the treatment of obstructive lung diseases.

Ipratropium is also combined with albuterol (salbutamol) (trade names Combivent and Duoneb, in Italy known as Breva) for the management of chronic obstructive pulmonary disease (COPD) and asthma.

Ipratropium is also combined with fenoterol (trade names Duovent and Berodual N) for the management of asthma.

Ipratropium can reduce rhinorrhea but will not help nasal congestion.

Pharmacology

It blocks muscarinic cholinergic receptors, without specificity for subtypes, resulting in a decrease in the formation of cyclic guanosine monophosphate (cGMP). Most likely due to actions of cGMP on intracellular calcium, this results in decreased contractility of smooth muscle in the lung, inhibiting bronchoconstriction and mucus secretion. It is a non-selective muscarinic antagonist, and does not diffuse into the blood, which prevents systemic side-effects. Ipratropium is a derivative of atropine^[2] but is a quaternary amine and therefore does not cross the blood-brain barrier, which prevents central side-effects (anticholinergic syndrome). Ipratropium is considered a short-acting bronchodilator.^[3]^[4]

Side effects

If ipratropium is inhaled, side-effects resembling those of other anticholinergics are minimal. However, dry mouth and sedation have been reported. Also effects such as skin flushing, tachycardia, acute angle ocular dislocure, nausea, palpitations and headache have been observed. Ipratropium does not decrease mucuciliary clearance unlike other muscarininc antagonists.

References

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Decongestants and other nasal preparations (R01)

Topical

Sympathomimetics, plain	Cyclopentamine • Ephedrine • Phenylephrine • Oxymetazoline • Tetryzoline • Xylometazoline • Naphazoline • Tramazoline • Metizoline • Tuaminoheptane • Fenoxazoline • Tymazoline • Epinephrine
Antiallergic agents, excluding corticosteroids	Spaglumic acid histamine antagonists (Levocabastine, Antazoline, Thonzylamine) mast cell stabilizer (some are also antihistamines) (Cromoglicic acid, Nedocromil, Azelastine, Olopatadine, Lodoxamide)
Corticosteroids	Beclometasone • Prednisolone • Dexamethasone • Flunisolide • Budesonide • Betamethasone • Tixocortol • Fluticasone • Mometasone furoate • Triamcinolone • Ciclesonide
Other nasal preparations	Cafaminol • Calcium hexamine thiocyanate • Retinol • Ipratropium bromide • Ritiometan • Mupirocin • Hexamidine • Framycetin • Hyaluronic acid • Eucalyptus oil

Systemic use:
Sympathomimetics

Phenylpropanolamine • Pseudoephedrine • Phenylephrine • Phenylpropylamine

M: RES

anat(n, x, l, c)/phys/devp

noco(c)/cong/tumr, sysi/epon, injr

proc, drug(R1/2/3/5/6/7)

Drugs for obstructive airway diseases: asthma/COPD (R03)

Adrenergics, inhalants

Short acting β₂-agonists	Salbutamol/Levosalbutamol • Fenoterol • Terbutaline • Pirbuterol • Procaterol • Bitolterol • Rimiterol • Carbuterol • Tulobuterol • Reproterol
Long acting β₂-agonists (LABA)	Arformoterol • Bambuterol • Clenbuterol • Formoterol • Salmeterol Ultra LABA: Indacaterol
other	Epinephrine • Hexoprenaline • Isoprenaline (Isoproterenol) • Orciprenaline (Metaproterenol)

Glucocorticoids

Beclometasone • Budesonide • Ciclesonide • Fluticasone • Mometasone

Anticholinergics/
muscarinic antagonist

Ipratropium • Tiotropium

Mast cell stabilizers

Cromoglicate • Nedocromil

Xanthines

Doxofylline • Theobromine • Theophylline/Aminophylline

Eicosanoid inhibition

Leukotriene antagonists	Montelukast • Pranlukast • Zafirlukast
Lipoxygenase inhibitor	Zileuton
Thromboxane receptor antagonists	Ramatroban • Seratrodast

Combination products

Budesonide/formoterol • Fluticasone/salmeterol • Ipratropium/salbutamol

M: RES

anat(n, x, l, c)/phys/devp

noco(c)/cong/tumr, sysi/epon, injr

proc, drug(R1/2/3/5/6/7)

Cholinergics

Receptor ligands

mAChR

Agonists: 77-LH-28-1 • AC-42 • AC-260,584 • Aceclidine • Acetylcholine • AF30 • AF150(S) • AF267B • AFDX-384 • Alvameline • AQRA-741 • Arecoline • Bethanechol • Butyrylcholine • Carbachol • CDD-0034 • CDD-0078 • CDD-0097 • CDD-0098 • CDD-0102 • Cevimeline • cis-Dioxolane • Ethoxysebacylcholine • LY-593,039 • L-689,660 • LY-2,033,298 • McNA343 • Methacholine • Milameline • Muscarine • NGX-267 • Ocvimeline • Oxotremorine • PD-151,832 • Pilocarpine • RS86 • Sabcomeline • SDZ 210-086 • Sebacylcholine • Suberylcholine • Talsaclidine • Tazomeline • Thiopilocarpine • Vedaclidine • VU-0029767 • VU-0090157 • VU-0152099 • VU-0152100 • VU-0238429 • WAY-132,983 • Xanomeline • YM-796
Antagonists: 3-Quinuclidinyl Benzilate • 4-DAMP • Aclidinium Bromide • Anisodamine • Anisodine • Atropine • Atropine Methonitrate • Benactyzine • Benzatropine (Benztropine) • Benzydamine • BIBN 99 • Biperiden • Bornaprine • CAR-226,086 • CAR-301,060 • CAR-302,196 • CAR-302,282 • CAR-302,368 • CAR-302,537 • CAR-302,668 • CS-27349 • Cyclobenzaprine • Cyclopentolate • Darifenacin • DAU-5884 • Dimethindene • Dexetimide • DIBD • Dicyclomine (Dicycloverine) • Ditran • EA-3167 • EA-3443 • EA-3580 • EA-3834 • Elemicin • Etanautine • Etybenzatropine (Ethylbenztropine) • Flavoxate • Himbacine • HL-031,120 • Ipratropium • J-104,129 • Hyoscyamine • Mamba Toxin 3 • Mamba Toxin 7 • Mazaticol • Mebeverine • Methoctramine • Metixene • Myristicin • N-Ethyl-3-Piperidyl Benzilate • N-Methyl-3-Piperidyl Benzilate • Orphenadrine • Otenzepad • Oxybutynin • PBID • PD-102,807 • Phenglutarimide • Phenyltoloxamine • Pirenzepine • Piroheptine • Procyclidine • Profenamine • RU-47,213 • SCH-57,790 • SCH-72,788 • SCH-217,443 • Scopolamine (Hyoscine) • Solifenacin • Telenzepine • Tiotropium • Tolterodine • Trihexyphenidyl • Tripitamine • Tropatepine • Tropicamide • WIN-2299 • Xanomeline • Zamifenacin; Others: 1st Generation Antihistamines (Brompheniramine, chlorpheniramine, cyproheptadine, dimenhydrinate, diphenhydramine, doxylamine, mepyramine/pyrilamine, phenindamine, pheniramine, tripelennamine, triprolidine, etc) • Tricyclic Antidepressants (Amitriptyline, doxepin, trimipramine, etc) • Tetracyclic Antidepressants (Amoxapine, maprotiline, etc) • Typical Antipsychotics (Chlorpromazine, thioridazine, etc) • Atypical Antipsychotics (Clozapine, olanzapine, quetiapine, etc)

nAChR

Agonists: 5-HIAA • A-84,543 • A-366,833 • A-582,941 • A-867,744 • ABT-202 • ABT-418 • ABT-560 • ABT-894 • Acetylcholine • Altinicline • Anabasine • AR-R17779 • Butyrylcholine • Carbachol • Cotinine • Cytisine • Decamethonium • Desformylflustrabromine • Dianicline • Dimethylphenylpiperazinium • Epibatidine • Epiboxidine • Ethanol • Ethoxysebacylcholine • EVP-4473 • EVP-6124 • Galantamine • GTS-21 • Ispronicline • Lobeline • MEM-63,908 (RG-3487) • Nicotine • NS-1738 • PHA-543,613 • PHA-709,829 • PNU-120,596 • PNU-282,987 • Pozanicline • Rivanicline • Sazetidine A • Sebacylcholine • SIB-1508Y • SIB-1553A • SSR-180,711 • Suberylcholine • TC-1698 • TC-1734 • TC-1827 • TC-2216 • TC-5214 • TC-5619 • TC-6683 • Tebanicline • Tropisetron • UB-165 • Varenicline • WAY-317,538 • XY-4083
Antagonists: 18-Methoxycoronaridine • α-Bungarotoxin • α-Conotoxin • Alcuronium • Amantadine • Anatruxonium • Atracurium • Bupropion (Amfebutamone) • Chandonium • Chlorisondamine • Cisatracurium • Coclaurine • Coronaridine • Dacuronium • Decamethonium • Dextromethorphan • Dextropropoxyphene • Dextrorphan • Diadonium • DHβE • Dimethyltubocurarine (Metocurine) • Dipyrandium • Dizocilpine (MK-801) • Doxacurium • Duador • Esketamine • Fazadinium • Gallamine • Hexafluronium • Hexamethonium (Benzohexonium) • Ibogaine • Isoflurane • Ketamine • Kynurenic acid • Laudexium (Laudolissin) • Levacetylmethadol • Malouetine • Mecamylamine • Memantine • Methadone • Methorphan (Racemethorphan) • Methyllycaconitine • Metocurine • Mivacurium • Morphanol (Racemorphanol) • Neramexane • Nitrous Oxide • Pancuronium • Pempidine • Pentamine • Pentolinium • Phencyclidine • Pipecuronium • Radafaxine • Rapacuronium • Rocuronium • Surugatoxin • Suxamethonium (Succinylcholine) • Thiocolchicoside • Toxiferine • Trimethaphan • Tropeinium • Tubocurarine • Vecuronium • Xenon

Reuptake inhibitors

Plasmalemmal

CHT Inhibitors	Hemicholinium-3 (Hemicholine; HC3) • Triethylcholine

Vesicular

VAChT Inhibitors	Vesamicol

Enzyme inhibitors

Anabolism

ChAT inhibitors	1-(-Benzoylethyl)pyridinium • 2-(α-Naphthoyl)ethyltrimethylammonium • 3-Chloro-4-stillbazole • 4-(1-Naphthylvinyl)pyridine • Acetylseco hemicholinium-3 • Acryloylcholine • AF64A • B115 • BETA • CM-54,903 • N,N-Dimethylaminoethylacrylate • N,N-Dimethylaminoethylchloroacetate

Catabolism

AChE inhibitors

Reversible: Carbamates: Aldicarb • Bendiocarb • Bufencarb • Carbaryl • Carbendazim • Carbetamide • Carbofuran • Chlorbufam • Chloropropham • Ethienocarb • Ethiofencarb • Fenobucarb • Fenoxycarb • Formetanate • Furadan • Ladostigil • Methiocarb • Methomyl • Miotine • Oxamyl • Phenmedipham • Pinmicarb • Pirimicarb • Propamocarb • Propham • Propoxur; Stigmines: Ganstigmine • Neostigmine • Phenserine • Physostigmine • Pyridostigmine • Rivastigmine; Others: Acotiamide • Ambenonium • Donepezil • Edrophonium • Galantamine • Huperzine A • Minaprine • Tacrine • Zanapezil
Irreversible: Organophosphates: Acephate • Azinphos-methyl • Bensulide • Cadusafos • Chlorethoxyfos • Chlorfenvinphos • Chlorpyrifos • Chlorpyrifos-Methyl • Coumaphos • Cyclosarin (GF) • Demeton • Demeton-S-Methyl • Diazinon • Dichlorvos • Dicrotophos • Diisopropyl fluorophosphate (Guthion) • Diisopropylphosphate • Dimethoate • Dioxathion • Disulfoton • EA-3148 • Echothiophate • Ethion • Ethoprop • Fenamiphos • Fenitrothion • Fenthion • Fosthiazate • GV • Isofluorophate • Isoxathion • Malaoxon • Malathion • Methamidophos • Methidathion • Metrifonate • Mevinphos • Monocrotophos • Naled • Novichok agent • Omethoate • Oxydemeton-Methyl • Paraoxon • Parathion • Parathion-Methyl • Phorate • Phosalone • Phosmet • Phostebupirim • Phoxim • Pirimiphos-Methyl • Sarin (GB) • Soman (GD) • Tabun (GA) • Temefos • Terbufos • Tetrachlorvinphos • Tribufos • Trichlorfon • VE • VG • VM • VR • VX; Others: Demecarium • Onchidal (Onchidella binneyi)

BChE inhibitors

* Many of the acetylcholinesterase inhibitors listed above act as butyrylcholinesterase inhibitors.

Others

Precursors	Choline (Lecithin) • Citicoline • Cyprodenate • Dimethylethanolamine (DMAE, deanol) • Glycerophosphocholine • Meclofenoxate (Centrophenoxine) • Phosphatidylcholine • Phosphatidylethanolamine • Phosphorylcholine • Pirisudanol
Cofactors	Acetic acid • Acetylcarnitine • Acetyl-coA • Vitamin B₅ (Pantethine, Pantetheine, Panthenol)
Others	Acetylcholine releasing agents: α-Latrotoxin • β-Bungarotoxin; Acetylcholine release inhibitors: Botulinum toxin (Botox); Acetylcholinesterase reactivators: Asoxime • Obidoxime • Pralidoxime

de:Ipratropiumbromid

es:Ipratropio eu:Ipratropio fa:ایپراتروپیوم بروماید it:Ipratropio hu:Ipratropium pl:Bromek ipratropium pt:Ipratrópio

ru:Ипратропия бромид

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↑ Yamatake Y, Sasagawa S, Yanaura S, Okamiya Y (1977). "[Antiallergic asthma effect of ipratropium bromide (Sch 1000) in dogs (author's transl)]". Nippon Yakurigaku Zasshi (in Japanese). 73 (7): 785–91. PMID 145994.
↑ Kerstjens HA, Bantje TA, Luursema PB; et al. (2007). "Effects of short-acting bronchodilators added to maintenance tiotropium therapy". Chest. 132 (5): 1493–9. doi:10.1378/chest.06-3059. PMID 17890476.
↑ Knott L (November 20, 2007). "Antimuscarinic Bronchodilators". PatientUK. EMIS. Retrieved 2008-06-16.

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Difference between revisions of "Ipratropium"

Latest revision as of 15:49, 27 September 2010

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Uses

Pharmacology

Side effects

See also

References

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Revision as of 11:43, 18 August 2010 (view source) 78.144.197.83 (Talk) (→‎Side effects: Typo fix, Irpatropium --> Ipratropium) ← Older edit	Latest revision as of 15:49, 27 September 2010 (view source) Jontas (Talk \| contribs) m (1 revision: World Health Organization essential medicines)
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