Atrovent Nasal Forte

Atrovent Nasal Forte - Precautions | Side Effects

This article was medically reviewed by M.Pharm, Marko Tanaskovic on Wed, 15 Apr 2020. To read more about an author, click here.

Atrovent Nasal Forte is a nasal spray containing the ipratropium. It belongs to a group of anticholinergic drugs - drugs that block the action of acetylcholine. It is manufactured by a company called Sanofi Consumer Healthcare in Virginia, Australia.

Atrovent Nasal Forte is a spray that delivers 44 micrograms of ipratropium bromide per spray. It is indicated for the symptomatic treatment of rhinorrhea that occurs due to common cold or allergic rhinitis.

Pharmacokinetics

Accroding to the FDA, this drug is very poorly absorbed into the systemic circulation after oral administration (only 2-3%), while less than 20% is absorbed from the mucous membranes of the nostrils into the systemic circulation.

Studies also indicate that the level of drug excreted unchanged in the urine is higher in children aged 6-18 years than in adult patients. The pharmacokinetic characteristics of the drug are not very different between man and woman.

The risk of an overdose after nasal administration is minimal, given that absorption after nasal administration is very low. In a study involving 10 volunteers, administration of about 4 spray bottles (20 mg) did not cause changes in blood pressure or tachycardia (rapid heart rate). However, this does not mean that you can use more than your doctor or pharmacist has recommended.

Contraindications

Given the similar chemical structure between atropine (an anticholinergic drug) and ipratropium bromide, Atrovent Nasal Forte is contraindicated in patients who have had or have a known hypersensitivity reaction to atropine or ipratropium bromide.

If you are experiencing symptoms of an allergy, such as urticaria, oropharyngeal edema, or angioedema, contact your doctor immediately. An allergic reaction can cause anaphylactic shock, which can endanger your life.

Precautions

As anticholinergic drugs should not be used in patients who have glaucoma, enlarged prostate or bladder obstruction, caution is advised if Atrovent Nasal Forte is administered to these patients. This drug is unlikely to cause disease exacerbation in patients who have glaucoma, enlarged prostate or bladder obstruction, but caution should be exercised.

As there are no studies on the use of this medicine in patients with impaired hepatic or renal function, caution is advised in patients who have any kidney or liver disease.

A double-blind study involving 233 patients using this drug has shown that the only significant side effects that occurred in subjects using Atrovent Nasal Forte (ipratropium) were dry nose and epistaxis (nosebleeds). The same study showed a significant reduction in rhinorrhea symptoms, which improved quality of subject's life.

Dosage

Non-allergic conditions (common cold)

The usual dose in treating cold-associated rhinorrhea is 2 sprays to each nostril 3-4 times a day (every 6 or 8 hours).

Allergic rhinitis

The usual dose in rhinorrhea associated with allergic rhinitis is 1-2 sprays into each nostril 2-3 times a day (every 8 and 12 hours, respectively).

Do not spray the spray in or near the eyes as it may cause visual disturbances.

How Should You Use Atrovent Nasal Forte?

To use this medicine, first remove the protective cap. Before using the pump for the first time, it is necessary to press (activate) the pump 5-6 times until a uniform spray is released. If you use the spray daily, you will not need to reactivate the spray again. However, if you have not used the spray for more than 24 hours, it is necessary to reactivate the spray by pressing the pump and releasing a couple of sprays before applying it to the nostrils.

Blow your nose before applying Atrovent Nasal Forte. Insert the pump into the nostril and release the spray by pressing the pump. Take a breath slowly through the nose. Repeat this procedure to administer the appropriate dose prescribed by your doctor.

After application, put back a protective cap and return to storage.

Use of Atrovent Nasal Forte During Pregnancy and Breastfeeding

Studies at rats and rabbits at doses significantly higher than those used in humans indicate that Atrovent Nasal Forte has no adverse effects on the fetus, which is why the FDA classifies it as category B. However, there are no well-controlled studies focusing on use of this medicine in pregnant women, which is why this medicine should be used during pregnancy with extreme caution.

It is unknown how much of Atrovent Nasal Forte is excreted in breast milk, therefore, this medicine should not be used during breastfeeding.

Interactions

Atrovent Nasal Forte is absorbed into the systemic circulation (blood) at very low concentrations, so interactions with other drugs are not likely. However, interactions may occur if you use other forms of ipratropium bromide or other anticholinergic drugs.

Dimenhydrinate (an antihistaminic drug) exerts anticholinergic effects, which is why concomitant use with this medicine is not recommended.

Tell your doctor about any medicines you are using.

Adverse Effects

Atrovent Nasal Forte can cause the following adverse effects:

  • Nosebleeds (epistaxis)
  • Dryness of the nose
  • Irritation of the nose
  • Sore throat
  • Nausea
  • Urticaria
  • Swelling of the tongue and throat
  • Angioedema
  • Anaphylactic shock
  • Coughing
  • Rapid heart beat
  • Urinary retention

Tell your doctor if you are experiencing any side effects.

References

  1. FDA
  2. Bronsky EA, Druce H, Findlay Sr, et all. A clinical trial of ipratropium bromide nasal spray in patients with perennial nonallergic rhinitis. J Allergy Clin. Immunol. 1995. 95(5): 1117-22.

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