Ipratropium / Tiotropium

Summary

Ipratropium and tiotropium are inhaled anticholinergic medications. By inducing bronchodilation, these drugs can be used to treat COPD and asthma. These drugs are notably different in their time course. Ipratropium is a fast-acting drug that can be combined with albuterol in a rescue inhaler to treat acute asthma and COPD exacerbations. On the other hand, Tiotropium is a slow-acting medication that is taken chronically as a maintenance medication, to prevent exacerbations from happening in the first place. The main side effect of both drugs is dry mouth, which can be mitigated by rinsing the mouth out with water after the use of the inhaler.

Key Points

• Ipratropium, tiotropium
  • Mechanism
    • Anticholinergic
      • Blocks muscarinic receptors on the bronchioles, causing bronchodilation
      • Administered as a capsule that contains powder that must be put into a special inhaler. The capsule should not be swallowed.
  • Clinical Uses
    • COPD and Asthma
      • Ipratropium is short-acting
        • Fast onset, short duration
        • Ipratropium may be used along with albuterol as a rescue treatment for acute exacerbations
      • Tiotropium is long-acting
        • Slow onset, long duration
        • Should not be taken orally; comes in capsule form that should be put into a capsule aerosolizer
        • Tiotropium is a long-acting drug used as a maintenance treatment. It should not be used as a rescue inhaler.
    • **When combined with albuterol, ipratropium may be used for acute asthma and COPD exacerbations, but keep in mind that the albuterol is the key rescue medication. Ipratropium is simply used to help promote bronchodilation. It should not be used alone to treat asthma attacks.
  • Side Effects and Adverse Reactions
    • Local anticholinergic effects
      • Dry mouth
        • Advise patients to sip on fluids and suck on sugar-free hard candies
        • Rinse out mouth after inhaler use
      • Hoarseness