Inhaled Anticholinergic Bronchodilator Agents
How do Anticholinergic (Parasympatholytic) Bronchodilators work?
Anticholinergic bronchodilators are specifically parasympatholytic, that is, antimuscarinic agents, blocking the effect of Ach at the cholinergic (muscarinic) receptors on bronchial smooth muscle.
Ipratropium Bromide and Albuterol (Combivent Respimat, DuoNeb)
Combivent: SMI: ipratropium 20 mcg/puff and albuterol 100 mcg/puff, 1 inhalation qid DuoNeb: SVN: ipratropium 0.5 mg and albuterol 2.5 mg Onset: 15 min Peak: 1-2 hr Duration: 6hr
Aclidinium Bromide (Tudorza Pressair)
DPI: 400 mcg/inhalation, 1 inhalation bid Onset: 10 min Peak: 2 hr Duration:12
Umeclidinium Bromide (Incruse Ellipta)
DPI: 62.5 mcg/inhalation, 1 inhalation daily Onset: 5-15 min Peak: 1-3 hr Duration: 24 hr
Unmeclidinium Bromide and Vilanterol (Anoro Ellipta)
DPI: unmeclidinium 62.5 mcg/inhalation and vilanterol 25 mcg/inhalation, 1 inhalation daily Onset: 5-15 min Peak: 1-3 hr Duration: 24 hr
What are some commonly seen side effects with anticholinergic aerosol ipratropium in MDIs and SVN?
Dry mouth and cough.
Ipratropium Bromide (Atrovent HFA)
HFA MDI: 17 mcg/puff; 2 puffs qid SVN: 0.02% solution (0.2 mg/mL), 500 mcg tid, qid Nasal spray: 21 mcg, 42 mcg; 2 sprays per nostril 2-4 times daily (dosage varies) Onset: 15-30 min Peak: 1-2 hr Duration: 6 hr
What are the broad anticholinergic effects?
Increased heart rate. Mydriasis (pupil dilation). Cycloplegia (lens flattened). Drying of upper airway. Inhibition of tear formation. Urinary retention. Antidiarrheal or constipation. Mucociliary slowing. Inhibition of constriction.
What is the indication for Anticholinergic Bronchodilators?
Ipratropium, tiotropium, aclidinium, and unmeclidinium are indicated as bronchodilators for maintenance treatment in COPD, including CB and emphysema. Ipratropium is used and may be indicated in some individuals with asthma.
The anticholinergic bronchodilators are nonspecific blockers of muscarinic receptors subtypes:
M1, M2 and M3 in the airway.
What are the occasional side effects seen with anticholinergic aerosol ipratropium in MDIs?
Nervousness. Irritation. Dizziness. Headache. Palpitation. Rash.
What are the occasional side effects seen with anticholinergic aerosol ipratropium in SVN?
Pharyngitis. Dyspnea. Flulike symptoms. Bronchitis. Upper respiratory infections. Nausea. Occasional bronchoconstriction. Eye pain. Urinary retention (less than 3%).
Tiotropium Bromide and Olodaterol (Stiolto Respimat)
SMI: tiotropium 2.5 mcg/inhalation and olodaterol 2.5 mcg/inhalation, 2 inhalations once daily Onset: 15 min Peak: 1-2 hr Duration: 24 hr
Tiotropium Bromide (Spiriva, Spiriva Respimat)
Spiriva: DPI: 18 mcg/inhalation, 1 inhalation once daily (one capsule) Spiriva Respimat: SMI: 2.5 mcg/inhalation, 2 inhalations once daily Onset: 30 min Peak: 1-3 hr Duration: 24 hr
Precautions
Use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, bladder neck obstruction, constipation, bowel obstruction, or tachycardia.
Blockade of M1 and M3 receptors in the nasal passages prevents...
gland secretion and rhinitis.