NDC 60687-394 Ipratropium Bromide
Solution Respiratory (inhalation)

Product Information

Ipratropium Bromide is a human prescription drug product labeled by American Health Packaging. The product's dosage form is solution and is administered via respiratory (inhalation) form.

Product Code60687-394
Proprietary Name What is the Proprietary Name?
The proprietary name also known as the trade name is the name of the product chosen by the medication labeler for marketing purposes.
Ipratropium Bromide
Non-Proprietary Name What is the Non-Proprietary Name?
The non-proprietary name is sometimes called the generic name. The generic name usually includes the active ingredient(s) of the product.
Ipratropium Bromide
Product Type What kind of product is this?
Indicates the type of product, such as Human Prescription Drug or Human Over the Counter Drug. This data element matches the “Document Type” field of the Structured Product Listing.
Human Prescription Drug
Dosage FormSolution - A clear, homogeneous liquid1 dosage form that contains one or more chemical substances dissolved in a solvent or mixture of mutually miscible solvents.
Administration Route(s) What are the Administration Route(s)?
The translation of the route code submitted by the firm, indicating route of administration.
  • Respiratory (inhalation) - Administration within the respiratory tract by inhaling orally or nasally for local or systemic effect.
Product Labeler Information What is the Labeler Name?
Name of Company corresponding to the labeler code segment of the Product NDC.
American Health Packaging
Labeler Code60687
FDA Application Number What is the FDA Application Number?
This corresponds to the NDA, ANDA, or BLA number reported by the labeler for products which have the corresponding Marketing Category designated. If the designated Marketing Category is OTC Monograph Final or OTC Monograph Not Final, then the Application number will be the CFR citation corresponding to the appropriate Monograph (e.g. “part 341”). For unapproved drugs, this field will be null.
ANDA075693
Marketing Category What is the Marketing Category?
Product types are broken down into several potential Marketing Categories, such as NDA/ANDA/BLA, OTC Monograph, or Unapproved Drug. One and only one Marketing Category may be chosen for a product, not all marketing categories are available to all product types. Currently, only final marketed product categories are included. The complete list of codes and translations can be found at www.fda.gov/edrls under Structured Product Labeling Resources.
ANDA - A product marketed under an approved Abbreviated New Drug Application.
Start Marketing Date What is the Start Marketing Date?
This is the date that the labeler indicates was the start of its marketing of the drug product.
12-26-2018
Listing Expiration Date What is the Listing Expiration Date?
This is the date when the listing record will expire if not updated or certified by the product labeler.
12-31-2023
Exclude Flag What is the NDC Exclude Flag?
This field indicates whether the product has been removed/excluded from the NDC Directory for failure to respond to FDA"s requests for correction to deficient or non-compliant submissions ("Y"), or because the listing certification is expired ("E"), or because the listing data was inactivated by FDA ("I"). Values = "Y", "N", "E", or "I".
N
NDC Code Structure

What are the uses for Ipratropium Bromide?


Product Packages

NDC 60687-394-83

Package Description: 30 POUCH in 1 CARTON > 1 AMPULE in 1 POUCH (60687-394-79) > 2.5 mL in 1 AMPULE

Price per Unit: $0.05799 per ML

Product Details

What are Ipratropium Bromide Active Ingredients?

An active ingredient is the substance responsible for the medicinal effects of a product specified by the substance's molecular structure or if the molecular structure is not known, defined by an unambiguous definition that identifies the substance. Each active ingredient name is the preferred term of the UNII code submitted.
  • IPRATROPIUM BROMIDE .5 mg/2.5mL - A muscarinic antagonist structurally related to ATROPINE but often considered safer and more effective for inhalation use. It is used for various bronchial disorders, in rhinitis, and as an antiarrhythmic.

NDC to RxNorm Crosswalk

What is RxNorm? RxNorm is a normalized naming system for generic and branded drugs that assigns unique concept identifier(s) known as RxCUIs to NDC products.The NDC to RxNorm Crosswalk for this produdct indicates multiple concept unique identifiers (RXCUIs) are associated with this product:
  • RxCUI: 836358 - ipratropium bromide 0.02 % Inhalation Solution
  • RxCUI: 836358 - ipratropium bromide 0.2 MG/ML Inhalation Solution
  • RxCUI: 836358 - ipratropium bromide 500 MCG per 2.5 ML Inhalation Solution

Inactive Ingredient(s)

The inactive ingredients are all the component of a medicinal product OTHER than the active ingredient(s). The acronym "UNII" stands for “Unique Ingredient Identifier” and is used to identify each inactive ingredient present in a product.
  • SODIUM CHLORIDE (UNII: 451W47IQ8X)
  • HYDROCHLORIC ACID (UNII: QTT17582CB)
  • WATER (UNII: 059QF0KO0R)

Pharmacologic Class(es)

A pharmacologic class is a group of drugs that share the same scientifically documented properties. The following is a list of the reported pharmacologic class(es) corresponding to the active ingredients of this product.

* Please review the disclaimer below.

Patient Education

Ipratropium Oral Inhalation

Ipratropium Oral Inhalation is pronounced as (i pra troe' pee um)

Why is ipratropium oral inhalation medication prescribed?
Ipratropium oral inhalation is used to prevent wheezing, shortness of breath, coughing, and chest tightness in people with chronic obstructive pulmonary disease (COPD; a ...
[Read More]

* Please review the disclaimer below.

Ipratropium Bromide Labeling and Warnings

FDA filings in the form of structured product labels are documents that include all published material associated whith this product. Product label information includes data like indications and usage generic names, contraindications, active ingredients, strength dosage, routes of administration, appearance, usage, warnings, inactive ingredients, etc.

Table of Contents



Other



Prescribing Information
Rx Only

ATTENTION PHARMACIST: Detach "Patient's Instructions for Use" from Package Insert and dispense with solution.

Rx Only

Manufactured by:
The Ritedose Corporation
Columbia, SC 29203

Distributed by:
American Health Packaging
Columbus, OH 43217

To report SUSPECTED ADVERSE
REACTIONS, contact American Health
Packaging at 1-800-707-4621 or FDA

at 1-800-FDA-1088 or www.fda.gov/medwatch

RPIN0100
September 2018

Manufactured by:
The Ritedose Corporation
Columbia, SC 29203

Distributed by:
American Health Packaging
Columbus, OH 43217

To report SUSPECTED ADVERSE
REACTIONS, contact American Health
Packaging at 1-800-707-4621 or FDA at
1-800-FDA-1088 or www.fda.gov/medwatch

RPIN0100
September 2018


Description



The active ingredient, ipratropium bromide monohydrate, USP, is an anticholinergic bronchodilator chemically described as 8-azoniabicyclo [3.2.1]- octane, 3-(3-hydroxy-1-oxo-2-phenylpropoxy)-8-methyl-8-(1-methylethyl)-, bromide, monohydrate (endo, syn)-, (±)-; a synthetic quaternary ammonium compound, chemically related to atropine.

Ipratropium Bromide Monohydrate C 20H 30BrNO 3•H 2O Mol. Wt. 430.4

Ipratropium bromide is a white crystalline substance, freely soluble in water and lower alcohols. It is a quaternary ammonium compound and thus exists in an ionized state in aqueous solutions. It is relatively insoluble in non-polar media.

Ipratropium Bromide Inhalation Solution is administered by oral inhalation with the aid of a nebulizer. It contains ipratropium bromide, USP 0.02% (anhydrous basis) in a sterile, preservative-free, isotonic saline solution, pH-adjusted to 3.4 (3 to 4) with hydrochloric acid.


Clinical Pharmacology



Ipratropium bromide is an anticholinergic (parasympatholytic) agent that, based on animal studies, appears to inhibit vagally mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released from the vagus nerve.

Anticholinergics prevent the increases in intracellular concentration of cyclic guanosine monophosphate (cyclic GMP) that are caused by interaction of acetylcholine with the muscarinic receptor on bronchial smooth muscle.

The bronchodilation following inhalation of ipratropium bromide is primarily a local, site-specific effect, not a systemic one. Much of an administered dose is swallowed but not absorbed, as shown by fecal excretion studies. Following nebulization of a 2 mg dose, a mean 7% of the dose was absorbed into the systemic circulation either from the surface of the lung or from the gastrointestinal tract. The half-life of elimination is about 1.6 hours after intravenous administration. Ipratropium bromide is minimally (0 to 9% in vitro) bound to plasma albumin and a 1-acid glycoproteins. It is partially metabolized. Autoradiographic studies in rats have shown that ipratropium bromide does not penetrate the blood-brain barrier. Ipratropium bromide has not been studied in patients with hepatic or renal insufficiency. It should be used with caution in those patient populations.

In controlled 12-week studies in patients with bronchospasm associated with chronic obstructive pulmonary disease (chronic bronchitis and emphysema) significant improvements in pulmonary function (FEV 1 increases of 15% or more) occurred within 15 to 30 minutes, reached a peak in 1 to 2 hours, and persisted for periods of 4 to 5 hours in the majority of patients, with about 25% to 38% of the patients demonstrating increases of 15% or more for at least 7 to 8 hours. Continued effectiveness of ipratropium bromide inhalation solution was demonstrated throughout the 12-week period. In addition, significant increases in forced vital capacity (FVC) have been demonstrated. However, ipratropium bromide did not consistently produce significant improvement in subjective symptom scores nor in quality of life scores over the 12-week duration of study.

Additional controlled 12-week studies were conducted to evaluate the safety and effectiveness of ipratropium bromide inhalation solution administered concomitantly with the beta adrenergic bronchodilator solutions metaproterenol and albuterol compared with the administration of each of the beta agonists alone. Combined therapy produced significant additional improvement in FEV 1 and FVC. On combined therapy, the median duration of 15% improvement in FEV 1 was 5 to 7 hours, compared with 3 to 4 hours in patients receiving a beta agonist alone.


Indications And Usage



Ipratropium Bromide Inhalation Solution administered either alone or with other bronchodilators, especially beta adrenergics, is indicated as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema.


Contraindications



Ipratropium bromide is contraindicated in known or suspected cases of hypersensitivity to ipratropium bromide, or to atropine and its derivatives.


Warnings



The use of ipratropium bromide inhalation solution as a single agent for the relief of bronchospasm in acute COPD exacerbation has not been adequately studied. Drugs with faster onset of action may be preferable as initial therapy in this situation. Combination of ipratropium bromide and beta agonists has not been shown to be more effective than either drug alone in reversing the bronchospasm associated with acute COPD exacerbation.

Immediate hypersensitivity reactions may occur after administration of ipratropium bromide, as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm and oropharyngeal edema.


General



Ipratropium bromide should be used with caution in patients with narrow-angle glaucoma, prostatic hypertrophy or bladder-neck obstruction.


Information For Patients



Patients should be advised that temporary blurring of vision, precipitation or worsening of narrow-angle glaucoma or eye pain may result if the solution comes into direct contact with the eyes. Use of a nebulizer with mouthpiece rather than face mask may be preferable, to reduce the likelihood of the nebulizer solution reaching the eyes. Patients should be advised that ipratropium bromide inhalation solution can be mixed in the nebulizer with albuterol or metaproterenol if used within one hour. Drug stability and safety of Ipratropium Bromide Inhalation Solution when mixed with other drugs in a nebulizer have not been established. Patients should be reminded that ipratropium bromide inhalation solution should be used consistently as prescribed throughout the course of therapy.


Drug Interactions



Ipratropium bromide has been shown to be a safe and effective bronchodilator when used in conjunction with beta adrenergic bronchodilators. Ipratropium bromide has also been used with other pulmonary medications, including methylxanthines and corticosteroids, without adverse drug interactions.


Carcinogenesis, Mutagenesis, Impairment Of Fertility



Two-year oral carcinogenicity studies in rats and mice have revealed no carcinogenic potential at dietary doses up to 6 mg/kg/day of ipratropium bromide.

Results of various mutagenicity studies (Ames test, mouse dominant lethal test, mouse micronucleus test and chromosome aberration of bone marrow in Chinese hamsters) were negative.

Fertility of male or female rats at oral doses up to 50 mg/kg/day was unaffected by ipratropium bromide administration. At doses above 90 mg/kg increased resorption and decreased conception rates were observed.


Pregnancy Category B



Oral reproduction studies performed in mice, rats and rabbits at doses of 10, 100, and 125 mg/kg respectively, and inhalation reproduction studies in rats and rabbits at doses of 1.5 and 1.8 mg/kg (or approximately 38 and 45 times the recommended human daily dose) respectively, have demonstrated no evidence of teratogenic effects as a result of ipratropium bromide. However, no adequate or well-controlled studies have been conducted in pregnant women. Because animal reproduction studies are not always predictive of human response, ipratropium bromide should be used during pregnancy only if clearly needed.


Nursing Mothers



It is not known whether ipratropium bromide is excreted in human milk. Although lipid-insoluble quaternary bases pass into breast milk, it is unlikely that ipratropium bromide would reach the infant to a significant extent, especially when taken by inhalation since ipratropium bromide is not well absorbed systemically after inhalation or oral administration. However, because many drugs are excreted in human milk, caution should be exercised when ipratropium bromide is administered to a nursing woman.


Pediatric Use



Safety and effectiveness in the pediatric population below the age of 12 have not been established.


Adverse Reactions



Adverse reaction information concerning ipratropium bromide inhalation solution is derived from 12-week active-controlled clinical trials. Additional information is derived from foreign post-marketing experience and the published literature.

All adverse events, regardless of drug relationship, reported by three percent or more patients in the 12-week controlled clinical trials appear in the table below.

Additional adverse reactions reported in less than three percent of the patients treated with ipratropium bromide include tachycardia, palpitations, eye pain, urinary retention, urinary tract infection and urticaria. Cases of precipitation or worsening of narrow-angle glaucoma, mydriasis, and acute eye pain have been reported.

Lower respiratory adverse reactions (bronchitis, dyspnea and bronchospasm) were the most common events leading to discontinuation of ipratropium bromide therapy in the 12-week trials. Headache, mouth dryness and aggravation of COPD symptoms are more common when the total daily dose of ipratropium bromide equals or exceeds 2,000 mcg.

Allergic-type reactions such as skin-rash, angioedema of tongue, lips and face, urticaria, laryngospasm and anaphylactic reaction have been reported. Many of the patients had a history of allergies to other drugs and/or foods.

All Adverse Events, from a Double-blind, Parallel, 12-week Study of patients with COPD

All adverse events, regardless of drug relationship, reported by three percent or more patients in the 12-week controlled clinical trials.

PERCENT OF PATIENTS
IpratropiumMetaproterenolIpratropium/
Metaproterenol
AlbuterolIpratropium/
Albuterol
(500 mcg t.i.d.)(15 mg t.i.d.)(500 mcg t.i.d./
15 mg t.i.d.)
(2.5 mg t.i.d.)(500 mcg t.i.d./
2.5 mg t.i.d.)
n = 219n = 212n = 108n = 205n = 100

Body as a Whole-General Disorders

Headache

6.4

5.2

6.5

6.3

9.0

Pain

4.1

3.3

0.9

2.9

5.0

Influenza-like symptoms

3.7

4.7

6.5

0.5

1.0

Back Pain

3.2

1.9

1.9

2.4

0.0

Chest Pain

3.2

4.2

5.6

2.0

1.0

Cardiovascular Disorders

Hypertension/Hypertension Aggravated

0.9

1.9

0.9

1.5

4.0

Central & Peripheral Nervous System

Dizziness

2.3

3.3

1.9

3.9

4.0

Insomnia

0.9

0.5

4.6

1.0

1.0

Tremor

0.9

7.1

8.3

1.0

0.0

Nervousness

0.5

4.7

6.5

1.0

1.0

Gastrointestinal System Disorders

Mouth Dryness

3.2

0.0

1.9

2.0

3.0

Nausea

4.1

3.8

1.9

2.9

2.0

Constipation

0.9

0.0

3.7

1.0

1.0

Musculo-skeletal System Disorders

Arthritis

0.9

1.4

0.9

0.5

3.0

Respiratory System Disorders (Lower)

Coughing

4.6

8.0

6.5

5.4

6.0

Dyspnea

9.6

13.2

16.7

12.7

9.0

Bronchitis

14.6

24.5

15.7

16.6

20.0

Bronchospasm

2.3

2.8

4.6

5.4

5.0

Sputum Increased

1.4

1.4

4.6

3.4

0.0

Respiratory Disorder

0.0

6.1

6.5

2.0

4.0

Respiratory System Disorders (Upper)

Upper Respiratory Tract Infection

13.2

11.3

9.3

12.2

16.0

Pharyngitis

3.7

4.2

5.6

2.9

4.0

Rhinitis

2.3

4.2

1.9

2.4

0.0

Sinusitus

2.3

2.8

0.9

5.4

4.0


Overdosage



Acute systemic overdosage by inhalation solution is unlikely since ipratropium bromide is not well absorbed after inhalation at up to four-fold the recommended dose, or after oral administration at up to forty-fold the recommended dose. The oral LD 50 of ipratropium bromide ranged between 1001 and 2010 mg/kg in mice; between 1667 and 4000 mg/kg in rats; and between 400 and 1300 mg/kg in dogs.


Dosage And Administration



The usual dosage of ipratropium bromide inhalation solution is 500 mcg (1 Unit-Dose Vial) administered three to four times a day by oral nebulization, with doses 6 to 8 hours apart. Ipratropium bromide inhalation solution unit-dose vials contain 500 mcg ipratropium bromide, USP anhydrous in 2.5 mL normal saline. Ipratropium bromide inhalation solution can be mixed in the nebulizer with albuterol or metaproterenol if used within one hour. Drug stability and safety of Ipratropium Bromide Inhalation Solution when mixed with other drugs in a nebulizer have not been established.


How Supplied



Ipratropium Bromide Inhalation Solution Unit Dose Vial is supplied as a 0.02% clear, colorless solution containing 2.5 mL.

NDC 60687-394-83, 30 vials per carton / 1 vial per foil pouch

Each vial is made from a low density polyethylene (LDPE) resin.

Vials are supplied in a foil pouch.


Storage And Handling



Store between 59°F (15°C) and 86°F (30°C).

Protect from light.

Store unused vials in the foil pouch.


Patient's Instructions For Use



Ipratropium Bromide
Inhalation Solution 0.02%

Read complete instructions carefully before using.

  • Twist open the top of one unit dose vial and squeeze the contents into the nebulizer reservoir. (Figure 1).
  • 2. Connect the nebulizer reservoir to the mouthpiece or face mask (Figure 2).

    3. Connect the nebulizer to the compressor.

    4. Sit in a comfortable, upright position; place the mouthpiece in your mouth (Figure 3) or put on the face mask and turn on the compressor. If a face mask is used, care should be taken to avoid leakage around the mask as temporary blurring of vision, pupil enlargement, precipitation or worsening of narrow angle glaucoma, or eye pain may occur if the solution comes into direct contact with the eyes.

    5. Breathe as calmly, deeply, and evenly as possible until no more mist is formed in the nebulizer chamber (about 5 to 15 minutes). At this point, the treatment is finished.

    6. Clean the nebulizer (see manufacturer's instructions).

    Note: Use only as directed by your physician. More frequent administration or higher doses are not recommended. Ipratropium Bromide Inhalation Solution can be mixed in the nebulizer with albuterol or metaproterenol if used within one hour but not with other drugs. Drug stability and safety of Ipratropium Bromide Inhalation Solution when mixed with other drugs in the nebulizer have not been established.

    Store between 59°F (15°C) and 86°F (30°). Protect from light. Store unused vials in the foil pouch.

    ADDITIONAL INSTRUCTIONS:

    __________________________________________________________________________________________________


Package/Label Display Panel – Carton – 0.5 Mg Per 2.5 Ml



NDC 60687- 394-83

Ipratropium Bromide
Inhalation Solution, 0.02%

0.5 mg/2.5 mL

30 x 2.5 mL Sterile Unit-Dose Vials,
each in a foil pouch.

Rx Only
FOR ORAL INHALATION ONLY

INGREDIENTS: Each low density polyethylene vial contains: 2.5 mL Ipratropium Bromide 0.02%,
preservative free, isotonic sterile aqueous solution containing sodium chloride.
Adjusted to pH 3.4 (3 to 4) with hydrochloric acid.

Usual Dosage: See accompanying prescribing information.

Store between 15° and 30°C (59° and 86°F). Protect from light.

Rx Only

ATTENTION PHARMACIST: Detach "Patient's Instructions For Use" from
package insert and dispense with solution.

Manufactured by: The Ritedose Corporation, Columbia, SC 29203
Distributed by: American Health Packaging, Columbus, OH 43217


Package/Label Display Panel – Pouch – 0.5 Mg Per 2.5 Ml



NDC 60687-394-79

Ipratropium
Bromide
Inhalation Solution

0.02% (0.5 mg/vial)

FOR ORAL INHALATION ONLY

Each low density polyethylene vial
contains: 2.5 mL Ipratropium
Bromide 0.02%,
preservative free, isotonic sterile
aqueous solution containing
sodium chloride.
Adjusted to pH 3.4 (3 to 4) with
hydrochloric acid.

Usual Dosage: See accompanying
prescribing information.

Store between 15° and 30°C (59°
and 86°F). Protect from light.

ATTENTION PHARMACIST:
Detach "Patient's Instructions For
Use" from package insert and
dispense with solution.

Rx Only

STERILE

One 2.5 mL Unit-Dose Vial

Manufactured by:
The Ritedose
Corporation
Columbia, SC 29203

Distributed by:
American Health
Packaging
Columbus, OH 43217

RPFP0221


* Please review the disclaimer below.