Intranasal Ipratropium Buys Time

Many of the patients who seek our help in the midst of the cold and flu season seek what anybody suffering seeks: palliation. But perhaps it is the nature of our times and practice that we find ourselves steeling our nerves for confrontation the moment we mentally conclude that no antibiotic or antiviral is required. Recently, more often than not, I am pleasantly surprised by patient response to this. But perhaps I am more at ease with my position considering the increasing number of patients developing recalcitrant Clostridium difficile colitis from antibiotics.

Some patients may already be fully engaged with products frequenting my laundry list of cold remedies: ibuprofen, acetaminophen, decongestants, guaifenesin, vitamin C, and copious amounts of fluids. For patients who are struggling with the rhinorrhea associated with the common cold, intranasal ipratropium could work as well.

When taken intranasally, ipratropium bromide blocks muscarinic acetylcholine receptors, which, in turn, inhibits mucous secretion. Caution should be exercised in patients with urinary tract obstruction and glaucoma.

But are we prescribing it for the common cold? How effective is it?

AlBalawi et al. updated their systematic review on intranasal ipratropium as a treatment for rhinorrhea and nasal congestion associated with the common cold. Investigators searched for randomized controlled trials that compared ipratropium to placebo or to no treatment in children and adults with the common cold (Cochrane Database Syst. Rev. 2013;6:CD008231 [doi: 10.1002/14651858.CD008231.pub3]).

Seven trials were included with a total of 2,144 participants. All studies were consistent in reporting significant benefits of ipratropium. However, ipratropium is associated with side effects (odds ratio, 2.09; 95% confidence interval, 1.40-3.11). The most common side effects include nasal dryness, blood-tinged mucus, and epistaxis.

Nasal ipratropium is expensive, however. The approximate retail price is $130 for a 30 mL bottle at 0.03%. Patients would need to check if their insurance covers it. If not, then patients can decide themselves if it is worth the expense.

We sometimes need to remind ourselves that our job frequently is to reassure. Ipratropium may buy the patient and ourselves some time as we wait for the patient’s immune system to eradicate the problem. Checking with the insurance company on coverage may buy us even a little more time.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author. He reports no conflicts of interest.

Many of the patients who seek our help in the midst of the cold and flu season seek what anybody suffering seeks: palliation. But perhaps it is the nature of our times and practice that we find ourselves steeling our nerves for confrontation the moment we mentally conclude that no antibiotic or antiviral is required. Recently, more often than not, I am pleasantly surprised by patient response to this. But perhaps I am more at ease with my position considering the increasing number of patients developing recalcitrant Clostridium difficile colitis from antibiotics.

Some patients may already be fully engaged with products frequenting my laundry list of cold remedies: ibuprofen, acetaminophen, decongestants, guaifenesin, vitamin C, and copious amounts of fluids. For patients who are struggling with the rhinorrhea associated with the common cold, intranasal ipratropium could work as well.

When taken intranasally, ipratropium bromide blocks muscarinic acetylcholine receptors, which, in turn, inhibits mucous secretion. Caution should be exercised in patients with urinary tract obstruction and glaucoma.

But are we prescribing it for the common cold? How effective is it?

AlBalawi et al. updated their systematic review on intranasal ipratropium as a treatment for rhinorrhea and nasal congestion associated with the common cold. Investigators searched for randomized controlled trials that compared ipratropium to placebo or to no treatment in children and adults with the common cold (Cochrane Database Syst. Rev. 2013;6:CD008231 [doi: 10.1002/14651858.CD008231.pub3]).

Seven trials were included with a total of 2,144 participants. All studies were consistent in reporting significant benefits of ipratropium. However, ipratropium is associated with side effects (odds ratio, 2.09; 95% confidence interval, 1.40-3.11). The most common side effects include nasal dryness, blood-tinged mucus, and epistaxis.

Nasal ipratropium is expensive, however. The approximate retail price is $130 for a 30 mL bottle at 0.03%. Patients would need to check if their insurance covers it. If not, then patients can decide themselves if it is worth the expense.

We sometimes need to remind ourselves that our job frequently is to reassure. Ipratropium may buy the patient and ourselves some time as we wait for the patient’s immune system to eradicate the problem. Checking with the insurance company on coverage may buy us even a little more time.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author. He reports no conflicts of interest.

Many of the patients who seek our help in the midst of the cold and flu season seek what anybody suffering seeks: palliation. But perhaps it is the nature of our times and practice that we find ourselves steeling our nerves for confrontation the moment we mentally conclude that no antibiotic or antiviral is required. Recently, more often than not, I am pleasantly surprised by patient response to this. But perhaps I am more at ease with my position considering the increasing number of patients developing recalcitrant Clostridium difficile colitis from antibiotics.

Some patients may already be fully engaged with products frequenting my laundry list of cold remedies: ibuprofen, acetaminophen, decongestants, guaifenesin, vitamin C, and copious amounts of fluids. For patients who are struggling with the rhinorrhea associated with the common cold, intranasal ipratropium could work as well.

When taken intranasally, ipratropium bromide blocks muscarinic acetylcholine receptors, which, in turn, inhibits mucous secretion. Caution should be exercised in patients with urinary tract obstruction and glaucoma.

But are we prescribing it for the common cold? How effective is it?

AlBalawi et al. updated their systematic review on intranasal ipratropium as a treatment for rhinorrhea and nasal congestion associated with the common cold. Investigators searched for randomized controlled trials that compared ipratropium to placebo or to no treatment in children and adults with the common cold (Cochrane Database Syst. Rev. 2013;6:CD008231 [doi: 10.1002/14651858.CD008231.pub3]).

Seven trials were included with a total of 2,144 participants. All studies were consistent in reporting significant benefits of ipratropium. However, ipratropium is associated with side effects (odds ratio, 2.09; 95% confidence interval, 1.40-3.11). The most common side effects include nasal dryness, blood-tinged mucus, and epistaxis.

Nasal ipratropium is expensive, however. The approximate retail price is $130 for a 30 mL bottle at 0.03%. Patients would need to check if their insurance covers it. If not, then patients can decide themselves if it is worth the expense.

We sometimes need to remind ourselves that our job frequently is to reassure. Ipratropium may buy the patient and ourselves some time as we wait for the patient’s immune system to eradicate the problem. Checking with the insurance company on coverage may buy us even a little more time.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author. He reports no conflicts of interest.