Long-term safety and efficacy study of intranasal ipratropium bromide

Cold-Induced Rhinitis in Skiers—Clinical Aspects and Treatment with Ipratropium Bromide Nasal Spray: A Randomized Controlled Trial

Cold-induced rhinitis (CIR) is common among skiers and is perceived as a troublesome disease. We studied the clinical characteristics of CIR in a population of skiers and we evaluated the effectiveness of ipratropium bromide nasal spray (IBNS) in relieving symptoms in a double-blind placebo-controlled fashion. By means of specific questionnaires, we evaluated 144 subjects (69% men; mean age, 42.2 years). The prevalence of CIR was 48.6% and the distinctive symptom was rhinorrhea (96%), often severe. The prevalence of atopy was higher in the CIR patients (χ2; p = 0.004). Twenty-eight CIR subjects participated in a double-blind placebo-controlled cross-over trial for evaluating the effectiveness of IBNS (80 μg twice per day [b.i.d.]). The severity of symptoms was assessed by a visual analog scale, and the number of cleaning tissues used also was evaluated. The actively treated group showed a significant improvement of rhinorrhea (p = 0.0007) and a reduction in the number of cleaning tissues used (p = 0.0023). Only four mild local side effects were reported. We conclude that IBNS could be regarded as an optimal therapeutic option for treating CIR symptoms in skiers.

Efficacy and safety of intranasal xylometazoline and ipratropium in patients with common cold

BACKGROUND

Many over-the-counter medications are available to treat common cold nasal symptoms, but patients may be unsure which one to use.

METHODS

This review assesses two widely used intranasal treatments for nasal congestion and rhinorrhea in the common cold: xylometazoline hydrochloride and ipratropium bromide.

RESULTS

Xylometazoline quickly and effectively relieves nasal congestion, while ipratropium is effective at reducing rhinorrhea. When used in combination, a novel approach to treatment, nasal congestion and rhinorrhea are treated simultaneously, providing effective relief from two of the most troublesome symptoms of the common cold Both drugs are well tolerated, with only mild to moderate, nasal-related side effects.

CONCLUSIONS

The efficacy and safety of the combination product suggest that it should be used first-line in the symptomatic relief of nasal congestion and rhinorrhea, before the use of oral treatments.

Intranasal delivery: physicochemical and therapeutic aspects

Interest in intranasal (IN) administration as a non-invasive route for drug delivery continues to grow rapidly. The nasal mucosa offers numerous benefits as a target issue for drug delivery, such as a large surface area for delivery, rapid drug onset, potential for central nervous system delivery, and no first-pass metabolism. A wide variety of therapeutic compounds can be delivered IN, including relatively large molecules such as peptides and proteins, particularly in the presence of permeation enhancers. The current review provides an in-depth discussion of therapeutic aspects of IN delivery including consideration of the intended indication, regimen, and patient population, as well as physicochemical properties of the drug itself. Case examples are provided to illustrate the utility of IN dosing. It is anticipated that the present review will prove useful for formulation scientists considering IN delivery as a delivery route.

Optimum treatment of rhinitis in the elderly

With aging, multiple physiological changes occur in the connective tissue and vasculature of the nose which may predispose or contribute to chronic rhinitis. Accurate differentiation of allergic from nonallergic causes of rhinitis requires skin testing or in vitro measures of specific IgE. Empiric treatment with over-the-counter first generation antihistamines and oral decongestants frequently results in CNS, anticholinergic and cardiovascular adverse effects. While newer second generation histamine antagonists do not cause these problems, selected drugs in this class may cause electrocardiographic QT prolongation and, in rare cases, ventricular arrhythmias. Topical therapies including sodium cromoglycate (cromolyn sodium), corticosteroids and ipratropium bromide are all well-tolerated with minimal adverse effects. Avoidance of allergens and/or irritants is an important adjunct in treating patients with allergic and vasomotor rhinitis. If all other therapies fail in patients with confirmed allergic rhinitis, immunotherapy can be safely instituted in most older patients.

The use of intranasal anticholinergic agents in the treatment of nonallergic perennial rhinitis

Nonallergic perennial rhinitis is a heterogenous disorder. Although the underlying cause is unknown, there is evidence of an autonomic imbalance with parasympathetic hyperreactivity in affected persons. We review this evidence and the role of ipratropium bromide, an anticholinergic drug with topical activity, in the management of nonallergic perennial rhinitis. The pharmacologic features, safety, and efficacy of ipratropium bromide are reviewed.

A double-blind, placebo-controlled study of the safety and efficacy of ipratropium bromide nasal spray versus placebo in patients with the common cold

Ipratropium bromide (IB) has been found to reduce secretions in the upper respiratory tract; this is accomplished through competitive inhibition of acetylcholine at muscarinic receptors that control rhinorrhea production. This study compared the safety and efficacy of IB with placebo in the symptomatic relief of rhinorrhea in patients with the common cold. Human subjects with symptoms of a common cold, primarily rhinorrhea, were enrolled and treated with either IB (84 micrograms/nostril) or placebo; each was administered as two sprays per nostril, four times a day, for 4 days. Primary efficacy analyses were in-clinic measurements of nasal discharge weights over a 3-hour period after administration on days 1 and 2 and assessment of rhinorrhea symptoms by use of a subjective patient-completed visual analog rating scale. IB significantly reduced rhinorrhea an average of 18% over placebo for days 1 and 2 (p = 0.01). Visual analog scale scores showed an average improvement in rhinorrhea of 22% over placebo (p = 0.001). When patients with relatively minor rhinorrhea (baseline weight of nasal discharge < or = 1.0 gm) were excluded, IB produced an average reduction in nasal discharge of 23% over placebo for days 1 and 2 (p = 0.003).

The anticholinergic treatment of allergic perennial rhinitis

Anticholinergic agents have been used for nonallergic rhinitis expressly to control rhinorrhea. In allergic rhinitis, rhinorrhea can be extremely troublesome and unresponsive to traditional pharmacotherapeutic rhinitis treatments. Anticholinergic agents, through their specific ability to decrease nasal secretory response, should have beneficial effects for allergic rhinitis. In a recent trial ipratropium bromide at concentrations of 0.03% and 0.06% reduced rhinorrhea in allergic subjects without any demonstrable rebound effect. Therefore anticholinergic therapies may be a useful adjunct in controlling the rhinorrhea associated with allergic rhinitis.

Intranasal anticholinergic therapy of rhinorrhea

This article reviews the role of anticholinergic therapy for the rhinorrhea that occurs in various rhinopathies, including irritant reactions, perennial nonallergic rhinitis, viral infection rhinitis, allergic rhinitis, and temperature-induced rhinitis. The use of a topical anticholinergic medication, ipratropium bromide, and its ability to inhibit methacholine and rhinitis-induced hypersecretion is emphasized. Ipratropium bromide appears to be both safe and effective in reducing this troublesome symptom.