Prescribing Notes
- Short-acting antimuscarinic agents (SAMAs) should be discontinued when LAMAs are initiated.
- LAMAs are not suitable for the relief of acute bronchospasm and must not be given in combination with ipratropium.
- Patients with very severe COPD who are receiving regular home nebulised ipratropium or Combivent® (containing ipratropium and salbutamol) should not be prescribed a LAMA in addition.
- Consider renal function when selecting a LAMA – see BNF cautions re use of tiotropium and glycopyrronium.
Cautions
- Antimuscarinic bronchodilators should be used with caution in patients with prostatic hyperplasia, bladder outflow obstruction and those susceptible to angle-closure glaucoma (see below).
- LAMAs should be used with caution in cardiac disorders. (particularly cardiac rhythm disorders) see newsletter ‘LAMAs and Cardiovascular Risk’.
- Acute angle-closure glaucoma has been reported with nebulised ipratropium, particularly when given with nebulised salbutamol (and possibly other beta-2 agonists); care is needed to protect the patient’s eyes from nebulised drug or from drug powder, e.g. administer via mouthpiece.