When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to ipratropium or to other medicines like ipratropium (such as atropine, hyoscyamine, or scopolamine).

How to Use This Medicine:
Spray

• Your doctor will tell you how much medicine to use. Do not use more than directed.
• This medicine is for use only in the nose. Do not get any of it in your eyes or on your skin. If it does get on these areas, rinse it off right away.
• Some patients using this medicine may feel better right away. For others, it may take 1 or 2 weeks before the medicine helps. Keep using the medicine on a regular schedule as your doctor ordered.
• Take the plastic dust cap and safety clip off of the spray pump.
• If you are using the spray pump for the first time or if it has been more than a week since you last used the medicine, you will need to prime the spray pump. Hold the bottle with your thumb on the bottom of the bottle and your index and middle fingers on the tabs on the side of the pump.
• Hold the bottle upright and point it away from your eyes. Push up quickly and firmly with your thumb 7 times. You do not need to prime the pump again unless it has been more than 24 hours since you last used it. Then you may need to prime the pump with 2 sprays.
• Before using the medicine, gently blow your nose to clear the nostrils.
• Put the tip of the spray pump into one nostril, and hold the other nostril closed.
• Tilt your head forward slightly and spray the medicine into your nostril.
• Take the spray pump out of your nostril and sniff deeply through your nose. Then breathe out through your mouth.
• Tilt your head back for a few seconds so the medicine can go to the back of your nose.
• Wait a few seconds before using the spray in the same nostril. Then use the spray in your other nostril by following the same steps.
• If the spray pump gets clogged, hold the tip of the bottle under warm running water for about 1 minute. Dry the pump and prime it again.
• After using the nasal spray, wipe the tip of the bottle with a clean tissue and put the cap back on.
• If you do not use the bottle for more than 7 days, clean the spray tip and prime it again by releasing seven sprays.
• Keep track of the number of sprays you use. Throw the bottle away after you use 345 sprays even if some liquid remains in the bottle.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are also using atropine, dicyclomine (Bentyl®), hyoscyamine (Cystospaz®), Donnatal®, orphenadrine (Norflex®), scopolamine (Transderm Scop®), or other products containing ipratropium (such as mouth inhaler).

Warnings While Using This Medicine:

• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have an kidney disease, liver disease, enlarged prostate, glaucoma, trouble urinating, or if you have any drug or food allergies.
• This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Stop using this medicine and call your doctor right away if you or your child have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, or mouth while you are using this medicine.
• Do not spray the medicine into your eyes. If this does happen, rinse your eyes with cool water for a few minutes. Call your doctor if you have eye pain or blurred vision. Your eyes may be more sensitive to light for a few hours after the spray gets in your eyes. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).
• This medicine may make you dizzy or trouble in seeing clearly. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert or not able to see well.
• If you have dryness of the nose or have unexplained nosebleeds, call your doctor right away.
• Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments.
• Call your doctor if your symptoms do not improve or if they get worse.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blurred vision, or eye pain or irritation.
• Chest pain, or a fast, pounding heartbeat.
• Problems with bowel movements (stools).
• Trouble urinating or pain when urinating.

If you notice these less serious side effects, talk with your doctor:

• Bad taste in mouth.
• Dry mouth or throat, cough, hoarseness, sore throat, or runny or stuffy nose.
• Headache or dizziness.
• Nosebleeds, or nasal dryness or irritation.
• Skin rash.

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088