Ipratropium Bromide Nebuliser Solution: Severe Asthma Attack Dosing

Therapeutic action

Bronchodilator, anticholinergic drug.

Indications

Severe asthma attack, in combination with salbutamol.

Forms and strengths

Solution for inhalation, in unit dose vial of 0.25 mg in 1 ml (0.25 mg/ml) and 0.5 mg in 2 ml (0.25 mg/ml), to be administered via a nebuliser.

Dosage and duration

• Child under 5 years: 0.25 mg (1 ml) per nebulisation every 20 minutes for the first hour.
• Child 5 years and over and adult: 0.5 mg (2 ml) per nebulisation every 20 minutes for the first hour.

Contra-indications, adverse effects, precautions

• May cause throat irritation, headache, cough, vomiting, dryness of the mouth, constipation, dilation of the pupils, blurred vision, urinary retention, and tachycardia.
• Administer with caution to older patients and patients with closed-angle glaucoma, urethroprostatic disorders, or urinary retention.
• Avoid or monitor combination with drugs known to have anticholinergic effects, including tricyclic antidepressants, first-generation H1 antihistamines, biperiden, antispasmodics, and antipsychotics.
• Pregnancy and breast-feeding: no contra-indication.
• Volumes of nebuliser solution are insufficient for efficient nebulisation in most nebulisers. Add ipratropium to salbutamol, then add 0.9% sodium chloride to obtain a total volume of 5 ml in the nebuliser reservoir.
• Stop nebulisation when the reservoir is empty, after around 10 to 15 minutes.