Formulary
Ipratropium bromide: Indications, Dosing, Side Effects and Interactions
Ipratropium bromide clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Ipratropium bromide: Indications, Dosing, Side Effects and Interactions
Ipratropium bromide clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Reversible airways obstruction**
- **Child** (By Inhalation Of Aerosol): 12-17 years 20-40 micrograms 3-4 times a day.
**Reversible airways obstruction, particularly in chronic obstructive pulmonary disease**
- **Adult** (By Inhalation Of Aerosol): 20-40 micrograms 3-4 times a day.
- **Adult** (By Inhalation Of Nebulised Solution): 250-500 micrograms 3-4 times a day.
**Acute bronchospasm**
- **Child** (By Inhalation Of Nebulised Solution): 12-17 years 500 micrograms as required, doses higher than max. can be given under medical supervision; maximum 2 mg per day.
- **Adult** (By Inhalation Of Nebulised Solution): 500 micrograms as required, doses higher than max. can be given under medical supervision; maximum 2 mg per day.
**Severe or life-threatening acute asthma**
- **Child** (By Inhalation Of Nebulised Solution): 12-17 years 500 micrograms every 4-6 hours as required.
- **Adult** (By Inhalation Of Nebulised Solution): 500 micrograms every 4-6 hours as required.
**Reversible airways obstruction for ipratropium bromide**
- **Child 1 month-5 years** (By inhalation of aerosol): 20 micrograms 3 times a day.
- **Child 6-11 years** (By inhalation of aerosol): 20-40 micrograms 3 times a day.
- **Child 12-17 years** (By inhalation of aerosol): 20-40 micrograms 3-4 times a day.
**Acute bronchospasm for ipratropium bromide**
- **Child 1 month-5 years** (By inhalation of nebulised solution): 125-250 micrograms as required; maximum 1 mg per day.
- **Child 6-11 years** (By inhalation of nebulised solution): 250 micrograms as required; maximum 1 mg per day.
- **Child 12-17 years** (By inhalation of nebulised solution): 500 micrograms as required, doses higher than max. can be given under medical supervision; maximum 2 mg per day.
**Severe or life-threatening acute asthma for ipratropium bromide**
- **Child 1 month-11 years** (By inhalation of nebulised solution): 250 micrograms every 20-30 minutes for the first 2 hours, then 250 micrograms every 4-6 hours as required.
- **Child 12-17 years** (By inhalation of nebulised solution): 500 micrograms every 4-6 hours as required.
**Rhinorrhoea associated with allergic and non-allergic rhinitis for ipratropium bromide**
- **Child 12-17 years** (By intranasal administration): 2 sprays 2-3 times a day, dose to be sprayed into each nostril.
Cautions
For all antimuscarinics (inhaled) Bladder outflow obstruction; paradoxical bronchospasm; prostatic hyperplasia; susceptibility to angle-closure glaucoma Cautions, further information Elderly In adults: Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate with a history of angle-closure glaucoma (may exacerbate glaucoma) or bladder outflow obstruction (may cause urinary retention). Cautions For ipratropium bromide When used by inhalation Avoid spraying near eyes; cystic fibrosis With intranasal use Avoid spraying near eyes; bladder outflow obstruction; cystic fibrosis; prostatic hyperplasia (in adults); susceptibility to angle-closure glaucoma Cautions, further information Glaucoma When used by inhalation: Acute angle-closure glaucoma has been reported with nebulised ipratropium, particularly when given with nebulised salbutamol (and possibly other beta 2 agonists); care needed to protect the patient's eyes from nebulised drug or from drug powder.
Side effects
For all antimuscarinics (inhaled) Common or very common Arrhythmias; constipation; cough; dizziness; dry mouth; headache; nausea Uncommon Dysphonia; glaucoma; palpitations; skin reactions; stomatitis; urinary disorders; vision blurred Side-effects For ipratropium bromide General side-effects: Common or very common Gastrointestinal motility disorder; throat complaints Uncommon Corneal oedema; eye disorders; eye pain; respiratory disorders; vision disorders Specific side-effects: Common or very common With intranasal use Epistaxis; headache; nasal complaints Uncommon When used by inhalation Diarrhoea; vomiting With intranasal use Nausea; stomatitis Rare or very rare With intranasal use Palpitations Side-effects, further information For intranasal use, also consider the side-effects of inhaled antimuscarinics.
Pregnancy
When used for Asthma: Inhaled drugs can be taken as normal during pregnancy. When used for Reversible airways obstruction or Rhinorrhoea: Use only if potential benefit outweighs the risk. M
Breast feeding
No information available-manufacturer advises only use if potential benefit outweighs risk.
Medicinal forms
Spray
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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