Ipratropium is a bronchodilator and use for asthma and bronchospasm.
Acute bronchospasm
By inhalation of nebulised solution
Child 1 month–5 years
125–250 micrograms as required; maximum 1 mg per day.
Child 6–11 years
250 micrograms as required; maximum 1 mg per day.
Child 12–17 years
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
By inhalation of nebulised solution
Child 1 month–11 years
250 micrograms every 20–30 minutes for the first 2 hours, then 250 micrograms every 4–6 hours as required.
Child 12–17 years
500 micrograms every 4–6 hours as required.
Refer to BNFC for further information.
IPRATROPIUM BROMIDE (ATROVENT)
INDICATIONS AND USE: Bronchodilator for adjunctive treatment of acute bronchospasm. ACTIONS: Anticholinergic drug that acts by antagonizing the action of acetylcholine at the parasympathetic receptor sites, thereby producing bronchodilation.
DOSAGE:
Inhalation.
• Neonates: 25 mcg/kg/dose nebulized every 8 hours.
• Infants: 125 to 250 mcg/dose nebulized every 8 hours. Dilute to 3 mL with normal saline or concurrent albuterol.
Dosing: Pediatric
**Ref: Gomella neonatology 8th edition.
_ Asthma, acute exacerbation: Limited data available (Ref): Note: For moderate to severe exacerbations, ipratropium may be considered if poor response to initial short-acting beta-2 agonist (SABA) therapy during initial management in an acute care setting (eg, emergency department). Ipratropium has not been shown to provide further benefit (eg, after first 24 hours) once the patient is hospitalized (Ref):
Children:
Nebulization: 0.25 to 0.5 mg (250 to 500 mcg) every 20 minutes for 1 hour (ie, 3 doses), then as needed; in trials, the usual reported dose is 0.25 mg (250 mcg) and reported interval range is every 1 to 8 hours typically with an increasing dosing interval as patient improves; some trials continued combination SABA/ipratropium therapy for duration of hospitalization (up to 49 hours) although trials have not demonstrated additional benefit with extended use (Ref)
_ Asthma, maintenance therapy (nonacute): Limited data available: Note: Evidence is lacking that ipratropium provides added benefit to beta-2 agonists in long-term control asthma therapy (Ref)
Children <12 years:
Nebulization: 0.25 to 0.5 mg (250 to 500 mcg) every 6 to 8 hours
Children ≥12 years and Adolescents:
Nebulization: 0.25 to 0.5 mg (250 to 500 mcg) every 6 hours
_ Bronchospasm associated with chronic pulmonary conditions: Children ≥12 years and Adolescents: Nebulization: 0.5 mg (500 mcg, one unit-dose vial) 3 to 4 times daily with doses 6 to 8 hours apart.
**Ref: atrovent lexicomp monograph for pediatrics.
