Ipratropium Bromide

Adults: Nebuliser Solution, for adults (including elderly patients) and children over 12 years: 250-500 micrograms (that is, 1 ml or 2 ml) of ipratropium bromide nebuliser solution 3 to 4 times daily. For acute bronchospasm, 500 micrograms/2 ml is used. It is best not to go beyond the recommended daily dose during either acute or maintenance treatment, and daily doses above 2 mg in adults and children over 12 should only be given under medical supervision. For children aged 6 to 12 years: 250 micrograms (1 ml), up to a total daily dose of 1 mg (4 ml), with the interval between doses left to the physician's judgment. For children aged 0 to 5 years (for acute asthma only): 125-250 micrograms (0.5 ml to 1 ml), up to a total daily dose of 1 mg (4 ml). In children under 5 years, ipratropium should not be given more often than every 6 hours; doses may be repeated until the patient is stable, with the interval again left to the physician's judgment. Ipratropium nebuliser solution can be mixed with a short-acting beta 2-agonist in the same nebulizer chamber; once mixed, it should be used promptly and any leftover solution discarded. It can be given through most commercially available nebulizing devices, and the solution may need diluting, usually to a final volume of 2-4 ml, to suit the particular nebulizer; if dilution is needed, only sterile sodium chloride 0.9% solution should be used. This unit-dose solution is meant for inhalation through a nebulizer only and must not be swallowed or injected. Inhaler, for adults: the usual dose is 1-2 puffs (20 gm per spray) three or four times daily. A single dose of up to 80 gm (4 puffs) may be needed for best effect early in treatment, and further puffs may be taken as required, but total inhalations should not go beyond 12 in 24 hours. For children aged 6 to 12 years: usually 1-2 puffs, two to three times daily. Below 6 years: usually 1 puff (20 gm) three times daily. An adult should supervise use of the inhaler to make sure it is taken correctly. For elderly patients, there is no specific dosing information available, though clinical trials have included patients over 65 years without any adverse reactions particular to this age group being reported.