What is the recommended dosage of Atrovent (ipratropium) for treating post-viral cough?

From the Guidelines

For treating post-viral cough, the typical recommended dosage of Atrovent (ipratropium bromide) is 2 inhalations (36 mcg total) four times daily using a metered-dose inhaler, as supported by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1.

Key Considerations

• Treatment usually continues for 1-2 weeks or until symptoms resolve.
• Some clinicians may recommend using it on an as-needed basis up to four times daily.
• Ipratropium works by blocking muscarinic receptors in the airways, reducing mucus secretion and bronchial constriction that contribute to post-viral cough.
• This anticholinergic medication is particularly helpful when the post-viral cough is accompanied by excessive secretions.

Patient Education

• Patients should rinse their mouth after use to prevent dry mouth.
• They should be aware that common side effects may include headache, dry mouth, and throat irritation.
• If symptoms persist beyond two weeks or worsen, medical reevaluation is recommended as this may indicate a different underlying condition requiring alternative treatment.

Clinical Context

• The use of inhaled ipratropium may be helpful in patients with postinfectious cough, especially when the cough is associated with excessive mucus secretion and/or transient airway and cough receptor hyperresponsiveness 1.
• In patients with postinfectious cough, when the cough adversely affects the patient’s quality of life and when cough persists despite use of inhaled ipratropium, consider the use of inhaled corticosteroids 1.

From the FDA Drug Label

The usual dosage of ipratropium bromide inhalation solution is 500 mcg (1 Unit-Dose Vial) administered three to four times a day by oral nebulization, with doses 6 to 8 hours apart. The recommended dosage of Atrovent (ipratropium) for treating post-viral cough is 500 mcg administered three to four times a day by oral nebulization, with doses 6 to 8 hours apart 2.

From the Research

Recommended Dosage of Atrovent (Ipratropium) for Post-Viral Cough

The recommended dosage of Atrovent (ipratropium) for treating post-viral cough can be determined based on the following studies:

• A study published in 1992 3 found that inhaled ipratropium bromide (320 micrograms day-1) produced significantly less daytime and nighttime cough in non-smoking patients with persistent post-viral infective cough.
• Another study published in 2014 4 used a nebulized combination of salbutamol 1.875 mg/0.5 mL and ipratropium bromide 0.375 mg/0.5 mL for 10 days to treat post-viral cough, and found that it effectively reduced cough severity.

Key Findings

• The dosage of ipratropium bromide used in the 1992 study 3 was 320 micrograms per day.
• The 2014 study 4 used a combination of salbutamol and ipratropium bromide, with a dosage of 0.375 mg/0.5 mL of ipratropium bromide per treatment.
• Both studies found that ipratropium bromide was effective in reducing post-viral cough severity.

Dosage Considerations

• The optimal dosage of Atrovent (ipratropium) for post-viral cough may vary depending on individual patient needs and response to treatment.
• Patients should consult their healthcare provider to determine the best course of treatment and dosage for their specific condition, as supported by studies such as 4 and 3.