Pediatric Dosage of Ipratropium Bromide (Ipravent)
For pediatric patients, ipratropium bromide (Ipravent) should be administered via nebulizer at 0.25-0.5 mg every 20 minutes for 3 doses, then as needed for children under 12 years of age. 1
Dosing by Administration Route
Nebulizer Solution (0.25 mg/mL)
- Children under 12 years: 0.25-0.5 mg every 20 minutes for 3 doses, then as needed 1
- May be mixed in same nebulizer with albuterol for enhanced bronchodilation 1
- Should not be used as first-line therapy; should be added to short-acting beta-agonist (SABA) therapy for severe exacerbations 1
Metered-Dose Inhaler (MDI) (18 mcg/puff)
- Children under 12 years: 4-8 puffs every 20 minutes as needed up to 3 hours 1
- Should use with valved holding chamber (VHC) and face mask for children under 4 years 1
- Studies have examined ipratropium bromide MDI for up to 3 hours 1
Combination with Albuterol
- Nebulizer solution (each 3-mL vial contains 0.5 mg ipratropium bromide and 2.5 mg albuterol): 1.5 mL every 20 minutes for 3 doses, then as needed 1
- MDI (each puff contains 18 mcg ipratropium bromide and 90 mcg albuterol): 4-8 puffs every 20 minutes as needed up to 3 hours 1
Clinical Considerations
Efficacy
- May be used for up to 3 hours in the initial management of severe asthma exacerbations 1
- The addition of ipratropium to albuterol has not been shown to provide further benefit once the patient is hospitalized 1
- Studies show improved outcomes when combined with salbutamol (albuterol) in moderate asthma exacerbations 2
Administration Tips
- For nasal use in allergic rhinitis or common cold: 42 mcg per nostril 3 times daily for children 2-5 years 3
- For perennial rhinitis in children 6-18 years: 42 mcg per nostril twice daily 4
- Parents report administration of nasal spray as "extremely easy" or "very easy" in 67-91% of cases 3
Safety Considerations
- Well-tolerated in pediatric populations with infrequent and mild to moderate adverse events 3
- Study discontinuation due to adverse events occurs in less than 3% of pediatric patients 3
- No serious or systemic anticholinergic adverse effects reported in children 2-5 years 3
Important Notes
- Pediatric patients require individualized dosing based on age, size, and organ maturity - not simply reduced adult doses 5
- For children with perennial allergic rhinitis, more frequent administration (three times daily) might be beneficial compared to twice daily dosing 4
- The addition of ipratropium has shown significant improvement in PEFR (Peak Expiratory Flow Rate) when combined with salbutamol in moderate asthma 2
Remember that ipratropium bromide should not be used as first-line therapy for asthma exacerbations but should be added to SABA therapy for severe exacerbations 1.