What is the recommended dose for an Atrovent (ipratropium bromide) inhaler?

Recommended Dosage for Atrovent (Ipratropium Bromide) Inhaler

The standard dosage for ipratropium bromide (Atrovent) inhaler is 2 puffs (36 mcg) four times daily, with a maximum of 12 doses per day. 1

Adult Dosing

Metered-Dose Inhaler (MDI)

• Standard dose: 2 puffs (36 mcg) four times daily 1
• For acute asthma exacerbations: 8 puffs every 20 minutes as needed for up to 3 hours 2, 3
• Each puff contains 18 mcg of ipratropium bromide 3
• Maximum recommended doses should not exceed 12 puffs per day 1

Nebulizer Solution

• Standard dose: 500 mcg (1 unit-dose vial of 2.5 mL) administered 3-4 times daily, with doses 6-8 hours apart 4
• For acute asthma exacerbations: 500 mcg every 20 minutes for 3 doses, then as needed 2, 3
• Can be mixed with albuterol or metaproterenol in the nebulizer if used within one hour 4

Pediatric Dosing (under 12 years)

Metered-Dose Inhaler (MDI)

• For acute asthma exacerbations: 4-8 puffs every 20 minutes as needed for up to 3 hours 2, 3, 5

Nebulizer Solution

• For acute asthma exacerbations: 250-500 mcg every 20 minutes for 3 doses, then as needed 3, 5

Combination with Albuterol

For Adults

• Nebulizer: 3 mL (containing 0.5 mg ipratropium bromide and 2.5 mg albuterol) every 20 minutes for 3 doses, then as needed 3
• MDI: 8 puffs every 20 minutes as needed for up to 3 hours 3

For Children

• Nebulizer: 1.5 mL (containing 0.25 mg ipratropium bromide and 1.25 mg albuterol) every 20 minutes for 3 doses, then as needed 3, 5
• MDI: 4-8 puffs every 20 minutes as needed for up to 3 hours 3, 5

Clinical Considerations

• Ipratropium bromide has a delayed onset of action (within 15 minutes) compared to beta-agonists, with a mean dose-dependent duration of effect of 3-5 hours 1
• For asthma exacerbations, ipratropium should not be used as first-line therapy but should be added to beta-agonist therapy, particularly in severe cases 2, 3, 5
• The combination of ipratropium bromide and a beta-agonist has been shown to reduce hospitalizations, particularly in patients with severe airflow obstruction 2
• Once a patient is hospitalized, the addition of ipratropium to albuterol has not shown to provide additional benefit 3, 5
• For children under 4 years, ipratropium bromide should be used with a spacer chamber and face mask 3

Common Side Effects

• Most common adverse effects are mild and include cough, dry mouth, nausea, palpitations, nervousness, gastrointestinal distress, and dizziness 1, 6
• Respiratory system disorders are the most commonly reported adverse events in long-term use 6