What is the recommended dose of Duolin (ipratropium bromide and salbutamol) for a pediatric patient aged 3 years?

Duolin (Ipratropium Bromide and Salbutamol) Dosage for a 3-Year-Old Child

For a 3-year-old child, the recommended dose of Duolin (ipratropium bromide and salbutamol combination) via nebulization is 1.5 mL every 20 minutes for 3 doses, then as needed. 1, 2

Nebulization Dosing for Children Under 5 Years

• For children under 5 years, the albuterol (salbutamol) component should be dosed at 0.63 mg/3 mL via nebulizer 3
• For children under 12 years, the ipratropium bromide component should be dosed at 0.25-0.5 mg via nebulizer 1, 2
• When using the combination (Duolin), the appropriate dose is 1.5 mL of the solution (containing 0.25 mg ipratropium bromide and 1.25 mg salbutamol) 1, 2
• For children under 3 years of age, the optimal dose of ipratropium bromide is 125 micrograms (0.125 mg) delivered as a nebulized solution 4

Administration Guidelines

• Administer via nebulizer with an appropriate pediatric mask 1, 2
• For acute exacerbations, administer every 20 minutes for the first 3 doses, then as needed 1, 2
• Ensure proper fit of the mask to maximize medication delivery 2
• For children under 4 years, use with a spacer device and facial mask if using MDI formulation instead of nebulizer 1

Clinical Considerations

• The combination of ipratropium bromide and salbutamol provides better bronchodilation than salbutamol alone in moderate asthma exacerbations 5
• Ipratropium bromide is particularly useful in children under 3 years, when beta-2 stimulants alone may be less effective 4
• The combination should not be used as first-line therapy but should be added to salbutamol therapy for moderate to severe exacerbations 2
• The duration of action for ipratropium bromide (0.25 mg) is approximately 6 hours 6

Monitoring and Safety

• Monitor for potential adverse effects including drying of mouth and respiratory secretions 3
• Watch for increased wheezing in some individuals, which can occur with ipratropium 3
• The combination is generally well-tolerated in children, with most adverse events being infrequent and mild to moderate 7
• Vomiting may occur more frequently with repeated dosing of nebulized salbutamol 8

Important Cautions

• Do not exceed recommended doses, as higher doses may increase the risk of side effects without providing additional benefit 4, 8
• The combination formulation contains EDTA to prevent discoloration of the solution, which does not induce bronchospasm 3
• After the initial management in acute settings, reassess the need for continued combination therapy, as ipratropium may not provide additional benefit once the patient is stabilized 1, 2