Ipratropium Bromide Dosing for Bronchitis
The recommended dose of ipratropium bromide for bronchitis is 500 mcg (1 unit-dose vial) administered three to four times a day by oral nebulization, with doses 6 to 8 hours apart. 1
Dosing Guidelines by Administration Route
Nebulizer Solution
- For adults: 500 mcg (2.5 mL) administered three to four times daily by oral nebulization 1
- For children under 12 years: 0.25-0.5 mg every 20 minutes for 3 doses, then as needed 2
- Ipratropium bromide can be mixed in the nebulizer with albuterol or metaproterenol if used within one hour 1
Metered Dose Inhaler (MDI)
- For adults: 2 puffs (36 mcg) four times daily on a regular schedule 3
- During acute exacerbations: 8 inhalations every 20 minutes as needed up to 3 hours 4
- Each puff contains 18 mcg of ipratropium bromide 4
Combination Therapy with Albuterol
- For adults, nebulized combination therapy: 3 mL (containing 0.5 mg ipratropium bromide and 2.5 mg albuterol) every 20 minutes for 3 doses, then as needed 4
- For children, nebulized combination therapy: 1.5 mL every 20 minutes for 3 doses, then as needed 4, 2
- Combination therapy has shown superior efficacy compared to either agent alone in patients with bronchitis 5
Clinical Considerations
- Ipratropium bromide works by interrupting vagally mediated bronchoconstriction at parasympathetic nerve endings 6
- Onset of action occurs within 15 minutes, with a mean dose-dependent duration of effect of three to five hours 6
- The bronchodilatory effect in chronic obstructive pulmonary disease appears to be comparable, and may be superior, to beta-sympathomimetic agents 6
- Multiple doses in the emergency department setting provide additive benefit to short-acting beta-agonists (SABAs) 7
Potential Adverse Effects
- Side effects are generally mild and include drying of mouth and respiratory secretions 7, 6
- Other reported adverse effects include cough, nausea, palpitations, nervousness, gastrointestinal distress, and dizziness 6
- No significant alterations in pulse or blood pressure have been observed 8
Common Pitfalls to Avoid
- Do not exceed the recommended daily maximum dosage (typically 12 doses per day) 6
- Ensure proper inhaler technique to maximize drug delivery to the lungs 3
- Drug stability and safety when mixed with medications other than albuterol or metaproterenol in a nebulizer have not been established 1
- For MDI administration in children under 4 years, use with a spacer chamber and face mask for optimal delivery 4