What is the recommended dose of ipratropium bromide (ipratropium bromide) nasal spray for adults and children?

Ipratropium Bromide Nasal Spray Dosing

For rhinorrhea associated with the common cold or seasonal allergic rhinitis, use ipratropium bromide nasal spray 0.06% at 2 sprays (84 mcg) per nostril 3-4 times daily in adults and children ≥5 years, while for perennial allergic or nonallergic rhinitis, use the 0.03% concentration at 2 sprays (42 mcg) per nostril 2-3 times daily in patients ≥6 years. 1

Dosing by Indication and Age

Common Cold (0.06% Concentration)

Adults and children ≥12 years:

• 2 sprays (84 mcg) per nostril 3-4 times daily (total dose 504-672 mcg/day) 1
• Maximum duration: 4 days 1

Children 5-11 years:

• 2 sprays (84 mcg) per nostril 3 times daily (total dose 504 mcg/day) 1
• Maximum duration: 4 days 1

Children 2-5 years:

• 84 mcg per nostril 3 times daily for 4 days 2
• Well tolerated with 91% of parents finding administration "extremely easy" or "very easy" 2

Seasonal Allergic Rhinitis (0.06% Concentration)

Adults and children ≥5 years:

• 2 sprays (84 mcg) per nostril 4 times daily (total dose 672 mcg/day) 1
• Maximum duration: 3 weeks 1

Perennial Allergic and Nonallergic Rhinitis (0.03% Concentration)

Adults and children ≥6 years:

• 2 sprays (42 mcg) per nostril 3 times daily 3
• This concentration is FDA-approved specifically for perennial rhinitis 3

Children 2-5 years with allergies:

• 42 mcg per nostril 3 times daily for 14 days 2
• 90% of parents found this regimen "very useful" or "somewhat useful" 2

Pediatric considerations:

• Twice daily dosing (42 mcg per nostril bid) is adequate for perennial nonallergic rhinitis in children 6-18 years 4
• Children with perennial allergic rhinitis may benefit from more frequent administration (tid) 4

Administration Technique

Pump priming:

• Initial priming requires 7 sprays 1
• If unused for >24 hours: reprime with 2 sprays 1
• If unused for >7 days: reprime with 7 sprays 1
• Avoid spraying into eyes 1

Combination Therapy

With intranasal corticosteroids:

• Ipratropium bromide 0.03% (42 mcg per nostril tid) combined with beclomethasone (84 mcg per nostril bid) is more effective than either agent alone for rhinorrhea control 5
• Combination therapy shows benefit by the first day and continues throughout treatment 5
• No increase in adverse events with combination therapy 5

With antihistamines:

• Concomitant use provides increased efficacy over either drug alone without increased adverse events 3

Clinical Considerations

Onset and efficacy:

• Ipratropium has faster onset during the first week compared to intranasal corticosteroids 5
• Specifically targets rhinorrhea; modest benefit for congestion in pediatric patients 3
• Effective for cold-induced rhinitis and gustatory rhinitis 3

Long-term use:

• For perennial allergic rhinitis, can be used long-term with dose reduction to lowest amount needed to control rhinorrhea after initial 6 months 6
• 84 mcg per nostril tid is well tolerated for up to 1 year 6

Steroid non-responders:

• Ipratropium is equally effective in patients who previously did not respond well to nasal steroids 5

Safety Profile

Common adverse events:

• Epistaxis: 9% (vs 5% with saline vehicle) 3
• Nasal dryness: 5% (vs 1% with saline vehicle) 3
• Most adverse events are mild and transient 3

Important safety notes:

• Does not alter physiologic nasal functions (smell, ciliary beat, mucociliary clearance) 3
• Minimal systemic absorption due to quaternary structure 3
• No clinically significant anticholinergic side effects 6
• Drug discontinuation due to adverse events <10% 6

Common Pitfalls to Avoid

• Do not use ipratropium as monotherapy for congestion or sneezing—it is approved only for rhinorrhea 3
• Do not exceed recommended treatment duration for common cold (4 days) or seasonal allergic rhinitis (3 weeks) without reassessment 1
• Ensure proper concentration selection: 0.06% for common cold/seasonal allergic rhinitis vs 0.03% for perennial rhinitis 3, 1