What is the recommended dose of Duolin (ipratropium bromide and salbutamol) Respule for a 6.6kg infant?

Duolin Respule Dosing for a 6.6kg Infant

For a 6.6kg infant, use 0.5 mL (half) of a Duolin Respule (containing 0.25 mg ipratropium bromide and 1.25 mg salbutamol) every 20 minutes for 3 doses during acute exacerbations, then as needed.

Weight-Based Dosing Calculation

• The standard pediatric dose for ipratropium bromide is 0.25-0.5 mg every 20 minutes for 3 doses in children under 12 years 1, 2
• For salbutamol (albuterol), the recommended dose is 0.075 mg/kg (minimum 1.25 mg) every 20 minutes for 3 doses 1
• At 6.6kg, the calculated salbutamol dose would be 0.495 mg (6.6 × 0.075), but the minimum dose is 1.25 mg 1
• A standard Duolin Respule (3 mL) contains 0.5 mg ipratropium + 2.5 mg albuterol 1
• For this infant, use 1.5 mL (half a respule) which provides 0.25 mg ipratropium and 1.25 mg salbutamol 1, 2

Administration Protocol

Initial Treatment (First Hour)

• Administer 1.5 mL every 20 minutes for 3 doses during severe exacerbations 1, 2
• This provides the minimum effective dose while avoiding excessive beta-agonist exposure in this small infant 1

Maintenance Dosing

• After initial 3 doses, continue with 1.5 mL every 1-4 hours as needed based on clinical response 1
• The combination should be used for up to 3 hours in initial management of severe exacerbations 1, 2

Critical Clinical Considerations

When to Use Combination Therapy

• Do not use ipratropium as first-line therapy; it should be added to salbutamol for severe exacerbations only 1, 2
• The combination is most beneficial in the emergency department setting for moderate-to-severe bronchospasm 3, 4
• Once hospitalized, adding ipratropium provides no additional benefit beyond continued salbutamol alone 1, 2

Mixing and Compatibility

• Duolin components (ipratropium and salbutamol) may be mixed in the same nebulizer without loss of efficacy 1, 2
• The pre-mixed formulation ensures appropriate dosing ratios 1, 2

Common Pitfalls to Avoid

• Avoid using full 3 mL respules in infants under 10kg, as this delivers excessive salbutamol (2.5 mg) when the minimum effective dose (1.25 mg) is sufficient 1
• Do not continue combination therapy after hospital admission; switch to salbutamol alone once stabilized 1, 2
• Do not use as monotherapy; always ensure salbutamol is the primary bronchodilator with ipratropium as adjunctive therapy 1, 2
• Monitor for cardiovascular effects (tachycardia) given the infant's small size and potential sensitivity to beta-agonists 1

Monitoring Parameters

• Assess respiratory rate, oxygen saturation, and work of breathing at 15-minute intervals during initial treatment 3
• Evaluate clinical response after each dose to determine need for continued therapy 1
• Be prepared to provide respiratory support if bronchospasm worsens despite treatment 1