What is the recommended dose for Atrovent (Ipratropium) MDI (Metered-Dose Inhaler)?

Atrovent MDI Dosing

For adults, administer 8 puffs (144 mcg) every 20 minutes as needed for up to 3 hours during acute asthma exacerbations, with each puff delivering 18 mcg of ipratropium bromide. 1

Acute Exacerbation Dosing

Adults

• 8 puffs every 20 minutes as needed for up to 3 hours during severe asthma or COPD exacerbations 1, 2
• Each puff delivers 18 mcg of ipratropium bromide 1, 2
• Must be used with a valved holding chamber (spacer) for optimal delivery 1

Children (under 12 years)

• 4-8 puffs every 20 minutes as needed for up to 3 hours 1, 2
• For children under 4 years, must use spacer with face mask 1, 2

Maintenance Dosing for Stable Disease

Standard Chronic Therapy

• 2-4 puffs (36-72 mcg) four times daily for stable COPD or chronic bronchitis 3, 4
• Maximum of 12 inhalations per 24 hours 4
• If symptoms persist, may increase to 8 puffs (144 mcg) four times daily before considering nebulizer therapy 3

Critical Clinical Considerations

Role in Therapy

• Ipratropium should NOT be used as first-line monotherapy for acute exacerbations 1, 2
• Must be added to short-acting beta-agonist (SABA) therapy, particularly for severe exacerbations 1, 2
• The addition of ipratropium to albuterol has not shown further benefit once the patient is hospitalized 1, 2

Timing and Duration

• Studies have examined ipratropium MDI for up to 3 hours in acute settings 1
• Onset of action occurs within 15 minutes, with peak effect at approximately 1 hour 4, 5
• Duration of effect is 3-5 hours 4

Combination Therapy

• When using combination ipratropium/albuterol MDI (each puff contains 18 mcg ipratropium + 90 mcg albuterol): 8 puffs every 20 minutes as needed for up to 3 hours in adults 1
• For children: 4-8 puffs every 20 minutes as needed for up to 3 hours 1

Common Pitfalls to Avoid

• Do not delay SABA therapy to administer ipratropium—always use in combination during acute exacerbations 1, 2
• Ensure proper MDI technique with spacer device, especially in elderly patients or those with coordination difficulties 3
• Do not continue aggressive ipratropium dosing beyond the initial 3-hour period in acute settings, as benefit diminishes 1, 2
• Mild side effects include dry mouth, cough, and dizziness, but these are generally well-tolerated 4, 6