From the FDA Drug Label
The usual dosage of ipratropium bromide inhalation solution is 500 mcg (1 Unit-Dose Vial) administered three to four times a day by oral nebulization, with doses 6 to 8 hours apart. The dose of ipratropium for cough is 500 mcg administered three to four times a day by oral nebulization, with doses 6 to 8 hours apart 1.
From the Research
Ipratropium bromide can be used to treat cough, particularly in cases of chronic bronchitis or COPD-related cough, at a typical dose of 20 micrograms (2 puffs) inhaled via metered-dose inhaler 3-4 times daily, with the most effective nebulized dose being 0.4 mg, as shown in a study published in The American review of respiratory disease 2. For nebulized solution, the optimal dose is 0.4 mg, which achieved significantly more bronchodilatation than other treatments, with a peak effect between 1 and 2 hours and significant bronchodilatation persisting for 6.5 hours 2. Ipratropium works by blocking muscarinic acetylcholine receptors in the airways, reducing mucus secretion and bronchial constriction that contribute to cough. This anticholinergic medication is particularly effective for coughs associated with increased secretions. Side effects may include dry mouth, throat irritation, and rarely, urinary retention or increased intraocular pressure, as reported in a review of the literature 3. Patients should rinse their mouth after using the inhaler to prevent these local side effects. For acute cough without underlying respiratory disease, ipratropium is generally not the first-line treatment, and other approaches may be more appropriate, as suggested by a study comparing ipratropium with other bronchodilating agents 4. Key points to consider when prescribing ipratropium include:
- Typical dose: 20 micrograms (2 puffs) inhaled via metered-dose inhaler 3-4 times daily
- Optimal nebulized dose: 0.4 mg
- Onset of action: within 15 minutes
- Duration of action: 4-6 hours
- Potential side effects: dry mouth, throat irritation, urinary retention, increased intraocular pressure.