From the Guidelines
If you cannot use albuterol due to tachycardia, you can consider using ipratropium bromide (Atrovent) as an alternative bronchodilator. Ipratropium is an anticholinergic medication that works by blocking the muscarinic receptors in the airways, leading to bronchodilation without significantly affecting heart rate 1. The typical dose is 2-3 puffs every 4-6 hours, with a dosage of 200 mcg/puff for adults, as indicated in the expert panel report 3 (epr-3) guidelines for the diagnosis and management of asthma-summary report 2007 1.
Key Points to Consider
- Ipratropium bromide does not block exercise-induced bronchospasm (EIB) and only reverses cholinergically mediated bronchospasm, making it a suitable alternative for patients who cannot tolerate short-acting beta-agonists (SABAs) like albuterol due to tachycardia 1.
- For patients who require a combination therapy, a nebulizer solution containing ipratropium bromide and albuterol in lower doses may be considered, as the reduced albuterol component may not trigger significant tachycardia 1.
- It is essential to note that anticholinergics like ipratropium bromide may have a slower onset of action compared to beta-agonists like albuterol, so they might not provide relief as quickly during acute symptoms.
Dosage and Administration
- The dosage for ipratropium bromide via metered-dose inhaler is 2-3 puffs every 4-6 hours, with a dosage of 200 mcg/puff for adults 1.
- The nebulizer solution dosage for ipratropium bromide is 25 mg (0.025%) 1.
Potential Adverse Effects
- Potential adverse effects of ipratropium bromide include drying of mouth and respiratory secretions 1.
- Increased wheezing in some individuals has also been reported with the use of nebulizer solution ipratropium bromide 1.
From the Research
Alternatives to Albuterol for Tachycardia
If albuterol cannot be used due to tachycardia, there are alternative options available:
- Ipratropium bromide, an anticholinergic bronchodilator, can be used as an alternative to beta 2-adrenoceptor agonists like albuterol 2.
- Combination therapy with ipratropium bromide and salbutamol (a beta 2-adrenoceptor agonist) has been shown to provide greater bronchodilation than monotherapy with salbutamol alone in acute severe asthma 3.
- However, it's worth noting that ipratropium bromide can also increase heart rate, although the effect may be less pronounced compared to beta 2-adrenoceptor agonists like salbutamol 4.
Combination Therapies
Combination therapies involving albuterol and ipratropium bromide have been approved for the treatment of chronic obstructive pulmonary disease (COPD) and have been shown to provide better improvement in airflow than either component alone 5.
- The combination of nebulized albuterol and ipratropium bromide has been found to not cause significant tachycardia or tachyarrhythmias in critically ill adult patients 6.
Key Considerations
When considering alternative treatments to albuterol due to tachycardia, it's essential to weigh the potential benefits and risks of each option, including the potential for increased heart rate or other adverse effects 2, 4.