Ipratropium Bromide
Mechanism :
Ipratropium bromide is an anticholinergic (parasympatholytic) agent, which blocks the muscarinic receptors of acetylcholine and inhibits vagally mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released from the vagus nerve. Anticholinergics prevent the increases in intracellular concentration of cyclic guanosine monophosphate (cGMP) from the interaction of acetylcholine with the muscarinic receptors of bronchial smooth muscle.
Indication :
- Chronic reversible airway obstruction
- Severe acute asthma
Contraindications :
Ipratropium bromide is contraindicated in patients with a history of hypersensitivity to soya lecithin or related food products such as soybean and peanut. Aerosol should also not be taken by patients hypersensitive to any other components of the drug product or to atropine or its derivatives.
Dosing :
Available as 20 mcg/puff or as 0.025% nebulization solution.
Asthma: Inhalation:
<5 years:
2 inhalations every 20 min for 1 hour if required.
5-12 years:
4-8 puffs every 20 min as needed for up to 3 hours.
≥12 years:
8 puffs every 20 min as needed for up to 3 hours.
Asthma: Nebulization:
<5 years:
250 mcg nebulization every 20 min for 1 hour if necessary.
5-12 years:
250-500 mcg nebulization every 20 min for 3 doses, then as needed.
≥12 years:
500 mcg nebulization every 20 min for 3 doses, then as needed.
Adverse Effect :
Adverse effects are due to anticholinergic effects, dry mouth, urinary retention, constipation, worsening of bronchospasm.
Interaction :
Anticholinergics: Although ipratropium bromide is minimally absorbed into the systemic circulation, there is some potential for an additive interaction with concomitantly used anticholinergic medications.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function |
| HD | Not dialysed. Dose as in normal renal function |
| HDF/High flux | Not dialysed. Dose as in normal renal function |
| CAV/VVHD | Not dialysed. Dose as in normal renal function |
Hepatic Dose :
No dose adjustments are recommended.