Anticholinergic Bronchodilator
Pregnancy: Use with caution; benefits likely outweigh risks in severe asthma
Ipratropium Bromide
Brand names: Atrovent
Adult dose
Dose: 500 micrograms nebulised
Route: Nebulised
Frequency: Every 4-6 hours (acute severe asthma: every 20-30 min for first 3 doses)
Max: 2 mg/day
Combine with salbutamol for acute severe or life-threatening asthma
Paediatric dose
Dose: Fixed dose by age micrograms/kg
Route: Nebulised
Frequency: Every 20-30 min for first 3 doses (acute severe); then every 4-6 hours
Max: 250 micrograms per dose (under 12 years)
Child under 1 year: 62.5-125 micrograms. Child 1-5 years: 125-250 micrograms. Child 6-11 years: 250 micrograms. Child 12 years and over: 250-500 micrograms. Add to salbutamol nebulisation for acute severe asthma per BTS/SIGN 2019
Dose adjustments
Renal
No adjustment required
Hepatic
No adjustment required
Paediatric weight-based calculator
Child under 1 year: 62.5-125 micrograms. Child 1-5 years: 125-250 micrograms. Child 6-11 years: 250 micrograms. Child 12 years and over: 250-500 micrograms. Add to salbutamol nebulisation for acute severe asthma per BTS/SIGN 2019
Clinical pearls
- Evidence shows ipratropium adds benefit to salbutamol in acute severe and life-threatening asthma — reduces hospital admissions (BTS/SIGN, NICE NG80)
- No role in mild-to-moderate asthma or long-term maintenance
- Use mouthpiece where possible — eye contact can precipitate acute angle-closure glaucoma
- Onset of action: 15-30 minutes; peak effect 1-2 hours; duration 4-6 hours
- Not a substitute for systemic corticosteroids in acute exacerbation
Contraindications
- Hypersensitivity to ipratropium or atropine derivatives
- Narrow-angle glaucoma (protect eyes from nebulised solution)
Side effects
- Dry mouth
- Throat irritation
- Headache
- Tachycardia (rare at inhaled doses)
- Paradoxical bronchospasm (rare)
- Blurred vision if nebulised drug contacts eyes
Interactions
- Other anticholinergics (additive effects)
Monitoring
- SpO2
- Respiratory rate
- Heart rate
- Clinical response to bronchodilation
Reference: BNF for Children; BTS/SIGN British Guideline on Asthma Management 2019; NICE NG80. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.