Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Ipratropium bromide

Generic name
Ipratropium bromide
Brand name
ATC Code
R03BB01

Pharmacokinetics in children

No information

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dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

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Available formulations

No information is present at this moment.

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Dosages

Acute asthma attack
  • Inhalation
    • Aerosol
      • 1 month up to 18 years
        • with a holding chamber (where SpO2 > 94%) 80 microg./dose at least 2 times. in combination with salbutamol, 400-800 mcg/dose.

        • If the child is badly out of breath, nebulization should continue as frequently as necessary with salbutamol and (at least) twice with ipratropium bromide for the initial inhalations.

          After 1 to 2 times inhaling with insufficient effect: start low-threshold prednisone


          FORMULATIONS
          0-3 yrs: dosing aerosol + holding chamber with a mask.
          4-6 yrs: dosing aerosol + holding chamber with a mouthpiece.
          ≥ 7 yrs: option: Dry powder inhaler (Diskus).

           

      • 1 month up to 18 years
        [3]
        • with a holding chamber (where SpO2 > 94%) 80 microg./dose at least 2 times. in combination with salbutamol, 400-800 mcg/dose.

        • If the child is badly out of breath, nebulization should continue as frequently as necessary with salbutamol and (at least) twice with ipratropium bromide for the initial inhalations.

          After 1 to 2 times inhaling with insufficient effect: start low-threshold prednisone


          FORMULATIONS
          0-3 yrs: dosing aerosol + holding chamber with a mask.
          4-6 yrs: dosing aerosol + holding chamber with a mouthpiece.
          ≥ 7 yrs: option: Dry powder inhaler (Diskus).

           

    • Solution for nebulization
      • 1 month up to 5 years
        • (where SpO2 ≤ 94%) 0.25 mg/dose at least 2 times. in combination with salbutamol, 2.5 mg/dose.
        • Duration of treatment:

           

           

        • If the child is badly out of breath, nebulization should continue as frequently as necessary with salbutamol and (at least) twice with ipratropium bromide for the initial inhalations.

          After 1 to 2 times inhaling with insufficient effect: start low-threshold prednisone

      • 5 years up to 18 years
        • (where SpO2 ≤ 94%):  0.5 mg/dose at least 2 times. in combination with salbutamol, 5.0 mg/dose.

        • If the child is badly out of breath, nebulization should continue as frequently as necessary with salbutamol and (at least) twice with ipratropium bromide for the initial inhalations.

          After 1 to 2 times inhaling with insufficient effect: start low-threshold prednisone

           
Bronchial dilation (short-acting)
  • Inhalation
    • Inhalation powder
      • 7 years up to 18 years
        • 40 - 80 microg./dose, as required, max. 8x daily.

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Renal impaiment in children > 3 months

GFR ≥10 ml/min/1.73m2: Dose adjustment not required.

GFR <10 ml/min/1.73m2: A general recommendation on dose adjustment cannot be provided.

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The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

Administration by inhalation does not trigger any systemic side effects.

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The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications

No information available on specific contra indications in children.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Administration: the inhalation fluid should be administered using a jet nebulizer or an ultrasonic nebulizer; the optimum flow rate is 6-8 l/min. The dosing aerosol can be used in combination with the AeroChamber holding chamber.

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Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

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Glucocorticoids
R03BA01
R03BA02
R03BA08
R03BA05
Anticholinergics
R03BB04
Antiallergic agents, excl. corticosteroids
R03BC01

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References

  1. Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007
  2. Brand PLP et al, Werkboek Kinderlongziekten, VU Uitgeverij, 2001
  3. NVK, Richtlijn Astma bij Kinderen, 2013
  4. Boehringer Ingelheim Pharma GmbH & Co. KG, SmPC, Atrovent® 250 μg/2 ml Fertiginhalat Lösung für einen Vernebler (37146.01.00), 08/16
  5. Boehringer Ingelheim Pharma GmbH & Co. KG, SmPC, Atrovent® 500 μg/2 ml Fertiginhalat Lösung für einen Vernebler (37146.00.00), 08/16
  6. Boehringer Ingelheim Pharma GmbH & Co. KG, SmPC, Atrovent® LS 250 μg/ml Lösung für einen Vernebler (6190779.00.00), 06/17
  7. Boehringer Ingelheim Pharma GmbH & Co. KG, SmPC, Atrovent N Dosier-Aerosol 20 μg/Aerosolstoß, Druckgasinhalation, Lösung (3000458.00.00), 08/16
  8. Laboratorio Aldo-Unión, S.L., SmPC, Iprabronch 20 Mikrogramm/Sprühstoß Druckgasinhalation, Lösung (95291.00.00), 01/19
  9. INFECTOPHARM Arzneimittel und Consilium GmbH, SmPC, Iprabronch 250 µg/ml Lösung für Vernebler (79638.00.00), 08/14
  10. Uptodate: UpToDate®, Pediatric Drug information: Ipratropium (oral inhalation) Topic 16003 Version 181.0, accessed 03/19

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Changes

Changes