Ipratropium bromide

Generic name
Ipratropium bromide
Brand name
ATC Code
R03BB01
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Ipratropium bromide

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

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

No information

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

No information is present at this moment.

Available formulations

No information is present at this moment.

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.

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.

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.

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.

Interactions

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

OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES, INHALANTS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

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

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

Changes

Therapeutic Drug Monitoring


Overdose