|Reviewed by Dr Simon Rowley, Dr Innes Asher, Dorothy Cooper|
|Endotracheal||0.025 mg/kg/dose as nebulised solution 4-6 hourly.|
|Via face mask||0.0625-0.25 mg/kg/dose as nebulised solution 4-6 hourly|
Ipratropium bromide is a quaternary derivative of atropine. Has low lipid solubility. The drug is a parasympathetic inhibitor (anticholinergic antimuscarinic agent) that blocks the vagal reflexes which mediate bronchoconstriction. Exerts a local effect on the airways. Has a high therapeutic ratio, producing bronchodilation without significant effect on other organ systems.
Systemic absorption after inhalation is very low (bioavailability <5%). Distribution is limited. Does not cross the blood brain barrier. Low binding (<20%) to human plasma protein. Some hepatic biotransformation, excretion via the kidneys. Elimination half-life in the adult is 3-4 hours.
Onset of action 5-30 minutes after inhalation. Peak effect occurs at approximately 60-120 minutes. Duration of action 3-8 hours. Incidence of systemic side effects is extremely low following inhalation. There is no evidence that in the therapeutic dose range ipratropium has any adverse effect on sputum viscosity or volume.