Thursday, May 25, 2017

Atrovent Nebulisation : Maximum Dose

Availability
  • Ipratropium Bromide 500mcg/2ml
Administration
  • dose of nebuliser solution may need to be diluted ato obtain a final volume suitable for the particular nebuliser being used (usually 2 – 4 ml)
  • if dilution is necessary use only sterile sodium chloride 0.9% solution

Dose
Adults (including the elderly) and children over 12 years of age:
  • 250 - 500 micrograms 3 to 4 times daily.
  • For treatment of acute bronchospasm, 500 micrograms.
  • Repeated doses can be administered until the patient is stable. The time interval between the doses may be determined by the physician.
  • advisable not to exceed the recommended daily dose during acute or maintenance treatment. 
  • Daily doses exceeding 2 mg should only be given under medical supervision.

Children 6 - 12 years of age:
  • 250 micrograms up to a total daily dose of 1mg (4 vials).
  • The time interval between doses may be determined by the physician.

Children 0 – 5 years of age (for treatment of acute asthma only):
  • 125 – 250 micrograms up to a total daily dose of 1 mg (4 vials).
  • should be administered no more frequently than 6 hourly in children under 5 years of age.
  • For acute bronchospasm, repeated doses may be administered until the patient is stable
Maximal Dose
  • Inhalation of 0.04mg of ipratropium from a metered dose aerosol causes bronchodilation, the maximal effect is seen after 30 - 60 minutes, with a duration of 4 hours. 
  • This is a dose related effect and use of a nebuliser produces greater bronchodilation, a dose of 0.5mg producing maximal bronchodilation
  • The half-life of elimination of the drug and metabolites is 3.6 hours. The half-life of the terminal elimination phase is about 1.6 hours
Overdose:
  • Palpitation and increases in heart rate have been produced with inhaled doses of 5 mg. 
  • Side effects have not been caused by single inhaled doses of 2 mg in adults and 1 mg in children. Single oral doses of 30 mg of ipratropium bromide caused anticholinergic side effects, but these did not require treatment.
  • Severe overdose is characterized by atropine-like symptoms like tachycardia, tachypnea, high fever and central effects like restlessness, confusion and hallucinations
References:
  1. http://www.medicines.org.uk/emc/medicine/27927
  2. https://www.ncbi.nlm.nih.gov/pubmed/1837931

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