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