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Ipratropium bromide nebulised


Solution for nebulisation containing ipratropium bromide.

Drugs List

  • ATROVENT UDVs 250microgram/1ml nebuliser solution
  • ATROVENT UDVs 500microgram/2ml nebuliser solution
  • ipratropium bromide 250microgram/1ml unit dose nebuliser solution
  • ipratropium bromide 500microgram/2ml unit dose nebuliser solution
  • STERI-NEB IPRATROPIUM 250microgram/1ml unit dose nebulising solution
  • STERI-NEB IPRATROPIUM 500microgram/2ml unit dose nebulising solution
  • Therapeutic Indications


    Acute asthma
    Chronic asthma
    Chronic obstructive airways disease (with reversible element)


    It is advisable not to exceed the recommended daily dose during acute or maintenance treatment. Daily doses exceeding 2mg in adults and children over 12 years of age should only be given under medical supervision.


    Individual brands may vary in their dosage recommendations and maximum daily dosage.

    Reversible airways obstruction: 250 to 500 micrograms three to four times daily.

    Acute Asthma: 500 micrograms. Repeated doses can be administered until the patient is stable. The time interval between the doses may be determined by the physician.


    Individual brands differ in their dosage recommendations and maximum doses for children.

    Children aged over 12 years
    Reversible airways obstruction: 250 to 500 micrograms three to four times daily.
    Acute Asthma: 500 micrograms. Repeated doses can be administered until the patient is stable. The time interval between the doses may be determined by the physician.

    Children aged 6 to 12 years
    Reversible airways obstruction and Acute Asthma:250 micrograms up to a total daily dose of 1mg. The time interval between doses may be determined by the physician.

    Children aged 0 to 6 years
    Acute asthma: 125 to 250 micrograms up to a total daily dose of 1mg. Ipratropium bromide should not be administered more frequently than 6 hourly in children under 5 years of age.

    The following alternative dosing schedule may be suitable:
    Children 1 month to 12 years
    Acute asthma: 250 micrograms repeated every 20 to 30 minutes for the first two hours, then repeat every four to six hours as required.


    None known

    Precautions and Warnings

    Benign prostatic hyperplasia
    Bladder outflow obstruction
    Cystic fibrosis
    Narrow angle glaucoma

    Advise ability to drive/operate machinery may be affected by side effects
    Do not allow solution or mist to enter eyes
    Close medical supervision during initial dosing
    Advise patient to report any blurred vision or any other eye symptoms
    Discontinue if paradoxical bronchospasm occurs
    Dose varies with brand
    Patient should seek medical advice if usual relief is diminished

    Only specialists in respiratory medicine should initiate and manage the use of nebulisers and associated nebulised medicines at home in children and adolescents for acute treatment of asthma.

    Pregnancy and Lactation


    Use ipratropium bromide with caution in pregnancy.

    Briggs et al note that ipratropium was not teratogenic in mice, rats and rabbits when administered either orally or by inhalation. A number of sources recommend the use of inhaled ipratropium for severe asthma, especially in patients not responding adequately to other therapies. There is no evidence that the drug is hazardous to the foetus, producing fewer systemic effects than atropine, and may have an additive bronchodilatory effect to Beta2 agonists.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use ipratropium bromide with caution in breastfeeding.

    Ipratropium bromide may appear in breast milk but in amounts that are probably insignificant, especially after inhalation.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Anaphylactic reaction
    Angioedema of tongue, lips and face
    Atrial fibrillation
    Blurred vision
    Bronchospasm (paradoxical)
    Cold extremities
    Conjunctival hyperaemia
    Corneal oedema
    Disturbances in accommodation
    Dry mouth
    Dry throat
    Gastro-intestinal motility disturbances
    Hypersensitivity reactions
    Increased intra-ocular pressure
    Narrow angle glaucoma
    Ocular pain
    Oropharyngeal oedema
    Supraventricular tachycardia
    Throat irritation
    Urinary retention
    Visual haloes


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: December 2016

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Atrovent 250 UDVs, 1 ml and 2 ml. Boehringer Ingelheim Limited. Revised September 2020.

    Summary of Product Characteristics: Respontin Nebules. Glaxo Wellcome UK Limited. Revised November 2015.

    Summary of Product Characteristics: Steri-Neb Ipratropium Unit Doses, 250 micrograms/1 ml and 500 micrograms/2 ml. IVAX Pharmaceuticals UK. Revised August 2015.

    NICE Evidence Services Available at: Last accessed: 22 August 2017

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