UNCONTROLLED WHEN PRINTED
Introduction
  • An anticholinergic bronchodilator. It inhibits the vagal reflexes that mediate bronchospasm
  • Combined with a nebulised short-acting beta-2 agonist (e.g. salbutamol), ipratropium bromide produces significantly greater bronchodilation than a short-acting beta-2 agonist alone

Pharmacology Review

Indications

Severe bronchospasm:

Adult: 

Paediatric:

  • Severe to life-threatening asthma
Contraindications
  • Hypersensitivity
Precautions / Notes
  • Glaucoma
  • Avoid contact with eyes.
COVID-19 / Febrile Respiratory Illness
  • Please review guidance on Nebulisers
  • Crews should allow the patient to administer their own Ipratropium Bromide MDI via spacer wherever possible
  • Allow patient to self-administer Ipratropium Bromide per their asthma management plan or under crew direction; stand clear and wait a minute before approaching the patient
  • If you have to use SJA supplied Ipratropium Bromide MDI, assess whether it can be reused and wipe with Clinell wipe after use. Discard the MDI in the sharps bin if the patient is very unwell or highly symptomatic of infectious respiratory condition.
  • Note: If administering St John supplied medication, crews are NOT to leave the remainder of the medication with the patient. This is a violation of the St John WA poisons licence and the Medicines and Poisons Act 2014.
  • Crews may tolerate lower oxygen saturations in patients with infective respiratory symptoms prior to considering intervention, as the use of MDI’s may precipitate a cough. See Oxygen Delivery for specifics regarding SpO2 tolerance.
Management

Adult: 

  • Nebulised (combined with salbutamol):
    • 500 microg in 2 mL (250 microg/mL)
    • Dilute solution for nebulisation to 2-3ml with sodium chloride 0.9%
    • Repeat nebulised dose every 20mins; maximum of 3 doses.
  • MDI:
    • 8 puffs (160 microg), 1 breath per puff - if possible, give via spacer
    • Repeat MDI dose every 20 minutes; maximum of 3 doses.

Paediatric:

     < 6 years> 6 yearsSubsequent dose if requiredNotes
    Nebulised250 microg in 1 mL500 microg in 2 mLRepeat nebulised dose every 20 minutes; maximum of 3 doses.Dilute solution for nebulisation to 2-3mL with sodium chloride 0.9%
    MDI4 puffs (80 microg)8 puffs (160 microg)Repeat MDI dose every 20 minutes; maximum of 3 dosesGive via spacer

     

Special Considerations
  • Headache
  • Nausea, dizziness
  • Dry mouth, throat irritation
  • Taste disturbance
  • Skin rash

References
References
Presentation
  • 250 microg/1 mL nebule
  • Metered Dose Inhaler (MDI)
    20 microg per puff

Atrovent

 

Atrovent-2

 

atrovent

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Clinical Services

Responsible Manager
Head of Clinical Services

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