Dose:    1 to 2 puffs (18 mcg per puff) MDI
               125 to 250 mcg by nebulization (see comments)

Frequency: Q 6 to 8 hours

Comments: Ipratropium bromide is an anticholinergic bronchodilator that blocks vagal receptors in the large airways. It inhibits smooth muscle contraction or bronchospasm. Unlike atropine, ipratropium is poorly absorbed from the mucus membranes and does not cross the blood-brain barrier. This gives ipratropium a longer duration of action than atropine and fewer reported systemic side effects.  Further comments on ipratropium.

Toxicity: Inhaled ipratropium bromide is poorly absorbed so side effects are rare. Reported adverse effects include cough, hoarseness, dry secretions, palpatations, tachycardia, flushing, hypotension, hypertension, nervousness, headache, insomnia, nausea, constipation, and dysuria. 

Preparation: Available as a metered dose inhaler (MDI). Metered dose inhaler delivers about 18 mcg per puff. Administer using spacer per protocol. A nebulizer or aerosol solution is available in a 2.5 ml ampule (0.02%), use once and discard.