Severe asthma attack, in combination with salbutamol
Forms and strengths
Solution for inhalation in pressurised metered dose inhaler,delivering 20 micrograms of ipratropium/puff
Dosage and duration
Child and adult: 4 to 8 puffs (80 to 160 micrograms) every 20 minutes for the first hour
Administration technique
Shake the inhaler. Remove the mouthpiece cover.
Inhale and breathe out as completely as possible. Place the lips tightly around the mouthpiece. Inhale deeply while activating the inhaler. Hold breath 10 seconds before exhaling.
Hand-breath co-ordination is very difficult in children under 6 years, older patients and patients with severe dyspnoea. Use a spacer to facilitate administration and improve the efficacy of treatment.
Contra-indications, adverse effects, precautions
May cause:
throat irritation, headache, cough, vomiting;
anticholinergic effects: dryness of the mouth, constipation, dilation of the pupils, blurred vision, urinary retention, tachycardia.
Administer with caution to older patients and patients with closed-angle glaucoma, urethroprostatic disorders, urinary retention.
Avoid or monitor combination with drugs known to have anticholinergic effects: tricyclic antidepressants (e.g. amitriptyline), first generation H-1 antihistamines (e.g. hydroxyzine, promethazine), biperiden, antispasmodics (e.g. atropine, hyoscine butylbromide), antipsychotics (e.g. chlorpromazine, haloperidol), etc. (increased risk of adverse effects).
Pregnancy: no contra-indication
Breast-feeding: no contra-indication
Remarks
In severe asthma attack, preferably administer the treatment by nebulisation. Clean the mouthpiece before and after each use.
Do not pierce or incinerate used aerosol containers (risk of explosion).