Nebulised Drug Doses
Paediatric nebulised medication reference. Always verify against BNFc.
Bronchodilators
Salbutamol (Beta-2 agonist)
Relaxes bronchial smooth muscle. Onset 5–15 min, duration 4–6 hours.
Dose: 2.5 mg (<5 yrs) / 5 mg (≥5 yrs)
⚠ Caution: risk of hypokalaemia with repeated doses
Ipratropium Bromide (Atrovent)
Anticholinergic. Blocks vagal-mediated bronchoconstriction. Onset 15–30 min.
Dose: 250 mcg (<12 yrs) / 500 mcg (≥12 yrs)
Adrenaline (Epinephrine)
Alpha + beta agonist. Mucosal vasoconstriction + bronchodilation. Used for croup, stridor.
Dose: 400 mcg/kg (max 5 mg) of 1:1000
⚠ Cardiac monitoring required
Mucolytics
Hypertonic Saline (HTS)
Osmotic agent. Draws water into airway, rehydrates mucus. Available in 3%, 6%, 7%.
Dose: 4 mL of 3%/6%/7% as prescribed
Pre-treat with bronchodilator if at risk of bronchospasm
DNase (Dornase Alfa / Pulmozyme)
Cleaves extracellular DNA in sputum. Reduces viscosity. Used in CF and PCCU.
Dose: 2,500 units (2.5 mg) once daily
Give ≥1 hour before physiotherapy for optimal effect
N-Acetylcysteine (NAC)
Breaks disulfide bonds in mucus glycoproteins. Reduces sputum viscosity.
Dose: As prescribed (varies by indication)
⚠ pH 2.2 — significant bronchospasm risk. Always pre-treat with bronchodilator.
Drying Agents
| Drug | Route | Notes |
|---|---|---|
| Glycopyrrolate | IV / Oral | Does not cross BBB — fewer CNS side effects |
| Hyoscine | Patch / IV | Crosses BBB — may cause sedation, agitation |