Trade Names:Combivent- Aerosol 18 mcg ipratropium bromide and 103 mcg albuterol sulfate per actuation (equiv. to 90 mcg albuterol base)
Trade Names:DuoNeb- Inhalation solution 0.5 mg ipratropium bromide and 3 mg albuterol sulfate (equiv. to 2.5 mg albuterol base)Combivent Inhalation Solution (Canada)Gen-Combo Sterinebs (Canada)ratio-Ipra Sal UDV (Canada)
Produces bronchodilation by relaxing bronchial smooth muscle through beta 2 -receptor stimulation.Ipratropium
Antagonizes action of acetylcholine on bronchial smooth muscle in lungs, causing bronchodilation.
Treatment of bronchospasm associated with COPD in patients requiring more than 1 bronchodilator.
History of hypersensitivity to soya lecithin or related food (eg, soybean, peanuts) ( Combivent only) or to atropine and its derivatives.
Inhalation 2 inhalations 4 times daily (max, 12 inhalations per 24 h).DuoNebAdults
Inhalation One 3 mL vial 4 times daily via nebulization with up to 2 additional 3 mL doses daily, if needed.
Store inhalation aerosol at ambient room temperature (59° to 86°F). Protect from excessive humidity. Store pressurized canister with nozzle end down, away from heat or open flame. Do not puncture or discard pressurized canister in incinerator.Inhalation solution
Store unused vials in protective foil pouch in refrigerator (36° to 46°F) or room temperature (less than 77°F). Protect vials from light.
Possible additive anticholinergic effects.Beta-adrenergic agonists
Risk of adverse CV effects may be increased.Beta-receptor blocking agents
These agents and albuterol may inhibit the effect of each other.Digoxin
Albuterol component may decrease serum digoxin concentrations and therapeutic effects.Diuretics
Albuterol component may exaggerate ECG and/or hypokalemia from non-potassium-sparing diuretics.MAOIs, tricyclic antidepressants
Concomitant use of these agents or use within 2 wk of stopping such agents may potentiate the CV effects of albuterol.
None well documented.
Hypertension, arrhythmia, palpitation, tachycardia, angina, hypotension (less than 2%).
Headache (6%); fatigue, dizziness, nervousness, tremor, paresthesia, insomnia (less than 2%); drowsiness, stimulation, coordination difficulty, weakness (postmarketing).
Pharyngitis (4%); dysphonia (less than 2%); worsening of narrow-angle glaucoma, acute eye pain, blurred vision, nasal congestion, drying of secretions, mucosal ulcers (postmarketing).
Nausea (2%); diarrhea, dry mouth, dyspepsia, vomiting, taste perversion (less than 2%); GI distress, constipation (postmarketing).
UTI, dysuria (less than 2%); urinary difficulty (postmarketing).
Arthralgia (less than 2%).
Bronchitis (12%); upper respiratory tract infection (11%); lung disease (6%); dyspnea (5%); coughing (4%); respiratory disorders (3%); sinusitis (2%); rhinitis, pneumonia (1%); paradoxical bronchospasm, wheezing, exacerbation of COPD symptoms (postmarketing).
Pain, chest pain (3%); influenza, leg cramps (1%); allergic type reactions (including skin rash, angioedema of tongue, lips, and face, laryngospasm, anaphylaxis), edema, increased sputum (less than 2%); heartburn, itching, flushing (postmarketing).
Monitor patient's respiratory status during each treatment. If bronchospasm worsens during or shortly after a treatment, discontinue the treatment and notify health care provider immediately.
Category C .
Safety and efficacy not established.
Immediate hypersensitivity reactions may occur.
Use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder neck obstruction.
Toxic symptoms may occur in patients with CV disorders. Use with caution in patients with coronary insufficiency, arrhythmias, or hypertension.
CNS stimulation may occur; use cautiously in patients with history of seizures or hyperthyroidism.
Dosage adjustment of insulin may be required.
Death may occur with excessive use of inhaled sympathomimetic drugs in patients with asthma.
Transient decreases in potassium levels may occur.
Life-threatening bronchospasms can occur, usually with the first use of a new container.
Tremor, palpitations, tachycardia, elevated BP, angina.
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