Pronunciation:

i-pra-TROE-pee-um BROE-mide, al-BYOO-ter-ol SUL-fate

Brand Names:

• Combivent
• Duoneb
• Ratio-Ipra Sal Udv

Dosage Forms:

• Solution
• Aerosol Powder
• Aerosol Liquid

Classifications:

Therapeutic—

Bronchodilator

Pharmacologic—

Ipratropium

Uses of This Medicine:

Ipratropium and albuterol combination is a bronchodilator (medicine that opens up narrowed breathing passages). It is taken by inhalation to help control the symptoms of lung diseases, such as asthma, chronic bronchitis, and emphysema.

Ipratropium in combination with albuterol helps decrease coughing, wheezing, shortness of breath, and troubled breathing by increasing the flow of air into the lungs.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Studies comparing the effects of the inhalation aerosol dosage form of ipratropium and albuterol in children with those in other age groups have not been done.

Older adults—

Ipratropium and albuterol combination has been tested in elderly patients and has not been found to cause different side effects or problems in older people than it does in younger adults.

Other medicines—

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acebutolol
• Alprenolol
• Arotinolol
• Atenolol
• Atomoxetine
• Befunolol
• Betaxolol
• Bevantolol
• Bisoprolol
• Bopindolol
• Bucindolol
• Bupranolol
• Carteolol
• Carvedilol
• Celiprolol
• Clorgyline
• Dilevalol
• Esmolol
• Iproniazid
• Isocarboxazid
• Labetalol
• Landiolol
• Levobetaxolol
• Levobunolol
• Mepindolol
• Metipranolol
• Metoprolol
• Moclobemide
• Nadolol
• Nebivolol
• Nialamide
• Nipradilol
• Oxprenolol
• Pargyline
• Penbutolol
• Phenelzine
• Pindolol
• Procarbazine
• Propranolol
• Selegiline
• Sotalol
• Talinolol
• Tertatolol
• Timolol
• Toloxatone
• Tranylcypromine

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Difficult urination—This medicine may make the condition worse

• Glaucoma—This medicine may make the condition worse if it gets into the eyes

• Heart rhythm problems or
• High blood pressure (hypertension) or
• Problems with blood circulation to the heart—The albuterol contained in this combination medicine can cause unwanted effects on the heart in some patients

Proper Use of This Medicine:

This medicine usually comes with patient directions. Read them carefully before using this medicine. If you do not understand the directions or you are not sure how to use the inhaler or nebulizer, ask your doctor, nurse, or pharmacist to show you how to use it.

When you use the inhaler for the first time, or if you have not used it for more than 24 hours, the inhaler may not give the right amount of medicine with the first puff. Therefore, before using the inhaler, prime it by spraying the medicine into the air three times. The inhaler will now be ready to give the right amount of medicine when you use it.

When you use the inhalation solution, make sure you use a jet nebulizer that is connected to an air compressor with a good air flow. Use a face mask or mouthpiece to inhale the medicine.

Keep the spray away from the eyes because this medicine may cause irritation or blurred vision. This is especially important for people with glaucoma. Closing your eyes while you are inhaling this medicine may help keep it out of your eyes.

It is very important that you use ipratropium and albuterol combination only as directed. Do not use more of it and do not use it more often than directed. To do so may increase the chance of serious side effects.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For inhalation aerosol dosage form :
  • For symptoms of chronic obstructive pulmonary disease:
    • Adults—2 puffs four times a day and as needed. No more than a total of 12 puffs should be used in any twenty-four-hour period.
    • Children—Use and dose must be determined by your doctor.

• For inhalation solution dosage form (used with a nebulizer):
  • For symptoms of chronic obstructive pulmonary disease:
    • Adults—Use one 3 mL (milliliter) vial in the nebulizer 4 times a day. You may have 2 additional treatments per day if needed.
    • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep the medicine in the foil pouch until you are ready to use it. Store at room temperature, away from heat and direct light. Do not freeze.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using This Medicine:

Check with your doctor at once if difficulty in breathing continues after using a dose of this medicine or if your condition gets worse.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Rare

Chest discomfort or pain

fast or irregular heartbeat

shortness of breath or wheezing

skin rash or hives

swelling of the face, lips, eyelids, mouth, or throat

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common or rare

Change in sense of taste

coughing

dizziness

dryness of mouth

headache

nausea

nervousness

tremor

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.