- Combivent®Metered Dose Inhaler (as a combination product containing Albuterol, Ipratropium)
- DuoNeb®Inhalant Solution (as a combination product containing Albuterol, Ipratropium)
The combination of albuterol and ipratropium is used to prevent wheezing, difficulty breathing, chest tightness, and coughing in people with chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways) such as chronic bronchitis (swelling of the air passages that lead to the lungs) and emphysema (damage to the air sacs in the lungs). Albuterol and ipratropium combination is used by people whose symptoms have not been controlled by a single inhaled medication. Albuterol and ipratropium are in a class of medications called bronchodilators. Albuterol and ipratropium combination works by relaxing and opening the air passages to the lungs to make breathing easier.
The combination of albuterol and ipratropium comes as a solution (liquid) to inhale by mouth using a nebulizer (machine that turns medication into a mist that can be inhaled) and as an aerosol to inhale by mouth using an inhaler. It is usually inhaled four times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use albuterol and ipratropium exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Your doctor may tell you to use additional doses of albuterol and ipratropium combination if you experience symptoms such as wheezing, difficulty breathing, or chest tightness. Follow these directions carefully, and do not use extra doses of medication unless your doctor tells you that you should. Do not use more than 2 extra doses of the nebulizer solution per day. Do not use more than 12 puffs of the inhalation aerosol in 24 hours.
Call your doctor if your symptoms worsen or if you feel that albuterol and ipratropium inhalation no longer controls your symptoms. If you were told to use albuterol and ipratropium as needed to treat your symptoms and you find that you need to use the medication more often than usual, call your doctor.
If you are using the inhaler, your medication will come in canisters. Each canister of albuterol and ipratropium aerosol is designed to provide 200 inhalations. After the labeled number of inhalations has been used, later inhalations may not contain the correct amount of medication. You should keep track of the number of inhalations you have used. You can divide the number of inhalations in your inhaler by the number of inhalations you use each day to find out how many days your inhaler will last. Throw away the canister after you have used the labeled number of inhalations even if it still contains some liquid and continues to release a spray when it is pressed. Do not float the canister in water to see if it still contains medication.
Be careful not to get albuterol and ipratropium into your eyes. If you are using the inhaler, keep your eyes closed when you use the medication. If you get albuterol and ipratropium in your eyes, you may develop narrow angle glaucoma (a serious eye condition that may cause loss of vision). If you already have narrow angle glaucoma, your condition may worsen. You may experience widened pupils (black circles in the center of the eyes), eye pain or redness, blurred vision, and vision changes such as seeing halos around lights. Call your doctor if you get albuterol and ipratropium into your eyes or if you develop these symptoms.
The inhaler that comes with albuterol and ipratropium aerosol is designed for use only with a canister of albuterol and ipratropium. Never use it to inhale any other medication, and do not use any other inhaler to inhale albuterol and ipratropium.
Do not use your albuterol and ipratropium inhaler when you are near a flame or source of heat. The inhaler may explode if it is exposed to very high temperatures.
Before you use albuterol and ipratropium for the first time, read the written instructions that come with the inhaler or nebulizer. Ask your doctor, pharmacist, or respiratory therapist to show you how to use it. Practice using the inhaler or nebulizer while he or she watches.
To use the inhaler, follow these steps:
- Hold the inhaler with the clear end pointing upward. Place the metal canister into the clear end of the inhaler. Be sure that the canister is fully and firmly in place.
- Remove the protective dust cap from the end of the mouthpiece. If the dust cap was not placed on the mouthpiece, check the mouthpiece for dirt or other objects.
- If you are using the inhaler for the first time or if you have not used the inhaler in more than 24 hours, you will need to prime it. Shake it well for at least 10 seconds and then press down on the canister three times to release three sprays into the air, away from your face. Be careful not to get albuterol and ipratropium in your eyes.
- Hold the inhaler between your thumb and your next two fingers with the mouthpiece on the bottom, facing you. Shake the inhaler well for at least 10 seconds.
- Immediately breathe out deeply through your mouth.
- Hold the canister with the mouthpiece on the bottom and facing you and the canister pointing upward. Place the open end of the mouthpiece into your mouth. Close your lips tightly around the mouthpiece. Close your eyes.
- Breathe in slowly and deeply through the mouthpiece. At the same time, press down once on the container to spray the medication into your mouth.
- Hold your breath for 10 seconds. Then remove the inhaler, and breathe out slowly.
- If you were told to use 2 puffs, wait about 2 minutes and then repeat steps 4 to 8.
- Replace the protective cap on the inhaler.
To inhale the solution using a nebulizer, follow these steps:
- Remove one vial of medication from the foil pouch. Put the rest of the vials back into the pouch until you are ready to use them.
- Twist off the top of the vial and squeeze all of the liquid into the reservoir of the nebulizer.
- Connect the nebulizer reservoir to the mouthpiece or face mask.
- Connect the nebulizer reservoir to the compressor.
- Put the mouthpiece in your mouth or put on the face mask. Sit in a comfortable, upright position and turn on the compressor.
- Breathe in calmly, deeply, and evenly through your mouth for about 5 to 15 minutes until mist stops forming in the nebulizer chamber.
Clean your inhaler or nebulizer regularly. Follow the manufacturer's directions carefully and ask your doctor or pharmacist if you have any questions about cleaning your inhaler or nebulizer.
This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.
Before using albuterol and ipratropium,
- tell your doctor and pharmacist if you are allergic to ipratropium (Atrovent), atropine (Atropen), albuterol (Proventil HFA, Ventolin HFA, Vospire ER), levalbuterol (Xoponex), any other medications, soya lecithin, soybeans, or peanuts.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements and herbal products you are taking or plan to take. Be sure to mention any of the following: beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); diuretics ('water pills'); epinephrine (Epipen, Primatene Mist); medications for colds; other inhaled medications, especially other medications for asthma such as formoterol (Foradil), metaproterenol (Alupent), levalbuterol (Xopenex), and salmeterol (Serevent); and terbutaline (Brethine). Also tell your doctor if you are taking any of the following medications or if you have stopped taking them within the past 2 weeks: antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); or monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and selegiline (Eldepryl, Emsam). Your doctor may have to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had glaucoma (an eye condition); difficulty urinating; a prostate (a male reproductive gland) condition; seizures; hyperthyroidism (condition in which there is too much thyroid hormone in the body); high blood pressure; an irregular heartbeat; diabetes; or heart, liver, or kidney disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using albuterol and ipratropium, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are using albuterol and ipratropium.
- you should know that albuterol and ipratropium inhalation sometimes causes wheezing and difficulty breathing immediately after it is inhaled. If this happens, call your doctor right away. Do not use albuterol and ipratropium inhalation again unless your doctor tells you that you should.
Unless your doctor tells you otherwise, continue your normal diet.
Use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.
This medication may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- leg cramps
- difficulty urinating
- frequent urination
- pain when urinating
- voice changes
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
- fast heartbeat
- chest pain
- swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs
- difficulty breathing or swallowing
- sore throat, fever, chills, and other signs of infection
Albuterol and ipratropium may cause other side effects. Call your doctor if you have any unusual problems while you are using this medication.
Keep this medication in the container it came in, tightly closed, and out of reach of children. Keep unused vials of nebulizer solution in the foil pouch until you are ready to use them. Store the medication at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication. Do not puncture the aerosol canister, and do not discard it in an incinerator or fire.
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
Keep all appointments with your doctor.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
AHFS® Consumer Medication Information. © Copyright, The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.
Selected Revisions: August 1, 2010.