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Generic Name: albuterol and ipratropium (inhalation) (al BYOO ter ol and ip ra TRO pee um)
Brand Names: Combivent, DuoNeb

What is albuterol and ipratropium inhalation?

Albuterol and ipratropium are bronchodilators that relax muscles in the airways and increase air flow to the lungs.

The combination of albuterol and ipratropium inhalation is used to prevent bronchospasm in people with chronic obstructive pulmonary disease (COPD) who are also using other medicines to control their condition.

Albuterol and ipratropium inhalation may also be used for conditions other than those listed in this medication guide.

What is the most important information I should know about albuterol and ipratropium inhalation?

Call your doctor right away if you feel that this medicine is not working as well as usual, or if it makes your condition worse. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

What should I discuss with my healthcare provider before using albuterol and ipratropium inhalation?

Before using this medication, tell your doctor if you have:

• heart disease, high blood pressure, or congestive heart failure;

• a seizure disorder such as epilepsy;

• diabetes;

• overactive thyroid;

• glaucoma;

• an enlarged prostate or problems with urination; or

• liver or kidney disease.

If you have any of these conditions, you may not be able to use albuterol and ipratropium inhalation or you may need a dosage adjustment or special tests during treatment.

How should I use albuterol and ipratropium inhalation?

Use this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

This medication may increase the risk of asthma-related death. It is critical that you use only the prescribed dose of this medicine and follow all patient instructions for safe use of the medication.

Albuterol and ipratropium inhalation comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

When using the inhaler device for the first time, prime it by spraying 2 test sprays into the air, away from your face. Also prime the inhaler if you have not used it for 3 days or longer.

To use the inhaler:

• Shake the canister vigorously for at least 10 seconds before each spray.
• Uncap the mouthpiece of the inhaler. Breathe out fully. Put the mouthpiece into your mouth and close your lips. Keep your eyes closed to prevent spraying any medicine into your eyes. Breathe in slowly while pushing down on the canister. Hold your breath for 10 seconds, then breathe out slowly.

• If you use more than one inhalation at a time, wait at least 2 minutes before using the second inhalation.

• Keep your inhaler clean and dry, and store it with the cap on the mouthpiece. Clean your inhaler once a week by removing the canister and placing the mouthpiece under warm running water for at least 30 seconds. Allow the parts to dry before putting the inhaler back together.

To use the solution with a nebulizer:

• Measure the correct amount of medicine using the dropper provided, or use the proper number of ampules. Place the liquid into the medication chamber of the nebulizer. If using a medicine dropper, do not allow the dropper to touch any surface including your hands or the nebulizer.

• Attach the mouthpiece or face mask to the drug chamber. Then, attach the drug chamber to the compressor. Sit upright in a comfortable position. Place the mouthpiece into your mouth or put the face mask on, covering your nose and mouth. Breathe in slowly and evenly until you have inhaled all of the medicine (usually 5 to 15 minutes). The treatment is complete when no more mist is formed by the nebulizer and the drug chamber is empty.

• Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

Call your doctor right away if you feel that this medicine is not working as well as usual, or if it makes your condition worse. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

To be sure this medication is helping your condition, your lung function will need to be tested on a regular basis. It is important that you not miss any scheduled visits to your doctor.

It is important to use this medication regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. Keep using all of your other medications as prescribed by your doctor.

Keep track of the number of sprays you have used and throw away the inhaler canister after 200 sprays, even if it feels like there is still medicine in it.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

What should I avoid while using albuterol and ipratropium inhalation?

Albuterol and ipratropium inhalation side effects

• bronchospasm (wheezing, chest tightness, trouble breathing), especially after starting a new canister of this medicine;

• chest pain and fast, pounding, or uneven heart beats;

• swelling of your ankles or feet;

• pain or burning with urination; or

• increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure).

Continue using this medication and talk with your doctor if you have any of these less serious side effects:

• headache, dizziness, nervousness;

• drowsiness or sleep problems (insomnia);

• cough, hoarseness, sore throat, runny or stuffy nose;

• dry mouth, unusual taste in your mouth;

• tremors, numbness or tingly feeling;

• nausea, vomiting, upset stomach, diarrhea, constipation; or

• blurred vision.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect albuterol and ipratropium inhalation?

Before using this medication, tell your doctor if you are taking any of the following medicines:

• atropine (Donnatal, and others);

• belladonna;

• clidinium (Quarzan);

• dicyclomine (Bentyl);

• glycopyrrolate (Robinul);

• hyoscyamine (Anaspaz, Cystospaz, Levsin, and others);

• mepenzolate (Cantil);

• methantheline (Provocholine);

• methscopolamine (Pamine), scopolamine (Transderm-Scop);

• propantheline (Pro-Banthine);

• a beta-blocker such as acebutolol (Sectral), atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor), or propranolol (Inderal);

• a stimulant, ADHD medication, diet pills, or over-the-counter cold or allergy medicines;

• a diuretic (water pill) such as furosemide (Lasix), bumetanide (Bumex), ethacrynic acid (Edecrin), torsemide (Demadex), hydrochlorothiazide (Hydrodiuril), chlorthalidone (Hygroton, Thalitone), or chlorothiazide (Diuril); or

• an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

If you are using any of these drugs, you may not be able to use albuterol and ipratropium, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect albuterol and ipratropium. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist has additional information about albuterol and ipratropium inhalation written for health professionals that you may read.

What does my medication look like?

Albuterol and ipratropium inhalation is available with a prescription under the brand names Combivent and DuoNeb. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

• Combivent 14.7 g--white mouthpiece with a clear sleeve and an orange mouthpiece cover

• DuoNeb 3 mL-inhalation solution

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.