Combivent ( ipratropium +  albuterol )

General Information and Indications:

The combination of ipratropium and albuterol, Combivent , a bronchodilator, is used with other bronchodilators to prevent wheezing, shortness of breath, and troubled breathing caused by chronic obstructive pulmonary disease (COPD). It relaxes and opens the air passages to the lungs, making it easier to breathe.

Information For Users:

The combination of ipratropium and albuterol comes as an aerosol to inhale by mouth. It is usually inhaled four times a day. Follow the directions on your prescription label, ask your doctor or pharmacist If you have any questions. Take ipratropium and albuterol exactly as directed. Do not take more or less of it or take it more often than prescribed by your health care provider. Your doctor may instruct you to take additional puffs if needed. However, do not take more than twelve puffs in 24 hours.

The combination of ipratropium and albuterol controls the symptoms of COPD but does not cure it. Continue to use ipratropium and albuterol even if you feel well. Do not discontinue taking ipratropium and albuterol without informing your doctor.

Before you use ipratropium and albuterol for the first time, read the written instructions that come with the medication. Ask your doctor, pharmacist, or respiratory therapist to demonstrate the proper technique. Practice using the inhaler while in his or her presence.

To use the inhaler, follow these steps:

o Shake the inhaler well.
o Remove the protective cap.
o Breathe out as completely as possible through your nose while keeping your mouth shut.
o Open Mouth Technique: Open your mouth wide, and place the open end of the mouthpiece about 1-2 inches from your mouth.
o Closed Mouth Technique: Place the open end of the mouthpiece well into your mouth, past your front teeth. Close your lips tightly around the mouthpiece.
o Take a slow, deep breath through the mouthpiece and, at the same time, pressdown on the container to spray the medication into your mouth. Be sure that the mist goes into your throat and is not blocked by your teeth or your tongue. Avoid spraying into eyes. Adults giving treatment to young children may hold the child's nose closed to be sure that the medication goes into the child's throat.
o Hold your breath for 5-10 seconds, remove the inhaler, and exhale slowly through your nose or mouth. If you take two puffs, wait 2 minutes and shake the inhaler well before taking the second puff.
o Replace the protective cap on the inhaler. If you have difficulty getting the medication into your lungs, a spacer (a special device that attaches to the inhaler) may help; ask your doctor, pharmacist, or respiratory therapist for more information.

Special precautions:

o Inform your doctor or pharmacist if you have allergy to ipratropium, atropine, albuterol, levalbuterol, or any other drug, or if you are allergic to soya lecithin or related food products such as soybean and peanut.
o Inform your doctor and pharmacist what prescription drugs you are taking, especially antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), trimipramine (Surmontil); atenolol (Tenormin); betaxolol (Kerlone); cartelol (Cartrol); diuretics ('water pills') such as bendroflumethiazide (Naturetin), benzthiazide (Exna), bumetanide (Bumex), chlorothiazide (Diuril), chlorthalidone (Hygroton), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (HydroDiuril), hydroflumethiazide (Diucardin), indapamide (Lozol), metahydrin (Naqua), methyclothiazide (Enduron), metolazone (Zaroxolyn), polythiazide (Renese), quinethazone (Hydromox), trichlormethiazide, and torsemide (Demedex); isocarboxazid (Marplan); labetolol (Normodyne, Trandate); metoprolol (Lopressor); nadolol (Corgard); other medications for asthma such as bitolterol (Tornalate), isoetharine, metaproterenol (Alupent), pirbuterol (Maxair), isoproterenol (Isuprel), levalbuterol (Xopenex), and salmeterol (Serevent); phenelzine (Nardil); propranolol (Inderal); sotalol (Betapace); theophylline; timolol (Blocadren); tranylcypromine (Parnate); hypertension; glaucoma; and heart disease.
o Inform your doctor and pharmacist what nonprescription vitamins and herbal products you are taking, including ephedrine, phenylephrine, phenylpropanolamine, or pseudoephedrine. Many nonprescription products contain these drugs (e.g., diet pills and medications for colds and asthma), so check labels carefully. Do not take any of these medications without informing your doctor (even if you never had a problem taking them before).
o inform your doctor if you are breast-feeding glaucoma, prostate problems or difficulty in urination, seizures, an overactive thyroid gland, high blood pressure, an irregular heart beat, increased heart rate, diabetes, or liver or kidney disease.
o Inform your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking ipratropium and albuterol, call your doctor without delay.
o if you are having surgery, including dental surgery, Inform your doctor or dentist that you are taking ipratropium and albuterol.
o if you spray ipratropium and albuterol into your eyes and experience worsening glaucoma, eye pain, temporary blurring of vision, halos or colored images in association with red itchy eyes, call your doctor without delay.

Inhalation devices require regular cleaning. Follow the written directions for care and cleaning included with the inhalation device. Once a week, remove the aerosol container from the mouthpiece, wash the mouthpiece with warm tap water, and dry it thoroughly.

To relieve the dry mouth or throat irritation caused by ipratropium and albuterol inhalation, rinse your mouth with water, chew gum, or suck sugarless hard candy after using ipratropium and albuterol.

Possible Adverse Effects:

Side effects from ipratropium and albuterol are not common, but they could occur. Tell yourdoctor if any of these symptoms are severe or do not go away:

o cough
o dry mouth or throat irritation
o nervousness
o dizziness
o headache
o upset stomach
o joint or muscle pain

If you have any of the following symptoms, call your doctor without delay:

o increased difficulty breathing
o irregular heartbeat
o rapid or increased heartbeats
o chest pain or discomfort
o sinus or respiratory infection

Brand Name(s):

o Duoneb®