(al byoo' ter ole) (i pra troe' pee um)

Brand Name(s): Combivent^® Metered Dose Inhaler¶, Combivent Respimat^® Inhalation Spray, DuoNeb^® Inhalant Solution

WHY is this medicine prescribed?

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.

Are there OTHER USES for this medicine?

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

HOW should this medicine be used?

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 a spray 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 inhalation 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 the inhalation spray more than six times in 24 hours.

Call your doctor if your symptoms worsen, if you feel that albuterol and ipratropium inhalation no longer controls your symptoms, or if you find that you need to use extra doses of the medication more often.

If you are using the inhaler, your medication will come in cartridges. Each cartridge of albuterol and ipratropium inhalation spray is designed to provide 120 inhalations. This is enough medication to last one month if you use one inhalation four times a day. After you use all 120 doses, the inhaler will lock and will not release any more medication, There is a dose indicator on the side of the inhaler that keeps track of how much medication is left in the cartridge. Check the dose indicator from time to time to see how much medication is left. When the pointer on the dose indicator enters the red area, the cartridge contains enough medication for 7 days and it is time to refill your prescription so that you will not run out of medication.

Be careful not to get albuterol and ipratropium inhalation into your eyes. 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, or seeing unusual colors 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 spray is designed for use only with a cartridge of albuterol and ipratropium. Never use it to inhale any other medication, and do not use any other inhaler to inhale the medication in a cartridge of albuterol and ipratropium.

Before you use albuterol and ipratropium inhalation 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 prepare the inhaler for use, follow these steps:

1. Put the inhaler together before you use it for the first time. To start, take the inhaler out of the box, and keep the orange cap closed. Press the safety catch and pull off the clear base of the inhaler. Be careful not to touch the piercing element inside of the base
2. The inhaler must be discarded three months after you put it together. Write this date on the label of the inhaler so you will not forget when you need to discard your inhaler.
3. Take the cartridge out of the box and insert the narrow end into the inhaler. You can press the inhaler against a hard surface to be sure it is inserted correctly. Replace the clear plastic base on the inhaler.
4. Hold the inhaler upright with the orange cap closed. Turn the clear base in the direction of the white arrows until it clicks.
5. Flip the orange cap so that it is fully open. Point the inhaler toward the ground.
6. Press the dose release button. Close the orange cap.
7. Repeat steps 4-6 until you see a spray coming out of the inhaler. Then repeat these steps three more times.
8. The inhaler is now primed and ready for use. You will not need to prime your inhaler again unless you do not use it for longer than 3 days. If you do not use your inhaler for more than 3 days, you will need to release one spray toward the ground before you start to use it again. If you do not use your inhaler for more than 21 days, you will need to follow steps 4-7 to prime the inhaler again.

To inhale the spray using the inhaler, follow these steps:

1. Hold the inhaler upright with the orange cap closed. Turn the clear base in the direction of the white arrows until it clicks.
2. Open the orange cap.
3. Breathe out slowly and completely.
4. Place the mouthpiece in your mouth and close your lips around it. Be careful not to cover the air vents with your lips.
5. Point the inhaler toward the back of your throat and breathe in slowly and deeply.
6. While you are breathing in, press the dose release button. Continue to breathe in as the spray is released into your mouth.
7. Hold your breath for 10 seconds or as long as you comfortably can.
8. Take the inhaler out of your mouth and close the orange cap. Keep the cap closed until you are ready to use the inhaler again.

To inhale the solution using a nebulizer, follow these steps:

1. 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.
2. Twist off the top of the vial and squeeze all of the liquid into the reservoir of the nebulizer.
3. Connect the nebulizer reservoir to the mouthpiece or face mask.
4. Connect the nebulizer reservoir to the compressor.
5. Put the mouthpiece in your mouth or put on the face mask. Sit in a comfortable, upright position and turn on the compressor.
6. 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.

What SPECIAL PRECAUTIONS should I follow?

Before using albuterol and ipratropium inhalation,

• 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, or any of the ingredients in albuterol and ipratropium solution or spray. Ask your pharmacist or check the manufacturer's patient information for a list of the ingredients.

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements and herbal products you are taking or plan to take while using albuterol and ipratropium inhalation. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. .

• Tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: antidepressants [amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), trimipramine (Surmontil)] or monoamine oxidase (MAO) inhibitors [isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl, Emsam, Zelapar)].

• The following nonprescription products may interact with albuterol and ipratropium inhalation: medications for colds. Be sure to let your doctor and pharmacist know that you are taking these medications before you start using albuterol and ipratropium inhalation. Do not start any of these medications while using albuterol and ipratropium inhalation without discussing with your healthcare provider.

• tell your doctor if you have or have ever had glaucoma (an eye condition); difficulty urinating; a blockage in your bladder; 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.

• 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.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do IF I FORGET to take a dose?

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.

What SIDE EFFECTS can this medicine cause?

This medication may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• uncontrollable shaking of a part of the body
• nervousness

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

• fast or pounding heartbeat
• chest pain
• hives
• rash
• itching
• 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
• difficulty urinating

Albuterol and ipratropium may cause other side effects. Call your doctor if you have any unusual problems while you are using this medication.

What should I know about STORAGE and DISPOSAL of 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). Do not allow the inhalation spray to freeze.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• chest pain
• fast heartbeat

What OTHER INFORMATION should I know?

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.

^¶ This branded product is no longer on the market. Generic alternatives may be available.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: October 15, 2023.