Ipratropium and Albuterol (Inhalation)

Produced under brand names Combivent, Combivent Respimat, and Duoneb, it is administered to treat air flow blockage and prevent the worsening of chronic obstructive pulmonary disease (COPD) in patients on combination therapy.

Overview

Ipratropium and albuterol is a combination medication that belongs to the family of medicines known as bronchodilators. These are medicines that are breathed in through the mouth to open up the lungs' air passages (bronchial tubes). It is administered to help manage the symptoms of lung diseases such as chronic bronchitis, asthma, and emphysema. It is also used in combination with other medications to treat air flow blockage and prevent the worsening of chronic obstructive pulmonary disease (COPD) in patients on combination therapy.

Albuterol is a moderately selective beta2-andregenic agonist that stimulates receptors in the lungs, and vasculature supplying skeletal muscle. This results in the relaxation of the lungs' bronchial muscles, which in turn provides relief for bronchospasm, facilitates mucous drainage, reduces airway resistance, and increases vital capacity. Albuterol also inhibits the degranulation and release of inflammatory autocoids from mast cells.

Ipratropium, on the other hand, antagonizes acetylcholine action by blocking muscarinic cholinergic receptors that are present in the airways. Ipratropium's actions are parallel to those of atropine on the bronchial smooth muscle when administered intravenously. When administered via oral inhalation, however, ipratropium causes greater antimuscarinic activity on the bronchial smooth muscle with minimal systemic effect.

This medicine is only available with a doctor's prescription and comes in the following dosage forms:

  • Solution
  • Aerosol powder
  • Aerosol liquid
  • Spray

Conditions Treated

  • Symptoms of lung disease
  • Airflow blockage
  • Chronic obstructive pulmonary disease

Type Of Medicine

  • Anticholinergic Combinations with B2-stimulants, Inhalant

Side Effects

Alongside the intended effects, a drug may also trigger certain undesired effects. The severity of these side effects may vary from patient to patient depending on the condition under treatment as well as the patient's health condition. In addition, some side effects are mild and tend to go away as the patient adjusts to medication. However, some of this drug's side effects can be so severe as to require immediate medical attention.

Talk to your doctor if you experience the following ipratropium and albuterol side effects.

  • Persistent pain and body aches
  • Mucous producing cough
  • Chills
  • Ear congestion
  • Breathing difficulty
  • Fever
  • Loss of voice
  • Headache
  • Sneezing
  • Runny or stuffy nose
  • Sore throat
  • Unusual fatigue and general body weakness
  • Tightness in the chest
  • Bladder pain
  • Cloudy or bloody urine
  • Burning sensation while passing urine,
  • Blurred vision
  • Tingling feeling
  • Chest pain
  • Diarrhea
  • Congestion
  • Fainting
  • Dizziness
  • Irregular heart beat
  • Frequent urge to urinate
  • Hoarseness
  • General feeling of discomfort or illness
  • Joint pain
  • Lower back or side pain
  • Increased sputum
  • Loss of appetite
  • Nausea
  • Muscle aches and pain
  • Nervousness
  • Shivering
  • Pain or tenderness around the eyes and cheekbones
  • Sweating
  • Swelling
  • Shakiness in the hands, legs, and arms
  • Swollen, tender glands in the neck
  • Sleeping difficulty
  • Difficulty with swallowing food
  • Vomiting
  • Skin rashes and hives
  • Swelling on the face, lips, mouth, throat, and eye lids
  • Welts
  • Redness of the skin

Some ipratropium and albuterol side effects do not need medical attention as they tend to go away as your body adjusts to treatment. Also, your healthcare provider will be able to advise you on how to manage or reduce the severity of some of the side effects. Check with your doctor if any of the following ipratropium and albuterol side effects persist or are bothersome.

  • Bad or unpleasant after taste
  • Acid or sour stomach
  • Frequent belching
  • Diarrhea
  • Moving with difficulty
  • Heart burn
  • Dry mouth
  • Indigestion
  • Stomach discomfort, pain, or upset
  • Loss of voice
  • Muscle pain and stiffness
  • Dry throat
  • Dilated and enlarged pupil
  • Blurred vision leading to blindness
  • Increased sensitivity of the eyes to light
  • Noisy breathing
  • Tearing
  • Swelling of the eyes
  • Lack of strength
  • Swelling or inflammation of the mouth
  • Redness of the white part of the eyes or inside the eyelids

Call your healthcare provider for advice about these side effects. You may also report these side effects to the FDA at 1-800-FDA-1088.

Ipratropium and albuterol dosage

It is important that you read and understand the drug's Information Leaflet before you can start using the medication as well as each time you for a refill. Ipratropium and albuterol is used with a special piece of equipment called a nebulizer that changes the medication from solution to fine mist for easy inhalation. It is important that you learn how to properly prepare your solution and use the nebulizer. If a child is on this medication, the parent or caretaker should closely supervise the child during every use to prevent under-dosing or overdosing. Ask your doctor or respiratory therapist any questions you might have with respect to preparing and using this medication.

Steps to follow when preparing the inhaler for use:

  • Put the inhaler together for first time use. Start by getting the inhaler out of the box, while keeping the orange cap closed. Press the safety catch and pull off the inhaler's base. Exercise caution not to touch the piercing element at the base.
  • The inhaler must be discarded three months after assembling. Note this date on the inhaler's label so you will remember when to get rid of the inhaler.
  • Remove the cartridge from the box and insert the narrow end into the inhaler. To insert correctly, press the inhaler against a hard surface. Replace the clear plastic base on the inhaler.
  • With the orange cap closed, hold the inhaler in an upright position. Turn the clear base as directed by the white arrows until it clicks firmly.
  • Flip the orange cap to open and point the inhaler downwards
  • Press the dose release button and close the orange cap
  • The inhaler is now primed and ready for use. You do not need to prime your inhaler unless you fail to use it for over 3 days.

Ipratropium and Albuterol Dosing

Ipratropium and albuterol dosage varies from patient to patient. It is important that you follow your healthcare provider's prescription or directions on the label. The information provided here is only the average dosing for ipratropium and albuterol. If your dosage is different, do not change it unless with the approval of your healthcare provider.

The amount of medicine you take depends on the strength of the medication, the number of daily doses, the time recommended in between doses, as well as the length of time for which you take the medication.

  • Inhalation aerosol dosage form (used with an inhaler)

Adults' two puffs up to four times per day as needed. Never take more than 12 puffs within the 24 hours period

Children'use and dosage must be decided by the healthcare provider

  • For inhalation solution dosage form (used with nebulizer)

Adult dosage' one, 3 mL vial in the nebulizer four times per day. The patient may use 2 additional treatments during the day if need be.

Children' use and dosage must be decided by the healthcare provider

  • Inhalation spray dosage form (used with an inhaler)

Adults 'take one puff, four times per day. Additional doses may be taken if there is need. However, do not take more than six puffs within the 24-hour period.

Children'use and dosage must be decided by the healthcare provider.

Missing a dose

If you miss your ipratropium and albuterol dosage, take it as soon as possible. However, if it almost time for your next dose, you may skip the missed dose and resume your regular dosing schedule. Do not make up for the missed dosage by double dosing.

Overdose

In case of overdose, contact the emergency room or the poison control center immediately at 1-800-222-1222. Symptoms of ipratropium and albuterol overdose include chest pain, seizures, and fast/irregular heartbeat.

Ipratropium and albuterol interactions

Although certain medications should never be taken together, there are cases where two different medicines may be prescribed together even if there is a likelihood of an interaction. In such cases, your healthcare provider may change the dosage for one or both medications or recommend other precautionary measures. If you are using ipratropium and albuterol, it is specifically important that you let your healthcare provider know if you are on any of the following medications:

  • Amoxapine
  • Doxepin
  • Amitriptyline
  • Clomipramine
  • Amineptine
  • Amitriptylinoxide
  • Atomoxetine
  • Desipramine
  • Dibenzepin
  • Imipramine
  • Iobenguane I 123
  • Levalbuterol
  • Nortriptyline
  • Protriptyline
  • Tianeptine
  • Trimipramine
  • Opipramol
  • Melitracen
  • Tiotropium
  • Lofepramine
  • Nortriptyline

Combining ipratropium and albuterol with any of the following medications may increase the risk or severity of certain side effects even though using both medications may be right for you. If both medications are prescribed together, your healthcare provider may change the dosage or frequency of using both medicines.

  • Digoxin
  • Betel Nut

Ipratropium and albuterol interaction with food, tobacco, and alcohol

Certain foods must not be taken at or around the time of using certain medications since an interaction might occur. Using alcohol and tobacco products while on certain medications may also cause interactions. Discuss with your healthcare provider the use of this medication with food, alcohol, and tobacco products.

Other medical problems that may affect the efficiency of ipratropium and albuterol

Certain pre-existing medical conditions may affect the use of ipratropium and albuterol. Be sure to tell your healthcare provider if you have any medical problems, especially:

  • Allergy to soybean, soya lecithin, or peanuts
  • Heart or blood vessel disease
  • Blood circulation problems
  • Diabetes
  • Hypertension
  • Pain while passing urine
  • Enlarged prostate
  • Low potassium in the blood (hypokalemia)
  • Hyperthyroidism
  • Seizures
  • Narrow-angle glaucoma
  • Urinary bladder blockage
  • Liver problems

Anticholinergic agents

Concomitant use of anticholinergic medication has the potential of causing an additive interaction. Combination of ipratropium and albuterol with other anticholinergic-containing drugs may trigger an increase in anticholinergic adverse effects.

Beta adrenergic agonists

Caution is advised when administering ipratropium and albuterol alongside other sympathomimetic agents as this can increase the risk of adverse cardiovascular effects.

Beta-receptor blocking agents

Albuterol and beta-receptor blocking agents inhibit the effect of each other. Therefore, caution is advised when administering beta-receptor blocking agents to patients with hyperreactive airways.

Diuretics

The ECG changes, as well as hypokalemia which may result from administration of non-potassium sparing diuretics such as thiazide diuretics, can be severely worsened by beta2 agonists, especially when the patient exceeds the recommended beta2-agonist dosage. Therefore, caution is advised when combining ipratropium and albuterol with non-potassium sparing diuretics.

Monoamine oxidase inhibitors and tricyclic antidepressants

Ipratropium and albuterol should be administered with extreme caution to patients on monoamine oxidase inhibitors or tricyclic antidepressants therapy, or within two weeks of discontinuing treatment with this agent because albuterol's action on the cardiovascular system may be potentiated.

Ipratropium and albuterol warnings

Ipratropium and albuterol may make you dizzy, interfere with your judgement, as well as affect your vision. Do not drive, operate machinery or perform any activity that requires clear vision and alertness until you are sure you can perform such tasks without endangering your life or others. Also, limit alcoholic beverages while on this medication.

If you are scheduled for a surgical procedure, including dental surgery, tell your doctor all the medications you are using, including prescription, non-prescription, multivitamins, supplements, as well as herbal medications.

Ipratropium and albuterol should be used during pregnancy only when it is clearly necessary. Discuss the risks and benefits of using this medication while pregnant with your healthcare provider. Finally, it is not clear if this medication can be passed on via breastmilk to breastfeeding babies. Consult with your doctor before taking this medication while breastfeeding.

Paradoxical bronchospasm

Ipratropium and albuterol can trigger life threatening paradoxical bronchospasm. Should this occur, the treatment should be discontinued immediately, and alternative therapy adapted.

Cardiovascular effects

The albuterol sulfate contained in ipratropium and albuterol, like other beta-adrenergic agonists, can trigger clinically significant cardiovascular effects in some patients as indicated by the patients' blood pressure, pulse rate, and other associated symptoms. Should the patient exhibit these symptoms, ipratropium and albuterol therapy should be discontinued immediately. In addition, ipratropium and albuterol should be used with caution in patients with a history of cardiovascular problems, especially cardiac arrhythmias, coronary insufficiency, and hypertension.

Ocular effects

Ipratropium bromide, an ingredient of ipratropium and albuterol drug, is an anticholinergic and may increase the risk of intraocular pressure. This may trigger or worsen narrow-angle glaucoma. Thus, ipratropium and albuterol should be administered with caution to patients with a history of narrow-angle glaucoma.

In addition, patients should be careful not to get this medicine into contact with the eyes as this may cause severe eye pain and/or discomfort, mydriasis, blurred vision, visual halos, or redness in the white area of the eye. The patient should consult their healthcare provider immediately if any of these symptoms develop while on ipratropium and albuterol medication.

Urinary retention

Ipratropium bromide, an ingredient in ipratropium and albuterol, is an anticholinergic that may cause urinary retention in some patients. Caution is recommended when administering this medication to patients with a history of prostatic hyperplasia or bladder-neck obstruction.

Do not exceed the recommended dosage

Excessive use of inhaled sympathominetic medications, especially by asthma patients, can result in a fatality. The cause of death is often unclear, but cardiac arrest that follows an unexpected development of hypoxia that is accompanied with severe acute asthmatic crisis is suspected.

Hypersensitivity reactions including anaphylaxis

Administration of albuterol sulfate and ipratropium bromide can trigger hypersensitivity reactions such as angioedema, severe rashes, urticaria, anaphylaxis, oropharyngeal edema, and bronchospasm in some patients. Ipratropium and albuterol should be discontinued immediately if the patient exhibits any of these reactions.

Coexisting conditions

Ipratropium and albuterol contains albuterol sulfate, a beta-2 adrenergic sympathomimetic amine acid. As such, this medication should be administered with caution to patients suffering from (or have a history of) hyperthyroidism, convulsive disorders, diabetes mellitus, as well as in patients who are unresponsive to sympathomimetic amines.

Hypokalemia

The use of beta2-adrenergic agonists may trigger production of significant hypokalemia in some patients. This has the potential to trigger adverse cardiovascular effects.

Ipratropium and albuterol storage

Ipratropium and albuterol canister should be at room temperature (27 degrees C) away from excessive humidity, heat and direct light. Do not freeze the medication. Do not keep this medication inside your car where it could be exposed to extreme cold or heat. Avoid poking holes in the canister or throwing in the fire even if there is no medicine in the canister. Do not keep any outdated medicine longer than necessary. Do not flush unused medication in the toilet or kitchen sink. Ask your pharmacist or healthcare professional how to dispose of any unused medicine. Keep all medicine out of reach of pets and children.

Ipratropium and albuterol aerosol contains flammable ingredients under pressure. For safety reasons, keep the inhaler away from flames or extreme heat. Additionally, the container should never be punctured.

Ipratropium and albuterol inhalation should never be use by patients younger than 18 years old without the doctor's approval.

Hepatic and renal diseases

Ipratropium and albuterol should be administered with caution to patients with a history of renal impairment, including renal disease, renal failure, or hepatic disease.

Summary

Ipratropium and albuterol is a combination medication used to manage symptoms associated with chronic obstructive pulmonary disease (COPD). These include breathing difficulty, wheezing, coughing, and chest tightness. It is administered as a single product with two medications: ipratropium and albuterol.

Both ipratropium and albuterol belong to a group of medications referred to as bronchodilators. Ipratropium is also referred to as an antimuscarinic or anticholinergic agent, while albuterol is known as a beta-agonist. Both ingredients work by relaxing and opening the lungs' air passages to make breathing easier. Controlling the symptoms associated with breathing problems ensures that the patient is able to carry on with their normal life.

Like with other medications, ipratropium and albuterol does come with its share of side effects. Some of these side effects are mild and often disappear as the body gets used to the medication. However, other side effects are severe and may require medical attention. Common ipratropium and albuterol side effects include dizziness, headache, nausea, tremors, dry mouth, nervousness, and frequent constipation. It is important that you talk to your healthcare provider immediately if you experience severe ipratropium and albuterol side effects like irregular heartbeat, chest pains, muscle cramps, confusion, rapid breathing, and severe allergic reactions.

For safety purposes, be sure to inform your doctor if you are allergic to ipratropium and albuterol or any of its ingredients before using it. In addition, inform your doctor if you have any other allergies, including drug, food, paint, and pet allergies.

Do not share this medication with other patients. Also, regular laboratory and medical tests, such as blood pressure and lung function tests, should be performed on a regular basis to monitor your progress while looking out for any side effects.