Ipratropium Bromide/Albuterol Sulfate, Inhalation

What are other names for this medicine?

Type of medicine: bronchodilator

Generic and brand names: ipratropium bromide and albuterol sulfate, inhalation; Combivent; DuoNeb

What is this medicine used for?

This medicine is used to treat chronic obstructive pulmonary disease. It is a combination of 2 bronchodilators (medicines that make your breathing easier). It is used when a single medicine is not completely effective.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to soya lecithin (soybeans or peanuts) or any medicine
• an enlarged prostate gland or bladder problems
• diabetes
• glaucoma
• heart disease
• high blood pressure
• liver or kidney disease
• seizures
• thyroid disease

Do not use this medicine if you are allergic to soy (soybean) products or peanuts.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

This medicine comes in an aerosol pump called a metered dose inhaler (MDI), or as a solution (liquid) to be used in a nebulizer. The nebulizer produces a fine mist that you inhale through your mouth. Check the label on the medicine for directions about your specific dose.

If you have the MDI:

Follow the directions that come in the medicine package. Wash your hands before using this medicine. If you are not using a spacer, the technique most often recommended is as follows:

1. Shake the MDI vigorously.
2. Hold the MDI upright so the mouthpiece is at the bottom.
3. The best way to use the MDI is to hold the mouthpiece 1-and-1/2 to 2 inches in front of an open mouth (about 2 to 3 finger widths). Try this technique first. It helps keep medicine from ending up in your mouth, which may cause increased side effects. It also helps medicine to reach your lungs rather than the back of the throat. If the open mouth technique is too difficult, you may also place the MDI mouthpiece directly into your mouth and close your lips snugly around it. Talk with your provider or pharmacist about this.
4. Breathe out normally.
5. Press the MDI down once so it releases a spray of medicine into your mouth while you breathe in slowly. (One spray is called a puff.)
6. Continue breathing in as slowly and deeply as possible.
7. Hold your breath for 5 to 10 seconds, or as long as is comfortable (this gives the medicine time to reach the airways).
8. Breathe out slowly.
9. Take a few normal breaths and then repeat steps 1 through 8 for another inhalation (puff) if required. Take the number of puffs prescribed by your healthcare provider.

Do not use more than 12 sprays in 24 hours. If you are not sure how many sprays to use or if you do not understand how to use the pump, ask your healthcare provider or pharmacist to explain. Using a spacer (such as an AeroChamber) may make it easier for you to use this medicine correctly. Ask your provider about this.

If you have the nebulizer solution, follow the directions that come with the vials of medicine. Be sure you know how and when to use the nebulizer and how much medicine to use. Follow these steps when you use the nebulizer:

1. Put medicine into the medicine cup, following the directions for that type of system. Attach the mouthpiece or mask to the medicine cup. Attach the tubing to the medicine cup.
2. If you are using a mouthpiece, put the mouthpiece in your mouth between your teeth and close your lips around it. If you are using a mask, place the mask over your nose and mouth. Make sure it fits snugly.
3. Hold the nebulizer in an upright position. This prevents spilling and helps it work better.
4. Gently breathe out.
5. If you are using equipment with a finger valve, start the mist by covering the hole in the valve with a finger.
   • As the mist starts, breathe in slowly and deeply over 3 to 5 seconds. Keep your finger over the valve hole.
   • At the end of a deep breath, uncover the finger valve hole to stop the mist.
   • Hold your breath for up to ten seconds. This allows the medicine time to build up in the airway.
   • Start breathing normally.
6. If you are not using a finger valve, the nebulizer will mist constantly. Breathe in slowly and deeply through the mouthpiece or mask. Exhale normally through your nose.
7. Tap the side of the nebulizer occasionally to help the solution drop to where it can be misted.
8. Continue these steps until the nebulizer starts sputtering or the medicine is gone.

Use this medicine exactly as your healthcare provider prescribes. Do not use more or for a longer period than prescribed.

If you are using other inhaled medicines such as an inhaled steroid, use this medicine first. Wait at least 5 minutes before using the other inhaler.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: fast heartbeat, tremors, weakness, dry mouth.

What should I watch out for?

The effects of this medicine usually last at least 4 to 5 hours. If you need to use the medicine more often, or if your condition becomes worse, contact your healthcare provider right away.

This medicine can cause serious shortness of breath. Talk to your healthcare provider about this and the symptoms to watch for.

Do not spray this medicine in or near your eyes because it can cause eye pain, blurred vision, worsening of narrow-angle glaucoma, or vision halos. If you get some medicine in your eyes, flush them with cool water and contact your healthcare provider.

An adult should supervise the use of this medicine by a child.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you are unable to reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives, itching, tightness in your chest, trouble breathing, swelling of the lips, face, tongue, or throat), severe shortness of breath.

Other: Increased heart rate, muscle tremors or shakiness, coughing, stuffy nose, dry mouth, nausea, sore throat.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• alpha blockers such as doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin), tamsulosin (Flomax), Alfuzosin (Uroxatral)
• anticholinergic agents such as atropine (Sal-Tropine, Antrocol), glycopyrrolate (Robinul), mepenzolate (Cantil), propantheline bromide (Pro-Banthine), and tridihexethyl chloride (Pathilon)
• beta blockers such as atenolol (Tenormin), betaxolol (Kerlone), carteolol, pindolol, timolol, sotalol (Betapace), acebutolol (Sectral), nadolol (Corgard), metoprolol (Lopressor, Toprol XL), and propranolol (Inderal)
• diuretics (water pills) such as bumetanide (Bumex), ethacrynic acid (Edecrin), furosemide (Lasix), torsemide (Demadex), chlorothiazide (Diuril), hydrochlorothiazide (Microzide, Oretic), hydroflumethiazide (Diucardin), and polythiazide (Renese)
• MAO inhibitors such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan) (Do not take an MAO inhibitor and this medicine within 14 days of each other.)
• tricyclic antidepressants such as amitriptyline, nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), and doxepin (Sinequan). Do not take a tricyclic antidepressant and this medicine within 14 days of each other.

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Protect it from heat, high humidity, and bright light. Aerosol units are under pressure. Keep away from heat or flames; do not puncture. Do not use any medicine after the expiration date.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.