Ipratropium and albuterol (Combivent Respimat) is a combination of a beta-adrenergic receptor agonist and anticholinergic drug that is used in patients with acute exacerbation of asthma and chronic obstructive pulmonary disease who have an inadequate response to monotherapy.

Ipratropium and albuterol (Combivent Respimat) Uses:

• Chronic obstructive pulmonary disease:

  • It is indicated for the treatment of patients with chronic obstructive pulmonary disease who are on a regular bronchodilator for maintenance treatment but continued to have bronchospasm and require the addition of a bronchodilator.

• Off Label Use of Ipratropium and albuterol in Adults:

  • It is used as an off-label treatment for the acute exacerbation of asthma.

Ipratropium and albuterol dose in adults:

Ipratropium and albuterol (Combivent Respimat) Dose in the treatment of COPD: Oral inhalation:

• Soft-mist inhaler:

  • One inhalation every six hours (4 times a day).
  • A maximum of 6 inhalations/day may be used.

• Nebulization solution:

  • Initial: Ipratropium bromide 0.5 mg/albuterol 2.5 mg in a 3 ml bottle, taken every six hours.
  • A total of six vials, or 18 mL, may be given every 24 hours.

Ipratropium and albuterol (Combivent Respimat) Dose in the treatment of Acute asthma (exacerbations) (off-label): Oral inhalation:

• Soft-mist inhaler:

  • If necessary, 8 inhalations are given every 20 minutes for up to three hours.

Note:

• Combivent Respimat dosage for FDA-approved uses is half that of Combivent with CFC propulsion ( that has been discontinued).

• Nebulization solution:

  • Three doses of 1 vial (3 mL) each are given after 20 minutes, then as needed.

Ipratropium and albuterol (Combivent Respimat) Dose in the treatment of Bronchospasm in patients with asthma (quick-relief) (off-label):

• Soft-mist inhaler:

  • 2 to 3 inhalations are administered four times a day (every 6 hours).

Note: Dosing of Combivent Respimat for FDA-approved indications is 50% of CFCpropelled Combivent dosing.

• Nebulization solution:

  • 1 vial of 3 mL may be administered every 4 to 6 hours.

Ipratropium and albuterol dose in children:

Ipratropium and albuterol (Combivent Respimat) Dose in the treatment of Acute exacerbations of Asthma:

Note:

• Ipratropium is only indicated for severe exacerbations of asthma in emergency settings. It has not been shown to be beneficial once the patient is hospitalized.

• Infants and Children:

  • Nebulization solution (ipratropium bromide 0.5 mg/albuterol 2.5 mg):

    • Oral inhalation:
      • Nebulize the patient 1.5 to 3 mL as needed for up to three hours after the first three doses of every 20 minutes.

• Adolescents:

  • Nebulization solution (ipratropium bromide 0.5 mg/albuterol 2.5 mg):

    • Oral inhalation:
      • Three doses of 3 mL of the solution should be nebulized into the patient every 20 minutes, followed by as needed for up to three hours.

Ipratropium and albuterol (Combivent Respimat) Pregnancy Risk Factor C

• You can consult individual agents (Ipratropium or albuteral).
• In animal pregnancy studies, the combination has not yet been tested.

Use of albuterol and Ipratropium during lactation:

• It is unknown if the drug will be excreted into breast milk.
• Manufacturers recommend weighing the risks to the infant from drug exposure and the benefits for the mother.
• You can consult individual agents (ipratropium or albuterol).

Ipratropium and albuterol (Combivent Respimat) Dose in patients with kidney disease:

The drug has not been studied in patients with kidney diseases. Dose adjustments have not been recommended by the manufacturer.

Ipratropium and albuterol (Combivent Respimat) Dose in Liver disease:

The drug has not been studied in patients with liver diseases. Dose adjustments have not been recommended by the manufacturer.

Also, see individual agents (Ipratropium and Albuterol)

Side Effects of Ipratropium and albuterol (Combivent Respimat):

• Cardiovascular:

  • Hypertension
  • Cardiac Arrhythmia
  • Edema
  • Palpitations
  • Chest Discomfort
  • Tachycardia
  • Angina Pectoris

• Central Nervous System:

  • Fatigue
  • Pain
  • Nervousness
  • Dizziness
  • Insomnia
  • Voice Disorder
  • Headache

• Dermatologic:

  • Skin Rash
  • Pruritus

• Endocrine & Metabolic:

  • Hypokalemia

• Gastrointestinal:

  • Dyspepsia
  • Diarrhea
  • Vomiting
  • Dysgeusia
  • Xerostomia
  • Constipation

• Genitourinary:

  • Urinary Tract Infection
  • Dysuria

• Neuromuscular & Skeletal:

  • Asthenia
  • Myalgia
  • Muscle Spasm
  • Tremor
  • Arthralgia

• Ophthalmic:

  • Eye Pain

• Respiratory:

  • Sinusitis
  • Nasopharyngitis
  • Pharyngolaryngeal Pain
  • Bronchitis
  • Dyspnea
  • Pharyngitis
  • Dry Throat
  • Respiratory Insufficiency
  • Bronchospasm
  • Flu-Like Symptoms
  • Upper Respiratory Tract Infection
  • Increased Bronchial Secretions
  • Wheezing
  • Cough

Frequency of side effects not defined:

• Gastrointestinal:

  • Nausea

Contraindications to Ipratropium and albuterol (Combivent Respimat):

Hypersensitivity to albuterol, ipratropium, atropine (and their derivatives), or any component in the formulation

Cardiac tachyarrhythmias,

Hypertrophic obstructive Cardiomyopathy

Warnings and precautions

• Bronchospasm

  • Patients who use inhalational bronchodilators may experience paradoxical bronchospasm.
  • Paradoxical bronchospasm can be life-threatening and should not be confused with ineffective treatment.
  • If bronchospasm becomes worse, the treatment should be stopped.

• CNS effects

  • Patients can experience blurred or dizzy vision.
  • Be aware of those who operate heavy machinery or do mental tasks that require alertness.

• Hypersensitivity reactions

  • Angioedema, rash oropharyngeal symptoms, or bronchospasm, may all be possible.
  • Anaphylaxis and other serious reactions may also be possible.
  • The course of treatment should be discontinued right once if an allergic reaction happens.

• Deaths and serious effects:

  • Patients who take more medication than the recommended dosage or use the medication at a higher frequency may experience serious adverse drug reactions.
  • Inhaled sympathomimetic drug abuse can lead to fatalities.

• Sympathomimetic Amino Acid Sensitivity:

  • Sympathomimetics are not recommended for patients who are sensitive.

• Cardiovascular disease

  • Albuterol activates beta-receptors. It can cause hypertension, tachyarrhythmias, and heart failure.
  • Patients suffering from cardiovascular disease should be cautious about taking the drug.
  • ECG changes can also be caused by beta-agonists, such as flat-t waves, increased QTc interval, and ST segment depression.
  • In their scientific statement, the AHA has classified it as an agent that could cause myocardial damage or direct myocardial toxicities.

• Diabetes:

  • Beta-agonists can cause temporary increases in blood glucose.
  • Diabetes patients should be cautious when using it.

• Glaucoma:

  • Ipratropium raises intraocular pressure
  • Patients with narrow-angle vision should use caution.

• Hyperthyroidism:

  • Albuterol can stimulate thyroid activity and could cause hyperthyroidism.

• Hypokalemia

  • Transient hypokalemia may be caused by Albuterol.
  • Hypokalemia patients should be cautious when using the drug.

• Bladder neck obstruction/prostatic hyperplasia:

  • Urinary retention may be caused by Ipratropium
  • Patients with bladder neck obstruction and patients with prostatic hyperplasia should not use it.

• Seizure disorder:

  • Beta-agonists may cause CNS stimulation and precipitate seizures. Patients with seizures should be cautious.

Ipratropium and albuterol: Drug Interaction

Monitoring parameters:

• FEV-1
• urinary retention
• pulmonary function tests
• serum glucose
• heart rate
• serum potassium
• CNS stimulation
• signs and symptoms of glaucoma
• blood pressure
• hypersensitivity reactions
• shortness of breath
• peak flow

How to administer Ipratropium and albuterol (Combivent Respimat)?

It is indicated for oral inhalation only. Directly spraying into the eyes should be avoided.

Nebulization solution:

• Use a jet nebulizer with a sufficient airflow and a compressor that is equipped with a mouthpiece or face mask to administer the medication.

Soft-mist inhaler:

• Point the inhaler toward the ground and activate it until an aerosol cloud is visible before using it (or using it again after 21 or more days), then repeat three more times.
• Activate once before usage if not used for three or more days.
• At least once every week, only use a moist cloth or tissue to clean the mouthpiece, including the metal portion inside.

Mechanism of action of Ipratropium and albuterol (Combivent Respimat):

Ipratropium is an anticholinergic drug that blocks acetylcholine at parasympathetic nerve endings in bronchial smooth muscles causing bronchodilators and inhibiting bronchial and nasal secretions.

Salbutamol acts as a beta-agonist and relaxes bronchial smooth muscles. It can also cause hypokalemia by driving potassium into cells.

International Brand Names of Ipratropium and albuterol:

• Combivent Respimat
• Apo-Salvent-Ipravent Sterules
• Combivent Respimat
• Combivent UDV
• ratio-Ipra Sal UDV
• TevaCombo Sterinebs
• Aerotropa
• Atrodual
• Atrolin
• Berovent
• Besmate
• Breva
• Combair
• Combipul
• Combivent
• Combivent Aerosol
• Combivent UDV
• Di-Promal
• Dospir
• Duavent
• Duolin
• Farbivent
• I-Breath Plus
• Ipramol
• Ipravent-S
• Multivent
• Normotropium Plus
• Pulmodual
• Pulmodual MD
• Salpium
• Swabivent
• Zerseos

Ipratropium and albuterol Brand Names in Pakistan: