albuterol and ipratropium inhaler, Combivent, Combivent Respimat
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: albuterol and ipratropium inhaler
BRAND NAME: Combivent, Combivent Respimat
DRUG CLASS AND MECHANISM: Albuterol/ipratropium is a combination product consisting of two bronchodilators, albuterol (Proventil; Ventolin) and ipratropium (Atrovent) that is used in the treatment of chronic obstructive pulmonary disease (bronchitis and emphysema) when there is evidence of spasm (narrowing) of the airways (bronchi). Bronchodilators dilate or enlarge the airways by relaxing the muscles surrounding the airways. Albuterol and ipratropium work by different mechanisms, but both cause the muscles of the airways to relax. Albuterol is a bronchodilator of the beta-2 agonist type. Beta-2 agonists are medications that stimulate beta-2 receptors on the smooth muscle cells that line the airways, causing these muscle cells to relax and thereby opening airways. Ipratropium blocks the effect of acetylcholine in airways and nasal passages. Acetylcholine is a chemical that nerves use to communicate with muscle cells. In chronic obstructive pulmonary disease (COPD), cholinergic nerves going to the lungs cause narrowing of airways by stimulating muscles surrounding airways to contract. The "anti-cholinergic" effect of ipratropium blocks the effect of cholinergic nerves, causing the muscles to relax and airways to dilate. The FDA approved albuterol/ipratropium in October 1996.
GENERIC AVAILABLE: Yes
PREPARATIONS: Aerosol inhaler: 90/18 mcg or 100/20 mcg (albuterol/ipratropium) per actuation of the inhaler.
STORAGE: The inhaler should be stored at room temperature, 15-30 C (59-86 F) and kept away from moisture.
PRESCRIBED FOR: Albuterol/ipratropium is used in the treatment of bronchospasm or narrowing of the airways caused by emphysema or bronchitis in patients who require a second bronchodilator.
DOSING: The recommended dosing for albuterol/ipratropium is 2 inhalations 4 times daily and as needed not to exceed 12 inhalations per day. The dose of Combivent Respimat is 1 inhalation 4 times daily not to exceed 6 inhalations per day.
DRUG INTERACTIONS: Use with other anticholinergic drugs (for example, atropine) may increase the occurrence of side effects. Tricyclic antidepressants, for example, amitriptyline (Elavil, Endep), monoamine oxidase inhibitors, for example, tranylcypromine, should not be combined with albuterol/ipratropium because of their additive effects on the vascular system (increased blood pressure, heart rate, etc.). A period of two weeks should elapse between treatment with albuterol/ipratropium and tricyclic antidepressants or monoamine oxidase inhibitors.
Use of albuterol/ipratropium with other stimulant medications is discouraged because of their combined effects on heart rate, blood pressure, and the potential for causing chest pain in patients with underlying coronary heart disease. Beta blockers, for example, propranolol (Inderal, Inderal LA) block the effect of albuterol and may induce bronchospasm in asthmatics.
Albuterol/ipratropium may cause hypokalemia (low potassium). Therefore, combining albuterol/ipratropium with loop diuretics which reduce potassium in the body, for example, furosemide (Lasix) may increase the likelihood of hypokalemia.
PREGNANCY: There are no adequate studies of albuterol/ipratropium use during pregnancy. Some reports indicate that beta-agonists may interfere with uterine contractility.
NURSING MOTHERS: It is not known whether albuterol/ipratropium is excreted in human milk.
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