albuterol and ipratropium inhaler

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.

What brand names are available for albuterol and ipratropium inhaler?

Combivent Respimat

Is albuterol and ipratropium inhaler available as a generic drug?

Yes

Do I need a prescription for albuterol and ipratropium inhaler?

Yes

Side effects of albuterol/ipratropium combination products are due to the component drugs. Side effects of albuterol include nervousness, tremor, headache, palpitations, fast heart rate, elevated blood pressure, nausea, dizziness, and heartburn. Throat irritation and nosebleeds also can occur. Worsening of diabetes and lowering of potassium also have been reported.

The most common side effects associated with ipratropium are:

• dry mouth,
• cough,
• headache,
• nausea,
• dizziness, and
• difficulty breathing.

Because of its anticholinergic effect, ipratropium may worsen symptoms of benign prostatic hyperplasia, and narrow-angle glaucoma.

Other important side effects include allergic reactions, which may rarely occur and may manifest as:

• rash,
• hives,
• swelling,
• bronchospasm, or
• anaphylaxis (shock).

In rare patients, albuterol/ipratropium can paradoxically precipitate life-threatening bronchospasm.

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.

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.

There are no adequate studies of albuterol/ipratropium use during pregnancy. Some reports indicate that beta-agonists may interfere with uterine contractility.

It is not known whether albuterol/ipratropium is excreted in human milk.

What preparations of albuterol and ipratropium inhaler are available?

Aerosol inhaler: 90/18 mcg or 100/20 mcg (albuterol/ipratropium) per actuation of the inhaler.

How should I keep albuterol and ipratropium inhaler stored?

The inhaler should be stored at room temperature, 15 C - 30 C (59 F - 86 F) and kept away from moisture.