Dosing & Uses
Dosage Forms & Strengths
albuterol (base)/ipratropium bromide
aerosol metered-dose inhaler (Combivent Respimat)
nebulizer solution (generic)
Chronic Obstructive Pulmonary Disease
Treatment of chronic obstructive pulmonary disease (COPD) in patients on regular bronchodilator who continue to have bronchospasm and require second bronchodilator
Aerosol: 100 mcg/20 mcg (1 actuation of metered-dose inhaler) q6hr; not to exceed 6 actuations/day
Nebulizer solution: 3 mL inhaled q6hr; not to exceed 3 mL q4hr
Patients aged >65 years have higher steady-state systemic exposures for albuterol and ipratropium
Safety and efficacy not established
Serious - Use Alternative
Significant - Monitor Closely
Upper respiratory tract infection (1-10%)
Lung disease (6%)
Chest pain (2.6%)
Urinary tract infection (1.6%)
Leg cramps (1.4%)
Allergic-type reactions, such as skin reactions (eg, rash, pruritus, urticaria [including giant urticaria]), angioedema (eg, of tongue, lips, face), laryngospasm, and anaphylaxis
Cardiovascular: Palpitations, hypotension, myocardial infarction, decreased diastolic blood pressure (BP), increased systolic BP
General: Anaphylactoid reactions, drowsiness, flushing, alopecia, edema, hypokalemia, mental disorder, hyperhidrosis, metabolic acidosis (with albuterol products), asthenia
Gastrointestinal (GI): Mucosal ulcers, stomatitis, heartburn, distress (diarrhea, nausea, vomiting), GI motility disorder, constipation
Muscular: Muscle spasms, muscular weakness, myalgia
Neurologic and psychiatric: Central nervous system (CNS) stimulation, coordination difficulty
Other: Throat irritation, dry throat, hoarseness
Renal: Urinary retention
Respiratory: Bronchospasm (including paradoxical bronchospasm), nasal congestion, drying of secretions, wheezing, exacerbation of COPD symptoms
Sensory: Mydriasis, precipitation or worsening of narrow-angle glaucoma, glaucoma, increased intraocular pressure (IOP), acute eye pain, halo vision, blurred vision, accommodation disorder, ocular irritation, corneal edema, conjunctival hyperemia
Hypersensitivity to albuterol, ipratropium, atropine and derivatives, soy, or peanut
Paradoxical bronchospasm; discontinue immediately, and administer alternative therapy
History of cardiovascular disorders; beta-adrenergic stimulation can result in clinically significant cardiovascular effects, myocardial ischemia, or electrocardiographic (ECG) changes
Avoid spraying into eyes, and contact physician if visual disturbances (eg, blurred vision or halos) occur; monitor patients with narrow-angle glaucoma
May produce clinically important hypokalemia leading to adverse cardiovascular effects in some patients
May cause immediate hypersensitivity reaction (urticaria, angioedema, rash, bronchospasm, anaphylaxis, or oropharyngeal edema); discontinue immediately, and administer alternative therapy
Prostatic hyperplasia or bladder-neck obstruction
Convulsive disorders, hyperthyroidism, or diabetes mellitus
Do not exceed recommended dosage; fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs in patients with asthma
Keep out of reach of children
Pregnancy & Lactation
Pregnancy category: C
Lactation: Unknown whether drug is excreted in breast milk
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Albuterol: Beta2-adrenergic bronchodilator
Ipratropium: Anticholinergic (parasympatholytic) agent; inhibits vagally mediated reflexes by antagonizing acetylcholine action; prevents increase in intracellular calcium concentration caused by interaction of acetylcholine with muscarinic receptors on bronchial smooth muscle
Peak plasma time: Albuterol, 3 hr (from portion swallowed)
Peak plasma concentration: Albuterol, 419-802 pg/mL (from portion swallowed)
Protein bound: Ipratropium, 0-9%
Albuterol: Conjugatively metabolized to albuterol 4'-O-sulfate
Ipratropium: Partially metabolized to inactive ester hydrolysis products
Half-life: Albuterol, 3.6 hr (after 30-min infusion of 1.5 mg); ipratropium, 2 hr (after inhalation or IV administration)
Mean clearance: Albuterol, 439 mL/min/1.73 m²
Excretion: Albuterol, urine (27%); ipratropium, urine (4%)
See individual package inserts for instructions on use
Aerosol metered-dose inhalers
- Insert cartridge into metered-dose inhaler, and prime unit before initial use; actuate inhaler toward ground until aerosol cloud is visible, then repeat 3 more times
- If inhaler has not been used for >3 days, actuate it once before using it again
- If inhaler has not been used for ≥21 days, repeat priming process for initial use (ie, actuate until aerosol cloud is observed, then repeat 3 more times)
- Administer via jet nebulizer connected to air compressor with adequate air flow
- Equip with mouthpiece or suitable air mask
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.