albuterol/ipratropium (Rx)

Brand and Other Names:Combivent Respimat
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

albuterol (base)/ipratropium bromide

aerosol metered-dose inhaler (Combivent Respimat)

  • (100mcg/20mcg)/actuation

nebulizer solution (generic)

  • (2.5mg/0.5mg)/3mL
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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

Dosing Considerations

Patients aged >65 years have higher steady-state systemic exposures for albuterol and ipratropium

Safety and efficacy not established

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Interactions

Interaction Checker

and albuterol/ipratropium

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Bronchitis (2-12%)

            1-10%

            Upper respiratory tract infection (1-10%)

            Lung disease (6%)

            Headache (3-6%)

            Dyspnea (2-5%)

            Nasopharyngitis (4%)

            Cough (3-4%)

            Pharyngitis (2-4%)

            Pain (1-3%)

            Chest pain (2.6%)

            Sinusitis (2.3%)

            Nausea (1-2%)

            Diarrhea (1.8%)

            Urinary tract infection (1.6%)

            Influenza (1.4%)

            Leg cramps (1.4%)

            Nausea (1.4%)

            Pneumonia (1.4%)

            Rhinitis (1.1%)

            <1%

            Allergic-type reactions, such as skin reactions (eg, rash, pruritus, urticaria [including giant urticaria]), angioedema (eg, of tongue, lips, face), laryngospasm, and anaphylaxis

            Angina

            Arrhythmia

            Arthralgia

            Dizziness

            Dry mouth

            Dyspepsia

            Dysphonia

            Edema

            Fatigue

            Hypertension

            Insomnia

            Nervousness

            Palpitation

            Paresthesia

            Tachycardia

            Tremor

            Vomiting

            Postmarketing Reports

            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

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            Warnings

            Contraindications

            Hypersensitivity to albuterol, ipratropium, atropine and derivatives, soy, or peanut

            Cautions

            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

            Avoid freezing

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Unknown whether drug is excreted in breast milk

            Pregnancy Categories

            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.

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            Pharmacology

            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

            Absorption

            Peak plasma time: Albuterol, 3 hr (from portion swallowed)

            Peak plasma concentration: Albuterol, 419-802 pg/mL (from portion swallowed)

            Distribution

            Protein bound: Ipratropium, 0-9%

            Metabolism

            Albuterol: Conjugatively metabolized to albuterol 4'-O-sulfate

            Ipratropium: Partially metabolized to inactive ester hydrolysis products

            Elimination

            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%)

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            Administration

            Instructions

            See individual package inserts for instructions on use

            Avoid freezing

            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)

            Nebulizer solution

            • Administer via jet nebulizer connected to air compressor with adequate air flow
            • Equip with mouthpiece or suitable air mask
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            Formulary

            FormularyPatient Discounts

            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.

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
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            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.

            Tier Description
            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.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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