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

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

Next:

Interactions

Interaction Checker

and albuterol/ipratropium

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            Contraindicated (4)

            • cisapride

              albuterol and cisapride both increase QTc interval. Contraindicated.

            • dronedarone

              albuterol and dronedarone both increase QTc interval. Contraindicated.

            • saquinavir

              saquinavir, albuterol. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Contraindicated. Saquinavir boosted with ritonavir increases risk of hypokalemia, QT prolongation, and cardiac arrhythmias.

            • thioridazine

              albuterol and thioridazine both increase QTc interval. Contraindicated.

            Serious - Use Alternative (27)

            • amitriptyline

              amitriptyline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • amoxapine

              amoxapine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • azithromycin

              albuterol and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.

            • clomipramine

              clomipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • desipramine

              desipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • doxepin

              doxepin, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • fexinidazole

              fexinidazole and albuterol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.

            • glucagon

              glucagon increases toxicity of ipratropium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .

            • glucagon intranasal

              glucagon intranasal increases toxicity of ipratropium by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .

            • hydroxychloroquine sulfate

              albuterol and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.

            • imipramine

              imipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • isocarboxazid

              isocarboxazid increases effects of albuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • linezolid

              linezolid increases effects of albuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • lofepramine

              lofepramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • lopinavir

              albuterol and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

            • macimorelin

              ipratropium, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that may blunt the growth hormone (GH) response to macrimorelin may impact the accuracy of the diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering macimorelin.

            • maprotiline

              maprotiline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • nortriptyline

              nortriptyline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • phenelzine

              phenelzine increases effects of albuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • pimozide

              albuterol and pimozide both increase QTc interval. Contraindicated.

            • pramlintide

              pramlintide, ipratropium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • protriptyline

              protriptyline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • revefenacin

              revefenacin and ipratropium both decrease cholinergic effects/transmission. Avoid or Use Alternate Drug. Coadministration may cause additive anticholinergic effects.

            • tranylcypromine

              tranylcypromine increases effects of albuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • trazodone

              trazodone, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • trimipramine

              trimipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • umeclidinium bromide/vilanterol inhaled

              ipratropium, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Concomitant use with other anticholinergic-containing drugs may lead to additive anticholinergic adverse effects.

            Monitor Closely (375)

            • abobotulinumtoxinA

              abobotulinumtoxinA increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

            • acebutolol

              acebutolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              acebutolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • aceclofenac

              aceclofenac increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • acemetacin

              acemetacin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aclidinium

              ipratropium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • alfentanil

              alfentanil increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alprazolam

              alprazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amantadine

              ipratropium, amantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Potential for increased anticholinergic adverse effects.

            • amiloride

              amiloride increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • amiodarone

              albuterol and amiodarone both increase QTc interval. Use Caution/Monitor.

            • amitriptyline

              albuterol and amitriptyline both increase QTc interval. Use Caution/Monitor.

              ipratropium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              amitriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amobarbital

              amobarbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amoxapine

              ipratropium and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • amoxapine

              amoxapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • anticholinergic/sedative combos

              anticholinergic/sedative combos and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • apomorphine

              albuterol and apomorphine both increase QTc interval. Use Caution/Monitor.

            • arformoterol

              albuterol and arformoterol both decrease serum potassium. Use Caution/Monitor.

              albuterol and arformoterol both decrease sedation. Use Caution/Monitor.

              albuterol and arformoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • aripiprazole

              ipratropium decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              aripiprazole increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.

              aripiprazole increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • armodafinil

              albuterol and armodafinil both decrease sedation. Use Caution/Monitor.

            • atracurium

              atracurium and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • arsenic trioxide

              albuterol and arsenic trioxide both increase QTc interval. Use Caution/Monitor.

            • artemether/lumefantrine

              albuterol and artemether/lumefantrine both increase QTc interval. Use Caution/Monitor.

            • asenapine

              albuterol and asenapine both increase QTc interval. Use Caution/Monitor.

            • aspirin

              aspirin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aspirin rectal

              aspirin rectal increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • atenolol

              atenolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              atenolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • atomoxetine

              atomoxetine, albuterol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of tachycardia, increased blood pressure.

            • atropine

              atropine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • atropine IV/IM

              atropine IV/IM and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • azelastine

              azelastine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bedaquiline

              albuterol and bedaquiline both increase QTc interval. Use Caution/Monitor.

            • belladonna alkaloids

              belladonna alkaloids and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • belladonna and opium

              ipratropium and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              belladonna and opium increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bendroflumethiazide

              albuterol and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.

            • benperidol

              ipratropium decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              ipratropium decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.

              benperidol increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • benperidol

              benperidol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • benzphetamine

              albuterol and benzphetamine both decrease sedation. Use Caution/Monitor.

              albuterol and benzphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • benztropine

              benztropine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.

            • betaxolol

              betaxolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              betaxolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • bethanechol

              bethanechol increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bisoprolol

              bisoprolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              bisoprolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • brompheniramine

              brompheniramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bumetanide

              albuterol and bumetanide both decrease serum potassium. Use Caution/Monitor.

            • buprenorphine

              buprenorphine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butabarbital

              butabarbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butalbital

              butalbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butorphanol

              butorphanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • caffeine

              albuterol and caffeine both decrease sedation. Use Caution/Monitor.

            • carbachol

              carbachol increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbenoxolone

              albuterol and carbenoxolone both decrease serum potassium. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carvedilol

              carvedilol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              carvedilol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • celecoxib

              celecoxib increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • celiprolol

              celiprolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              celiprolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • cevimeline

              cevimeline increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chloroquine

              albuterol and chloroquine both increase QTc interval. Use Caution/Monitor.

            • chlorothiazide

              albuterol and chlorothiazide both decrease serum potassium. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlorpromazine

              chlorpromazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              ipratropium decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              chlorpromazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.

              albuterol and chlorpromazine both increase QTc interval. Use Caution/Monitor.

            • chlorthalidone

              albuterol and chlorthalidone both decrease serum potassium. Use Caution/Monitor.

            • cisatracurium

              cisatracurium and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • cinnarizine

              cinnarizine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ciprofloxacin

              albuterol and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • citalopram

              albuterol and citalopram both increase QTc interval. Use Caution/Monitor.

            • clarithromycin

              albuterol and clarithromycin both increase QTc interval. Use Caution/Monitor.

            • clemastine

              clemastine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clomipramine

              clomipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • clonazepam

              clonazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clozapine

              ipratropium decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              ipratropium decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.

              clozapine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • clorazepate

              clorazepate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clozapine

              clozapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and clozapine both increase QTc interval. Use Caution/Monitor.

            • codeine

              codeine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • crizotinib

              albuterol and crizotinib both increase QTc interval. Use Caution/Monitor.

            • cyclizine

              cyclizine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              cyclizine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • cyclobenzaprine

              cyclobenzaprine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • cyclopenthiazide

              albuterol and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • darifenacin

              darifenacin and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • dasatinib

              albuterol and dasatinib both increase QTc interval. Use Caution/Monitor.

            • deflazacort

              albuterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • degarelix

              albuterol and degarelix both increase QTc interval. Use Caution/Monitor.

            • desipramine

              desipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              albuterol and desipramine both increase QTc interval. Use Caution/Monitor.

            • deutetrabenazine

              albuterol and deutetrabenazine both increase QTc interval. Use Caution/Monitor.

            • dicyclomine

              dicyclomine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • dexchlorpheniramine

              dexchlorpheniramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexfenfluramine

              albuterol and dexfenfluramine both decrease sedation. Use Caution/Monitor.

              albuterol and dexfenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmethylphenidate

              albuterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.

              albuterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dextroamphetamine

              albuterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.

              albuterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dextromoramide

              dextromoramide increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diamorphine

              diamorphine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dichlorphenamide

              dichlorphenamide and albuterol both decrease serum potassium. Use Caution/Monitor.

              dichlorphenamide, albuterol. Either increases levels of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

            • diclofenac

              diclofenac increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diethylpropion

              albuterol and diethylpropion both decrease sedation. Use Caution/Monitor.

              albuterol and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • difenoxin hcl

              difenoxin hcl increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diflunisal

              diflunisal increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • digoxin

              digoxin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              diphenhydramine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • diphenoxylate hcl

              diphenoxylate hcl increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • donepezil

              donepezil increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dipipanone

              dipipanone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • disopyramide

              albuterol and disopyramide both increase QTc interval. Use Caution/Monitor.

            • dobutamine

              albuterol and dobutamine both decrease serum potassium. Use Caution/Monitor.

              albuterol and dobutamine both decrease sedation. Use Caution/Monitor.

              albuterol and dobutamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dolasetron

              albuterol and dolasetron both increase QTc interval. Use Caution/Monitor.

            • dopamine

              albuterol and dopamine both decrease sedation. Use Caution/Monitor.

              albuterol and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dopexamine

              albuterol and dopexamine both decrease serum potassium. Use Caution/Monitor.

              albuterol and dopexamine both decrease sedation. Use Caution/Monitor.

              albuterol and dopexamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              dopexamine, albuterol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • dosulepin

              ipratropium and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • doxepin

              doxepin increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • droperidol

              albuterol and droperidol both increase QTc interval. Use Caution/Monitor.

              ipratropium decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              droperidol increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              droperidol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.

            • drospirenone

              drospirenone increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • echothiophate iodide

              echothiophate iodide increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • encorafenib

              albuterol and encorafenib both increase QTc interval. Use Caution/Monitor.

            • entrectinib

              albuterol and entrectinib both increase QTc interval. Use Caution/Monitor.

            • ephedrine

              albuterol and ephedrine both decrease serum potassium. Use Caution/Monitor.

              albuterol and ephedrine both decrease sedation. Use Caution/Monitor.

              albuterol and ephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine

              albuterol and epinephrine both decrease serum potassium. Use Caution/Monitor.

              albuterol and epinephrine both decrease sedation. Use Caution/Monitor.

              albuterol and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine racemic

              albuterol and epinephrine racemic both decrease serum potassium. Use Caution/Monitor.

              albuterol and epinephrine racemic both decrease sedation. Use Caution/Monitor.

              albuterol and epinephrine racemic both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • eribulin

              albuterol and eribulin both increase QTc interval. Use Caution/Monitor.

            • erythromycin base

              albuterol and erythromycin base both increase QTc interval. Use Caution/Monitor.

            • erythromycin ethylsuccinate

              albuterol and erythromycin ethylsuccinate both increase QTc interval. Use Caution/Monitor.

            • erythromycin lactobionate

              albuterol and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

            • erythromycin stearate

              albuterol and erythromycin stearate both increase QTc interval. Use Caution/Monitor.

            • escitalopram

              albuterol and escitalopram both increase QTc interval. Use Caution/Monitor.

            • esmolol

              esmolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              esmolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • estazolam

              estazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ethacrynic acid

              albuterol and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.

            • ethanol

              ethanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • etodolac

              etodolac increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fenfluramine

              albuterol and fenfluramine both decrease sedation. Use Caution/Monitor.

              albuterol and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • fenoprofen

              fenoprofen increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fesoterodine

              fesoterodine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • fexinidazole

              albuterol and fexinidazole both increase QTc interval. Use Caution/Monitor.

            • flavoxate

              flavoxate and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • flecainide

              albuterol and flecainide both increase QTc interval. Use Caution/Monitor.

            • fluconazole

              albuterol and fluconazole both increase QTc interval. Use Caution/Monitor.

            • fluoxetine

              albuterol and fluoxetine both increase QTc interval. Use Caution/Monitor.

            • fluphenazine

              albuterol and fluphenazine both increase QTc interval. Use Caution/Monitor.

              fluphenazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              ipratropium decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

              fluphenazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • flurazepam

              flurazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • galantamine

              galantamine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • flurbiprofen

              flurbiprofen increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • formoterol

              albuterol and formoterol both decrease serum potassium. Use Caution/Monitor.

              albuterol and formoterol both decrease sedation. Use Caution/Monitor.

              albuterol and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • foscarnet

              albuterol and foscarnet both increase QTc interval. Use Caution/Monitor.

            • fostemsavir

              albuterol and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • furosemide

              albuterol and furosemide both decrease serum potassium. Use Caution/Monitor.

            • gemifloxacin

              albuterol and gemifloxacin both increase QTc interval. Use Caution/Monitor.

            • gemtuzumab

              albuterol and gemtuzumab both increase QTc interval. Use Caution/Monitor.

            • gentamicin

              albuterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

            • glasdegib

              albuterol and glasdegib both increase QTc interval. Use Caution/Monitor.

            • glycopyrrolate

              glycopyrrolate and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • glycopyrrolate inhaled

              glycopyrrolate inhaled and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • glycopyrronium tosylate topical

              glycopyrronium tosylate topical, ipratropium. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

            • goserelin

              albuterol and goserelin both increase QTc interval. Use Caution/Monitor.

            • green tea

              green tea increases effects of albuterol by pharmacodynamic synergism. Use Caution/Monitor. Due to caffeine content. Combination may increase CNS stimulatory effects due to caffeine in green tea.

            • haloperidol

              albuterol and haloperidol both increase QTc interval. Use Caution/Monitor.

              ipratropium decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              haloperidol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.

              haloperidol increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • henbane

              henbane and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • hydrochlorothiazide

              albuterol and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.

            • homatropine

              homatropine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • huperzine A

              huperzine A increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydromorphone

              hydromorphone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hyoscyamine

              hyoscyamine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • hyoscyamine spray

              hyoscyamine spray and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • ibuprofen

              ibuprofen increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ibuprofen IV

              ibuprofen IV increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ibutilide

              albuterol and ibutilide both increase QTc interval. Use Caution/Monitor.

            • iloperidone

              iloperidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              ipratropium decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              iloperidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              albuterol and iloperidone both increase QTc interval. Use Caution/Monitor.

            • imipramine

              ipratropium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              imipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • indapamide

              albuterol and indapamide both decrease serum potassium. Use Caution/Monitor.

            • lofepramine

              ipratropium and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • indomethacin

              indomethacin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • inotuzumab

              albuterol and inotuzumab both increase QTc interval. Use Caution/Monitor.

            • irbesartan

              irbesartan increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • isoproterenol

              albuterol and isoproterenol both decrease serum potassium. Use Caution/Monitor.

              albuterol and isoproterenol both decrease sedation. Use Caution/Monitor.

              albuterol and isoproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • ivosidenib

              albuterol and ivosidenib both increase QTc interval. Use Caution/Monitor.

            • ketoprofen

              ketoprofen increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketorolac

              ketorolac increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketorolac intranasal

              ketorolac intranasal increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • ketotifen, ophthalmic

              ketotifen, ophthalmic increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • labetalol

              labetalol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              labetalol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • lapatinib

              albuterol and lapatinib both increase QTc interval. Use Caution/Monitor.

            • lefamulin

              albuterol and lefamulin both increase QTc interval. Use Caution/Monitor.

            • leuprolide

              albuterol and leuprolide both increase QTc interval. Use Caution/Monitor.

            • levalbuterol

              albuterol and levalbuterol both decrease serum potassium. Use Caution/Monitor.

              albuterol and levalbuterol both decrease sedation. Use Caution/Monitor.

              albuterol and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • levofloxacin

              albuterol and levofloxacin both increase QTc interval. Use Caution/Monitor.

            • levorphanol

              levorphanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lisdexamfetamine

              albuterol and lisdexamfetamine both decrease sedation. Use Caution/Monitor.

              albuterol and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • lofepramine

              lofepramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lofexidine

              lofexidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and lofexidine both increase QTc interval. Use Caution/Monitor.

            • loprazolam

              loprazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lorazepam

              lorazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lormetazepam

              lormetazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lornoxicam

              lornoxicam increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine

              loxapine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              ipratropium decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              loxapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor.

            • loxapine inhaled

              loxapine inhaled increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              loxapine inhaled increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.

            • maprotiline

              albuterol and maprotiline both increase QTc interval. Use Caution/Monitor.

              ipratropium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              maprotiline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • marijuana

              marijuana increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meclizine

              ipratropium and meclizine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • meclofenamate

              meclofenamate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mefenamic acid

              mefenamic acid increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mefloquine

              albuterol and mefloquine both increase QTc interval. Use Caution/Monitor.

            • melatonin

              melatonin increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meloxicam

              meloxicam increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meperidine

              meperidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meprobamate

              meprobamate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaproterenol

              albuterol and metaproterenol both decrease serum potassium. Use Caution/Monitor.

              albuterol and metaproterenol both decrease sedation. Use Caution/Monitor.

              albuterol and metaproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methadone

              methadone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and methadone both increase QTc interval. Use Caution/Monitor.

            • methamphetamine

              albuterol and methamphetamine both decrease sedation. Use Caution/Monitor.

              albuterol and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methscopolamine

              ipratropium and methscopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • methyclothiazide

              albuterol and methyclothiazide both decrease serum potassium. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              albuterol and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.

              albuterol and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methylphenidate

              albuterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • metolazone

              albuterol and metolazone both decrease serum potassium. Use Caution/Monitor.

            • metoprolol

              metoprolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              metoprolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • midazolam

              midazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midodrine

              albuterol and midodrine both decrease sedation. Use Caution/Monitor.

              albuterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • mifepristone

              albuterol and mifepristone both increase QTc interval. Use Caution/Monitor.

            • mirtazapine

              mirtazapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • modafinil

              albuterol and modafinil both decrease sedation. Use Caution/Monitor.

            • morphine

              morphine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • motherwort

              motherwort increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • moxifloxacin

              albuterol and moxifloxacin both increase QTc interval. Use Caution/Monitor.

            • moxonidine

              moxonidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nabilone

              nabilone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nabumetone

              nabumetone increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nadolol

              nadolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nadolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • nalbuphine

              nalbuphine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • naproxen

              naproxen increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nebivolol

              nebivolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nebivolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • neostigmine

              neostigmine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nilotinib

              albuterol and nilotinib both increase QTc interval. Use Caution/Monitor.

            • norepinephrine

              albuterol and norepinephrine both decrease serum potassium. Use Caution/Monitor.

              albuterol and norepinephrine both decrease sedation. Use Caution/Monitor.

              albuterol and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • nortriptyline

              albuterol and nortriptyline both increase QTc interval. Use Caution/Monitor.

              nortriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • octreotide

              albuterol and octreotide both increase QTc interval. Use Caution/Monitor.

            • olanzapine

              ipratropium decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              ipratropium decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.

              olanzapine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • ofloxacin

              albuterol and ofloxacin both increase QTc interval. Use Caution/Monitor.

            • olanzapine

              olanzapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and olanzapine both increase QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances

            • olodaterol inhaled

              albuterol and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects

              albuterol and olodaterol inhaled both increase QTc interval. Use Caution/Monitor.

            • onabotulinumtoxinA

              onabotulinumtoxinA and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • ondansetron

              albuterol and ondansetron both increase QTc interval. Use Caution/Monitor.

            • opium tincture

              opium tincture increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • orphenadrine

              ipratropium and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • osilodrostat

              osilodrostat and albuterol both increase QTc interval. Use Caution/Monitor.

              albuterol and osilodrostat both increase QTc interval. Use Caution/Monitor. Dose dependent QT prolongation - avoid drugs known to prolong the QT interval

            • osimertinib

              albuterol and osimertinib both increase QTc interval. Use Caution/Monitor.

            • oxaliplatin

              oxaliplatin will increase the level or effect of albuterol by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

            • oxaprozin

              oxaprozin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxazepam

              oxazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxybutynin

              ipratropium and oxybutynin both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • oxybutynin topical

              ipratropium and oxybutynin topical both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • oxybutynin transdermal

              ipratropium and oxybutynin transdermal both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • oxycodone

              oxycodone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxymorphone

              oxymorphone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • paliperidone

              albuterol and paliperidone both increase QTc interval. Use Caution/Monitor.

              paliperidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              paliperidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              ipratropium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              ipratropium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.

            • pancuronium

              ipratropium and pancuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • panobinostat

              albuterol and panobinostat both increase QTc interval. Use Caution/Monitor.

            • papaveretum

              papaveretum increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • papaverine

              papaverine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • parecoxib

              parecoxib increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pasireotide

              albuterol and pasireotide both increase QTc interval. Use Caution/Monitor.

            • pazopanib

              albuterol and pazopanib both increase QTc interval. Use Caution/Monitor.

            • penbutolol

              penbutolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              penbutolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • pentamidine

              albuterol and pentamidine both increase QTc interval. Use Caution/Monitor.

            • pentazocine

              pentazocine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pentobarbital

              pentobarbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • perphenazine

              ipratropium decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              perphenazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

              perphenazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • phendimetrazine

              albuterol and phendimetrazine both decrease sedation. Use Caution/Monitor.

              albuterol and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • physostigmine

              physostigmine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              phenobarbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenoxybenzamine

              phenoxybenzamine, albuterol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

            • phentermine

              albuterol and phentermine both decrease sedation. Use Caution/Monitor.

              albuterol and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phenylephrine

              albuterol and phenylephrine both decrease sedation. Use Caution/Monitor.

              albuterol and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phenylephrine PO

              albuterol and phenylephrine PO both decrease sedation. Use Caution/Monitor.

              albuterol and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • pholcodine

              pholcodine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pilocarpine

              pilocarpine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pilocarpine ophthalmic

              pilocarpine ophthalmic increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pimavanserin

              albuterol and pimavanserin both increase QTc interval. Use Caution/Monitor.

            • pimozide

              pimozide increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

              ipratropium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              pimozide increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • pindolol

              pindolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              pindolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • pralidoxime

              ipratropium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • pirbuterol

              albuterol and pirbuterol both decrease serum potassium. Use Caution/Monitor.

              albuterol and pirbuterol both decrease sedation. Use Caution/Monitor.

              albuterol and pirbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • piroxicam

              piroxicam increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pitolisant

              albuterol and pitolisant both increase QTc interval. Use Caution/Monitor.

            • posaconazole

              albuterol and posaconazole both increase QTc interval. Use Caution/Monitor.

            • potassium acid phosphate

              potassium acid phosphate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • potassium chloride

              potassium chloride increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • primidone

              primidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • procainamide

              albuterol and procainamide both increase QTc interval. Use Caution/Monitor.

            • procarbazine

              procarbazine increases effects of albuterol by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • prochlorperazine

              prochlorperazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              ipratropium decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.

              prochlorperazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • promethazine

              ipratropium decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              ipratropium decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.

              promethazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              promethazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • propafenone

              albuterol and propafenone both increase QTc interval. Use Caution/Monitor.

            • propantheline

              ipratropium and propantheline both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • propranolol

              propranolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              propranolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • propylhexedrine

              albuterol and propylhexedrine both decrease sedation. Use Caution/Monitor.

              albuterol and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • protriptyline

              protriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and protriptyline both increase QTc interval. Use Caution/Monitor.

              ipratropium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • pseudoephedrine

              albuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • pyridostigmine

              pyridostigmine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • quazepam

              quazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • quetiapine

              ipratropium decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              quetiapine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              albuterol and quetiapine both increase QTc interval. Use Caution/Monitor.

              quetiapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.

            • quinidine

              albuterol and quinidine both increase QTc interval. Use Caution/Monitor.

            • rapacuronium

              ipratropium and rapacuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • quinine

              albuterol and quinine both increase QTc interval. Use Caution/Monitor.

            • ranolazine

              albuterol and ranolazine both increase QTc interval. Use Caution/Monitor.

            • ribociclib

              albuterol and ribociclib both increase QTc interval. Use Caution/Monitor.

            • rilpivirine

              albuterol and rilpivirine both increase QTc interval. Use Caution/Monitor.

            • risperidone

              albuterol and risperidone both increase QTc interval. Use Caution/Monitor.

              risperidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              risperidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • rocuronium

              ipratropium and rocuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • romidepsin

              albuterol and romidepsin both increase QTc interval. Use Caution/Monitor.

            • sacubitril/valsartan

              sacubitril/valsartan increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • salicylates (non-asa)

              salicylates (non-asa) increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • salmeterol

              albuterol and salmeterol both decrease serum potassium. Use Caution/Monitor.

              albuterol and salmeterol both decrease sedation. Use Caution/Monitor.

              albuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • salsalate

              salsalate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • saquinavir

              albuterol and saquinavir both increase QTc interval. Use Caution/Monitor.

            • scopolamine

              ipratropium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • scullcap

              scullcap increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • secobarbital

              secobarbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sertraline

              albuterol and sertraline both increase QTc interval. Use Caution/Monitor.

            • shepherd's purse

              shepherd's purse increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

              albuterol and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

            • solifenacin

              ipratropium and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              albuterol and solifenacin both increase QTc interval. Use Caution/Monitor.

            • solriamfetol

              albuterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • succinylcholine

              succinylcholine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sorafenib

              albuterol and sorafenib both increase QTc interval. Use Caution/Monitor.

            • sotalol

              sotalol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              albuterol and sotalol both increase QTc interval. Use Caution/Monitor.

            • spironolactone

              spironolactone increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • succinylcholine

              succinylcholine increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sufentanil

              sufentanil increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sulfasalazine

              sulfasalazine increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sulindac

              sulindac increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sunitinib

              albuterol and sunitinib both increase QTc interval. Use Caution/Monitor.

            • tacrolimus

              albuterol and tacrolimus both increase QTc interval. Use Caution/Monitor.

            • tapentadol

              tapentadol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • telavancin

              albuterol and telavancin both increase QTc interval. Use Caution/Monitor.

            • temazepam

              temazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • terbutaline

              albuterol and terbutaline both decrease serum potassium. Use Caution/Monitor.

              albuterol and terbutaline both decrease sedation. Use Caution/Monitor.

              albuterol and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • tetrabenazine

              albuterol and tetrabenazine both increase QTc interval. Use Caution/Monitor.

            • thioridazine

              thioridazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              ipratropium decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              thioridazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.

            • thiothixene

              thiothixene increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              ipratropium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.

              thiothixene increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • timolol

              timolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • tiotropium

              ipratropium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • tolfenamic acid

              tolfenamic acid increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tolmetin

              tolmetin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tolterodine

              ipratropium and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • tolvaptan

              tolvaptan increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • topiramate

              topiramate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • toremifene

              albuterol and toremifene both increase QTc interval. Use Caution/Monitor.

            • torsemide

              albuterol and torsemide both decrease serum potassium. Use Caution/Monitor.

            • tramadol

              tramadol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trazodone

              trazodone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • triamterene

              triamterene increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • trifluoperazine

              ipratropium decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              ipratropium decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.

              trifluoperazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • triazolam

              triazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • triclofos

              triclofos increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trifluoperazine

              trifluoperazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trihexyphenidyl

              ipratropium and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

            • trimipramine

              albuterol and trimipramine both increase QTc interval. Use Caution/Monitor.

              trimipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ipratropium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • triprolidine

              triprolidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trospium chloride

              ipratropium and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • umeclidinium bromide

              umeclidinium bromide and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agents

            • vandetanib

              albuterol and vandetanib both increase QTc interval. Use Caution/Monitor.

            • vardenafil

              albuterol and vardenafil both increase QTc interval. Use Caution/Monitor.

            • vecuronium

              ipratropium and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

            • vemurafenib

              albuterol and vemurafenib both increase QTc interval. Use Caution/Monitor.

            • voclosporin

              albuterol and voclosporin both increase QTc interval. Use Caution/Monitor.

            • voriconazole

              albuterol and voriconazole both increase QTc interval. Use Caution/Monitor.

            • vorinostat

              albuterol and vorinostat both increase QTc interval. Use Caution/Monitor.

            • xylometazoline

              albuterol and xylometazoline both decrease sedation. Use Caution/Monitor.

              albuterol and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • yohimbine

              albuterol and yohimbine both decrease sedation. Use Caution/Monitor.

              albuterol and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • ziconotide

              ziconotide increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziprasidone

              ziprasidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              ziprasidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              albuterol and ziprasidone both increase QTc interval. Use Caution/Monitor.

              ipratropium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              ipratropium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

            • zotepine

              ipratropium decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              ipratropium decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.

            Minor (15)

            • bendroflumethiazide

              albuterol, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • bumetanide

              albuterol, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • chlorothiazide

              albuterol, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • chlorthalidone

              albuterol, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • cyclopenthiazide

              albuterol, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • dimenhydrinate

              dimenhydrinate increases toxicity of ipratropium by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • donepezil

              donepezil decreases effects of ipratropium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • ethacrynic acid

              albuterol, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • eucalyptus

              eucalyptus increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • furosemide

              albuterol, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • galantamine

              galantamine decreases effects of ipratropium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • hydrochlorothiazide

              albuterol, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • indapamide

              albuterol, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • levodopa

              ipratropium, levodopa. Other (see comment). Minor/Significance Unknown. Comment: Anticholinergic agents may enhance the therapeutic effects of levodopa; however, anticholinergic agents can exacerbate tardive dyskinesia. In high dosage, anticholinergics may decrease the effects of levodopa by delaying its GI absorption. .

            • methyclothiazide

              albuterol, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

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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

            Use cution in patients with convulsive disorders, hyperthyroidism, diabetes mellitus, prostatic hyperplasia, or bladder-neck obstruction

            May cause dizziness and blurred vision; patients should use caution when performing tasks requiring mental alertness

            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

            There are no randomized clinical studies of the drug combination, or its individual components, ipratropium bromide and albuterol sulfate, in pregnant women; ipratropium is negligibly absorbed systemically following oral inhalation; therefore, maternal use is not expected to result in fetal exposure to drug

            Published literature, including cohort studies, case-control studies and case series, over several decades have not identified drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes with ipratropium bromide

            Available data from published epidemiological studies and postmarketing case reports of pregnancy outcomes following inhaled albuterol use do not consistently demonstrate a risk of major birth defects or, miscarriage; there are clinical considerations with use of therapy in pregnant women; animal reproduction studies have not been conducted with drug

            Because of potential for beta-agonist interference with uterine contractility, use of drug for the treatment of COPD during labor should be restricted to those patients in whom the benefits clearly outweigh risk; serious adverse reactions, including pulmonary edema, have been reported during or following treatment of premature labor with beta2-agonists, including albuterol

            Animal data

            • Animal studies are available with its individual components, ipratropium bromide and albuterol sulfate
            • Based on oral reproduction studies, no evidence of structural alterations was observed when ipratropium bromide was administered to pregnant mice, rats, and rabbits during organogenesis at doses approximately 340, 68,000 and 17,000 times, respectively, the maximum recommended human daily inhalation dose (MRHDID) in adults on a mg/m2 basis
            • When albuterol was administered to pregnant mice during organogenesis there was evidence of cleft palate at doses approximately equivalent to maximum recommended human daily inhalation

            Lactation

            There are no available data on presence of drug, or components, ipratropium bromide or albuterol, in human milk, effects on breastfed infant, or on milk production; although lipid-insoluble quaternary cations pass into breast milk, ipratropium concentrations in plasma after inhaled therapeutic doses are low

            Plasma levels of albuterol after inhaled therapeutic doses are low in humans; therefore, ipratropium and albuterol concentrations in human breast milk are likely to be correspondingly low; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for albuterol and any potential adverse effects on breastfed child from albuterol or from underlying maternal condition

            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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            Images

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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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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.

            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.

            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.