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Albuterol; Ipratropium inhalation aerosol and solution What are albuterol; ipratropium inhalation aerosol and solution? ALBUTEROL; IPRATROPIUM (Combivent®, DuoNeb™) is a combination of bronchodilators, which are medicines that open up your air passages and make breathing easier. The combination is used for patients with lung problems such as chronic bronchitis and emphysema. This medicine controls acute episodes or prevents recurring bouts of bronchospasm due to these conditions. Generic albuterol; ipratropium inhalation aerosols and nebulizer solutions are not yet available. What should my health care professional know before I use albuterol; ipratropium inhalation? They need to know if you have any of the following conditions: •bladder problems or difficulty passing urine •diabetes •glaucoma •heart disease, angina, or irregular heartbeat •high blood pressure •liver or kidney disease •prostate trouble •overactive thyroid gland •pheochromocytoma •seizures (convulsions) •an unusual or allergic reaction to albuterol, ipratropium, atropine, bromides, soya protein, soybeans or peanuts, other medicines, foods, dyes, or preservatives •pregnant or trying to get pregnant •breast-feeding How should I use this medicine? Albuterol; ipratropium inhalation aerosol or inhalation solutions are for inhalation only, do not swallow. Follow the instructions on your prescription. Do not use more often than directed. If you are using an aerosol inhaler: Shake the canister well. It is recommended that you "test-spray" the inhaler three times into the air before using your inhaler for the first time. You chould also "test spray" the inhaler in cases where you have not used it for more than 24 hours. Tilt your head back slightly. Breathe out fully, emptying as much air as possible from your lungs. Keep the canister upright. Keep the inhaler about 1 inch from your open mouth (or place the mouthpiece loosely between your open lips). Press down on the inhaler (one puff) while breathing in deeply and slowly. If you can, hold your breath to the count of 10 (or as long as you can) and then breathe out (exhale). Wait at least 1 to 2 minutes between puffs. Your inhaler will come with some instructions. Read the instructions carefully; ask your prescriber or pharmacist about instructions you do not understand. Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed. If you are using a nebulizer: Follow your prescribers instructions for use of the inhalation solution in your nebulizer machine. The albuterol; ipratropium nebulizer solution does not need dilution prior to use in the jet nebulizer. What if I miss a dose? If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses. What drug(s) may interact with albuterol; ipratropium inhalation? •arsenic trioxide •astemizole •atropine, hyoscyamine, or related medications •bepridil •beta-blockers, often used for high blood pressure or heart problems •caffeine •certain antibiotics (such as clarithromycin, erythromycin, gatifloxacin, gemifloxacin, grepafloxacin, levofloxacin, linezolid, moxifloxacin, sparfloxacin) •chloroquine •cisapride •droperidol •halofantrine •levomethadyl •medicines for colds and breathing difficulties •medicines for heart disease or high blood pressure •medicines known as MAO inhibitors, such as phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), and selegiline (Carbex®, Eldepryl®) •medicines to control heart rhythm (examples: amiodarone, disopyramide, dofetilide, flecainide, procainamide, quinidine, sotalol) •medicines for treating depression or mental illness (amoxapine, haloperidol, maprotiline, pimozide, phenothiazines, risperidone, sertindole, tricyclic antidepressants, ziprasidone) •methadone •pentamidine •probucol •some medicines for weight loss (including some herbal products, ephedra, ephedrine, dextroamphetamine) •steroid hormones such as dexamethasone, cortisone, hydrocortisone •terfenadine •theophylline •thyroid hormones •water pills or diuretics Tell your prescriber or health care professional about all other medicines you are taking, including nonprescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check before starting or stopping any of your medicines. What side effects may I notice from using albuterol; ipratropium inhalation? Side effects that you should report to your prescriber or health care professional as soon as possible: •difficulty breathing, wheezing •dizziness •chest pain, fast heartbeat (pounding), or irregular heartbeat •headache (severe) •muscle cramps •numbness in fingers or toes •skin rash or hives •swelling of the lips, tongue or face •vomiting •unusual weakness or tiredness Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome): •anxiety, nervousness, trembling •blurred vision •cough •difficulty passing urine •difficulty sleeping •dry mouth •mouth sores •nausea •stuffy nose •unusual taste or metallic taste in your mouth What should I watch for while taking albuterol; ipratropium inhalation? Check with your prescriber or health care professional as soon as possible if your breathing symptoms do not improve or if they get worse. If you find that your inhalers become less effective in treating your symptoms, you should contact your health care professional as soon as possible. You may be having an increase in your bronchitis symptoms. Do not stop using albuterol; ipratropium except on your prescriber's advice. Do not get the albuterol; ipratropium aerosol spray in your eyes. It can cause irritation, pain, or blurred vision. If you do get any in your eyes, rinse out with plenty of cool tap water. Let your prescriber know if you develop vision problems or eye pain. If you are using other inhaled medicines such as an inhaled steroid, use albuterol; ipratropium first. Wait at least 5 minutes before using the other inhaler. Make sure you are using your inhaler properly. Do not use extra or more frequent inhalations. They will not improve your condition. Once a day, remove the metal canister and rinse the plastic case in warm running water. Replace canister gently without using a twisting motion. Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water, will help. Where can I keep my medicine? Keep out of the reach of children. Store at a room temperature between 15—30 degrees C (36—86 degrees F); do not freeze. Cold temperature decreases the effectiveness of this medicine. Avoid excessive humidity. The albuterol; ipratropium inhaler contains flammable ingredients under pressure; keep away from heat or flames; do not puncture. Keep nebulizer solution in the foil package until time of use; protect from light. Throw away any unused medicine after the expiration date.

Source: http://pskills.pharm.ku.edu/rxgenerator/eo-counsel/pdf/Combivent.pdf