Buy Combivent Online

Combivent (albuterol sulfate/ipratropium bromide)

THERAPEUTIC CLASS

Anticholinergic/beta2 agonist

DEA CLASS

RX

INDICATIONS

Treatment of patients with chronic obstructive pulmonary disease on a regular aerosol bronchodilator who continue to have evidence of bronchospasm and who require a 2nd bronchodilator.

ADULT DOSAGE

Chronic Obstructive Pulmonary Disease

Bronchospasm Requiring a 2nd Bronchodilator:
Usual:
2 inh qid. May take additional inh as required
Max: 12 inh/24 hrs

ADMINISTRATION

Oral inh route

Shake for at least 10 sec before use
Avoid spraying into eyes

HOW SUPPLIED

MDI: (Albuterol Sulfate-Ipratropium Bromide) 103mcg-18mcg/inh [14.7g]

CONTRAINDICATIONS

Hypersensitivity to atropine or its derivatives and history of hypersensitivity to soya lecithin or related food products (eg, soybean, peanut).

WARNINGS/PRECAUTIONS

May produce paradoxical bronchospasm; d/c and institute alternative therapy if occurs. May produce significant cardiovascular (CV) effects (eg, ECG changes); d/c if symptoms occur. Caution with CV disorders (eg, coronary insufficiency, cardiac arrhythmias, HTN). Rare occurrences of myocardial ischemia reported. Fatalities reported with excessive use of inhaled sympathomimetic drugs in patients with asthma. Immediate hypersensitivity reactions may occur; d/c and consider alternative treatment if such a reaction occurs. Caution with narrow-angle glaucoma, prostatic hyperplasia, bladder-neck obstruction, convulsive disorders, hyperthyroidism, diabetes mellitus (DM), in patients who are unusually responsive to sympathomimetic amines, and hepatic/renal insufficiency. May produce significant but usually transient hypokalemia. Contents of product are under pressure.

ADVERSE REACTIONS

Bronchitis, upper respiratory tract infection, headache, dyspnea, cough.

DRUG INTERACTIONS

Potential for an additive interaction with other anticholinergic-containing drugs; avoid coadministration. Increased risk of adverse CV effects with other sympathomimetic agents; use with caution. ECG changes and/or hypokalemia which may result from non-K+-sparing diuretics (eg, loop or thiazide diuretics) may be acutely worsened; use with caution and consider monitoring K+ levels. β-blockers and albuterol inhibit the effect of each other; use β-blockers with caution in patients with hyperreactive airways. Administration with MAOIs or TCAs, or within 2 weeks of d/c of such agents may potentiate the action of albuterol on CV system; use with extreme caution and consider alternative therapy.

PREGNANCY AND LACTATION

Category C, not for use in nursing.

MECHANISM OF ACTION

Ipratropium: Anticholinergic bronchodilator; appears to inhibit vagally-mediated reflexes by antagonizing the action of acetylcholine. Prevents the increases in intracellular concentration of Ca2+, which is caused by interaction of acetylcholine with the muscarinic receptors on bronchial smooth muscle. Albuterol: Selective β2-adrenergic bronchodilator; activates β2-receptors on airway smooth muscle, leading to activation of adenylyl cyclase and an increase of intracellular concentration of cyclic-3',5'-adenosine monophosphate. This leads to activation of protein kinase A, which inhibits phosphorylation of myosin and lowers intracellular ionic Ca2+ concentrations, resulting in relaxation.

PHARMACOKINETICS

Absorption: Ipratropium: Not readily absorbed. Albuterol: Rapid and complete. Cmax=492pg/mL, Tmax=3 hrs. Distribution: Ipratropium: Plasma protein binding (0-9%). Metabolism: Ipratropium: Partial; ester hydrolysis. Albuterol: Conjugation; albuterol 4'-O-sulfate (metabolite). Elimination: Urine (27.1%, unchanged). Ipratropium: T1/2=2 hrs.

ASSESSMENT

Assess for hypersensitivity to drug or to atropine or its derivatives, history of hypersensitivity to soya lecithin or related food products, CV disorders, narrow-angle glaucoma, prostatic hyperplasia, bladder-neck obstruction, convulsive disorders, hyperthyroidism, DM, hepatic/renal insufficiency, pregnancy/nursing status, and possible drug interactions. Assess if unusually responsive to sympathomimetic amines.

MONITORING

Monitor for signs/symptoms of hypersensitivity reactions, paradoxical bronchospasm, CV effects (measured by pulse rate and BP), hypokalemia, unexpected development of severe acute asthmatic crisis, hypoxia, and other adverse reactions.

PATIENT COUNSELING

Instruct to use caution to avoid spraying the product into eyes; consult physician if ocular symptoms develop. Instruct not to increase dose or frequency without consulting physician. Instruct to seek immediate medical attention if therapy lessens in effectiveness, symptoms worsen, and/or need to use product more frequently than usual. Counsel to take other inhaled drugs only ud by physician. Instruct to contact physician if pregnant/nursing. Instruct to exercise caution when engaging in activities requiring balance and visual acuity (eg, driving a car, operating appliances/machinery).

STORAGE

25°C (77°F); excursions permitted to 15-30°C (59-86°F). Avoid excessive humidity. Do not puncture or use/store near heat or open flame.

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