Ipratropium and Albuterol Inhalation (patient information)

# Why this medication is prescribed
The combination of ipratropium and albuterol is used to prevent wheezing, difficulty breathing, chest tightness, and coughing in people with chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways) such as chronic bronchitis (swelling of the air passages that lead to the lungs) and emphysema (damage to the air sacs in the lungs). Ipratropium and albuterol combination is used by people whose symptoms have not been controlled by a single inhaled medication. Ipratropium and albuterol are in a class of medications called bronchodilators. Ipratropium and albuterol combination works by relaxing and opening the air passages to the lungs to make breathing easier.

# How this medication should be used
The combination of ipratropium and albuterol comes as a solution (liquid) to inhale by mouth using a nebulizer (machine that turns medication into a mist that can be inhaled) and as an aerosol to inhale by mouth using an inhaler. It is usually inhaled four times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use ipratropium and albuterol exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Your doctor may tell you to use additional doses of ipratropium and albuterol combination if you experience symptoms such as wheezing, difficulty breathing, or chest tightness. Follow these directions carefully, and do not use extra doses of medication unless your doctor tells you that you should. Do not use more than two extra doses of the nebulizer solution per day. Do not use more than 12 puffs of the inhalation aerosol in 24 hours.
Call your doctor if your symptoms worsen or if you feel that ipratropium and albuterol inhalation no longer controls your symptoms. If you were told to use ipratropium and albuterol as needed to treat your symptoms and you find that you need to use the medication more often than usual, call your doctor.
If you are using the inhaler, your medication will come in canisters. Each canister of ipratropium and albuterol aerosol is designed to provide 200 inhalations. After the labeled number of inhalations has been used, later inhalations may not contain the correct amount of medication. You should keep track of the number of inhalations you have used. You can divide the number of inhalations in your inhaler by the number of inhalations you use each day to find out how many days your inhaler will last. Throw away the canister after you have used the labeled number of inhalations even if it still contains some liquid and continues to release a spray when it is pressed. Do not float the canister in water to see if it still contains medication.
Be careful not to get ipratropium and albuterol into your eyes. If you are using the inhaler, keep your eyes closed when you use the medication. If you get ipratropium and albuterol in your eyes, you may develop narrow angle glaucoma (a serious eye condition that may cause loss of vision). If you already have narrow angle glaucoma, your condition may worsen. You may experience widened pupils (black circles in the center of the eyes), eye pain or redness, blurred vision, and vision changes such as seeing halos around lights. Call your doctor if you get ipratropium and albuterol into your eyes or if you develop these symptoms.
The inhaler that comes with ipratropium and albuterol aerosol is designed for use only with a canister of ipratropium and albuterol. Never use it to inhale any other medication, and do not use any other inhaler to inhale ipratropium and albuterol.
Do not use your ipratropium and albuterol inhaler when you are near a flame or source of heat. The inhaler may explode if it is exposed to very high temperatures.
Before you use ipratropium and albuterol for the first time, read the written instructions that come with the inhaler or nebulizer. Ask your doctor, pharmacist, or respiratory therapist to show you how to use it. Practice using the inhaler or nebulizer while he or she watches.
To use the inhaler, follow these steps:
- Hold the inhaler with the clear end pointing upward. Place the metal canister into the clear end of the inhaler. Be sure that the canister is fully and firmly in place.
- Remove the protective dust cap from the end of the mouthpiece. If the dust cap was not placed on the mouthpiece, check the mouthpiece for dirt or other objects.
- If you are using the inhaler for the first time or if you have not used the inhaler in more than 24 hours, you will need to prime it. Shake it well for at least 10 seconds and then press down on the canister three times to release three sprays into the air, away from your face. Be careful not to get ipratropium and albuterol in your eyes.
- Hold the inhaler between your thumb and your next two fingers with the mouthpiece on the bottom, facing you. Shake the inhaler well for at least 10 seconds.
- Immediately breathe out deeply through your mouth.
- Hold the canister with the mouthpiece on the bottom and facing you and the canister pointing upward. Place the open end of the mouthpiece into your mouth. Close your lips tightly around the mouthpiece. Close your eyes.
- Breathe in slowly and deeply through the mouthpiece. At the same time, press down once on the container to spray the medication into your mouth.
- Hold your breath for 10 seconds. Then remove the inhaler, and breathe out slowly.
- If you were told to use two puffs, wait about 2 minutes and then repeat steps 48.
- Replace the protective cap on the inhaler.
To inhale the solution using a nebulizer, follow these steps:
- Remove one vial of medication from the foil pouch. Put the rest of the vials back into the pouch until you are ready to use them.
- Twist off the top of the vial and squeeze all of the liquid into the reservoir of the nebulizer.
- Connect the nebulizer reservoir to the mouthpiece or face mask.
- Connect the nebulizer reservoir to the compressor.
- Put the mouthpiece in your mouth or put on the face mask. Sit in a comfortable, upright position and turn on the compressor.
- Breathe in calmly, deeply, and evenly through your mouth for about 515 minutes until mist stops forming in the nebulizer chamber.
Clean your inhaler or nebulizer regularly. Follow the manufacturer's directions carefully and ask your doctor or pharmacist if you have any questions about cleaning your inhaler or nebulizer.

# Other uses for this medicine
This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

# Special precautions
Before using ipratropium and albuterol:
- tell your doctor and pharmacist if you are allergic to ipratropium (Atrovent), atropine (Atropen), albuterol (Proventil HFA, Ventolin HFA, Vospire ER), levalbuterol (Xoponex), any other medications, or soya lecithin soybeans, or peanuts.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements and herbal products you are taking or plan to take. Be sure to mention any of the following: beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); diuretics ('water pills'); epinephrine (Epipen, Primatene Mist); medications for colds; other inhaled medications, especially other medications for asthma such as formoterol (Foradil), metaproterenol (Alupent), levalbuterol (Xopenex), and salmeterol (Serevent); and terbutaline (Brethine). Also tell your doctor if you are taking any of the following medications or if you have stopped taking them within the past two weeks: antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil);or monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and selegiline (Eldepryl, Emsam). Your doctor may have to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had glaucoma (an eye condition); difficulty urinating; a prostate (a male reproductive gland) condition; seizures; hyperthyroidism (condition in which there is too much thyroid hormone in the body); high blood pressure; an irregular heartbeat; diabetes; or heart, liver, or kidney disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using ipratropium and albuterol, call your doctor .
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are using ipratropium and albuterol.
- you should know that ipratropium and albuterol inhalation sometimes causes wheezing and difficulty breathing immediately after it is inhaled. If this happens, call your doctor right away. Do not use ipratropium and albuterol inhalation again unless your doctor tells you that you should.

# Special dietary instructions
Unless your doctor tells you otherwise, continue your normal diet.

# What to do if you forget a dose
Use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.

# Side effects

## Minor side effects
This medication may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- cough
- headache
- nausea
- heartburn
- diarrhea
- constipation
- leg cramps
- pain
- difficulty urinating
- frequent urination
- pain when urinating
- voice changes

## Severe side effects
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
- fast heartbeat
- chest pain
- hives
- rash
- itching
- swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs
- difficulty breathing or swallowing
- sore throat, fever, chills, and other signs of infection
Ipratropium and albuterol may cause other side effects. Call your doctor if you have any unusual problems while you are using this medication.

# Storage conditions needed for this medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Keep unused vials of nebulizer solution in the foil pouch until you are ready to use them. Store the medication at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication. Do not puncture the aerosol canister, and do not discard it in an incinerator or fire.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- chest pain
- fast heartbeat

# Other information
Keep all appointments with your doctor.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Combivent
- Duoneb

# Other names
- ipratropium and salbutamol inhalation