Ipratropium Bromide/Albuterol Sulfate, Inhalation

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KEY POINTS

• This medicine is inhaled through the mouth to treat COPD. Use it exactly as directed.
• Do not use this medicine for sudden breathing problems. Your healthcare provider can prescribe a short-acting inhaled medicine to use when you have a sudden breathing problem.
• If you get this medicine in your eyes it can cause eye pain, blurred vision, or worsening of narrow-angle glaucoma.
• This medicine may cause unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: bronchodilator; anticholinergic

Generic and brand names: ipratropium bromide/albuterol sulfate, inhalation; Combivent Respimat; DuoNeb

What is this medicine used for?

This medicine is inhaled through your mouth to treat COPD. It is a combination of 2 bronchodilators (medicines that make your breathing easier). It is used when a single medicine is not completely effective.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• An enlarged prostate gland or trouble urinating
• Diabetes
• Glaucoma
• Heart disease, heart failure, or irregular heartbeat
• High blood pressure
• Liver or kidney disease
• Long QT syndrome (problems with electrical activity in the heart muscle)
• Low blood levels of potassium
• Seizures
• Thyroid problems

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

This medicine comes as a spray inhaler (Combivent Respimat) or a solution (liquid) to be used in a nebulizer (DuoNeb). The nebulizer produces a fine mist that you inhale through your mouth. Talk with your healthcare provider about this.

Check the label on the medicine for directions about your specific dose. Carefully follow the instructions for using this medicine. Be sure you know when to take the medicine and how much medicine you should take. Use this medicine exactly as your healthcare provider prescribes. Do not use more or for a longer period than prescribed. If you are not sure how to use this medicine, ask your healthcare provider or pharmacist for help.

Check with your healthcare provider before using this medicine in children under age 18.

If you are using other inhaled medicines such as an inhaled steroid, use the other inhaled medicines only as directed by your healthcare provider.

The Combivent Respimat cartridge is only to be used with the Combivent Respimat inhaler.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: fast or irregular heartbeat, chest pain, tremors, weakness, dry mouth.

What should I watch out for?

This medicine is not intended to treat sudden bronchospasm (severe gasping for breath). Your healthcare provider may prescribe a different medicine that you inhale through your mouth for fast relief.

If you need to use the medicine more often, or if your symptoms get worse, contact your healthcare provider right away.

This medicine can cause serious shortness of breath. Talk to your healthcare provider about this and the symptoms to watch for.

Do not spray this medicine in or near your eyes because it can cause eye pain, blurred vision, worsening of narrow-angle glaucoma, or vision halos. If you get some medicine in your eyes, flush them with cool water and contact your healthcare provider.

This medicine may make you dizzy or cause blurred vision. Do not drive or operate machinery unless you are fully alert and can see clearly.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are using this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives, itching, tightness in your chest, trouble breathing, swelling of the lips, face, tongue, or throat), severe shortness of breath.

Serious (Report these to your healthcare provider right away.): Chest pain, increased trouble breathing, severe coughing or wheezing, irregular or fast heartbeat, trouble urinating, severe vision changes or eye problems, severe lightheadedness or fainting, severe nervousness.

Other: Hoarseness, dry mouth or throat, coughing, nausea, vomiting, constipation, dizziness, headache, restlessness, trouble sleeping, tremors, weakness, temporary blurred vision, stuffy or runny nose.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Alfuzosin (Uroxatral)
• Anagrelide (Agrylin)
• Antibiotics such as azithromycin (Zithromax, Zmax), bedaquiline (Sirturo), ciprofloxacin (Cipro), clarithromycin (Biaxin), erythromycin (E.E.S., Ery-Tab, Erythrocin), levofloxacin (Levaquin), linezolid (Zyvox), moxifloxacin (Avelox), pentamidine (NebuPent, Pentam), tedizolid (Sivextro), and telithromycin (Ketek)
• Anticholinergic medicines such as atropine/diphenoxylate (Lomotil), benztropine (Cogentin), dicyclomine (Bentyl), hyoscyamine (HyoMax, Levbid, Levsin), methscopolamine (Pamine), propantheline, and trihexyphenidyl
• Antidepressants such as amitriptyline, amoxapine, citalopram (Celexa), clomipramine, desipramine (Norpramin), escitalopram (Lexapro), fluoxetine (Prozac), imipramine (Tofranil), nortriptyline (Pamelor), and sertraline (Zoloft)
• Antifungal medicines such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil), and voriconazole (Vfend)
• Antihistamines such as brompheniramine, chlorpheniramine (Chlor-Trimeton), cyproheptadine, diphenhydramine (Benadryl), hydroxyzine (Vistaril), and meclizine (Dramamine)
• Antipsychotic medicines such as asenapine (Saphris), chlorpromazine, haloperidol (Haldol), iloperidone (Fanapt), loxapine, olanzapine (Zyprexa), paliperidone (Invega), pimozide (Orap), quetiapine (Seroquel), risperidone (Risperdal), thioridazine, and ziprasidone (Geodon)
• Apomorphine (Apokyn)
• Atomoxetine (Strattera)
• Beta blockers such as acebutolol (Sectral), atenolol (Tenormin), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), pindolol, and sotalol (Betapace, Sorine)
• Bladder control medicines such as darifenacin (Enablex), fesoterodine (Toviaz), mirabegron (Myrbetriq), oxybutynin (Ditropan XL, Oxytrol), solifenacin (VESIcare), tolterodine (Detrol), and trospium
• Caffeine in food, drinks, or medicines
• Cancer medicines such as arsenic trioxide (Trisenox), nilotinib (Tasigna), toremifene (Fareston), vandetanib (Caprelsa), and vemurafenib (Zelboraf)
• Corticosteroids such as betamethasone, cortisone, dexamethasone, fludrocortisone, hydrocortisone (A-Hydrocort, Cortef), methylprednisolone (Medrol, Solu-Medrol), prednisolone (Omnipred, Orapred, Prelone), prednisone (Prednisone Intensol), and triamcinolone (Aristospan, Kenalog)
• Decongestants such as oxymetazoline (Afrin, Dristan), phenylephrine (Neo-Synephrine, Sudafed PE), and pseudoephedrine (Sudafed)
• Diet pills such as diethylpropion (Tenuate), phendimetrazine, and phentermine (Adipex-P, Suprenza)
• Diuretics (water pills) such as bumetanide, chlorothiazide (Diuril), chlorthalidone, ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (Microzide), methyclothiazide (Enduron), and torsemide (Demadex)
• Doxepin (Silenor)
• Eliglustat (Cerdelga)
• Epinephrine (Adrenalin, Asthmanefrin, Auvi-Q, EpiPen)
• Fingolimod (Gilenya)
• Heart medicines such as amiodarone (Cordarone, Pacerone), disopyramide (Norpace), dofetilide (Tikosyn), dronedarone (Multaq), flecainide, procainamide, propafenone (Rythmol), and quinidine
• HIV medicines such as lopinavir/ritonavir (Kaletra) and saquinavir (Invirase)
• Malaria medicines such as artemether/lumefantrine (Coartem), chloroquine, mefloquine, primaquine, and quinine
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• Medicines to treat breathing or lung problems such as aclidinium (Tudorza), arformoterol (Brovana), aminophylline, budesonide/formoterol (Symbicort), fluticasone/vilanterol (Breo Ellipta), glycopyrrolate (Seebri), indacaterol (Arcapta), ipratropium (Atrovent), mometasone/formoterol (Dulera), oxtriphylline (Choledyl), salmeterol (Serevent), theophylline, tiotropium (Spiriva), and umeclidinium (Incruse Ellipta)
• Methadone (Dolophine, Methadose)
• Midodrine
• Mifepristone (Korlym, Mifeprex)
• Nausea medicines such as dolasetron (Anzemet), metoclopramide (Metozolv, Reglan), ondansetron (Zofran), prochlorperazine (Compro), and promethazine
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Procarbazine (Matulane)
• Products that contain methylene blue (Hyophen, Prosed DS, Urophen, Uta)
• Propranolol (Hemangeol, Inderal, InnoPran)
• Stimulants such as armodafinil (Nuvigil), dextroamphetamine (Dexedrine), methamphetamine (Desoxyn), and modafinil (Provigil)
• Tetrabenazine (Xenazine)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Protect it from heat, high humidity, and bright light. Do not freeze. The Combivent metered dose inhaler is under pressure. Do not puncture.

Do not use any medicine after the expiration date.

Discard the Combivent Respimat inhaler 3 months after first use or after 120 sprays, whichever comes first.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.