- Brand Name: Combivent / DuoNeb
- Generic Name: Ipratropium/Salbutamol
- Preparation: Inhalers: 50/20mcg
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Instruction for Use
- Basic physical and chemical properties: creamy homogeneous suspension without third-party or unpleasant odor;
- The composition includes one-dimensional dose of 21 mcg ipratropium bromide monohydrate and 120 mcg salbutamol sulphate;
- Other ingredients: soybean lecithin, propellent mixture (СFC11/12/114).
Pharmaceutical Form: dosed aerosol applied at asthma treatment.
Pharmacological Group: Bronchodilator. ATC code: R03AC04.
Combivent Inhaler Action
Ipratropium bromide is quaternary ammonium compound with anticholinergic (parasympatholytics) properties. Preclinical studies have shown that it blocks vagal reflexes by means of antagonizing interactions with acetylcholine, which neurotransmitter provides a transmission pulse of vagus nerve. Anticholinergics prevent increase in intracellular concentration of cyclic guanosine monophosphate (cGMP), which is caused by interaction with muscarinic acetylcholine receptors of bronchial smooth muscle.
Bronchiectasis after ipratropium bromide inhalation is explained mainly due to local and specific drug effect.
Salbutamol sulphate is beta 2-adrenergic agent, whose action on airway smooth muscle results in their relaxation. Salbutamol relaxes all smooth muscles from trachea to terminal bronchioles and protects against all bronchoconstrictor factors.
Combivent Inhaler – dosed aerosol simultaneously ensures isolation of ipratropium bromide and salbutamol sulphate, producing additive effect on muscarinic and beta 2-adrenergic receptors in lung, which results in bronchodilation, which exceeds for such agent.
Controlled studies in patients with reversible bronchospasm showed that Combivent inhaler – bronhodilator – shows greater effect than each of its individual components, does encourage side effects appearance.
Ipratropium bromide is quickly absorbed after inhalation. Renal excretion of active ingredient is 46% of dose after intravenous administration. Systemic bioavailability after inhalation is less than 10 % of dose. Half-life of metabolites and ipratropium is 6 hr. Ipratropium bromide does not penetrate through hematoencephalic barrier.
Salbutamol sulphate is rapidly and completely absorbed after inhalation. Salbutamol peak plasma concentration is observed for 3 hours after use. Salbutamol is excreted unchanged in urine condition after 24 hours. The half-life is 4 hours. Salbutamol passes through hematoencephalic barrier, cerebrospinal fluid concentration reaches 5% of plasma concentration.
Sharing of ipratropium bromide and salbutamol sulphate does not contribute to systemic absorption of single additive component and therefore Combivent Activity – metered aerosol is conditioned by combined local influence on lungs.
Combiven – metered aerosol – is indicated for asthma and reverse bronchospasm treatment associated with obstructive airway diseases in patients requiring more than one bronchodilator.
Method of Use and Dosage
Adults (including elderly patients): two inhalations four times a day. If necessary, dose can be increased by a maximum of 12 inhalations to 24 hours.
Children: there is no experience of using Combivent in children under 12 years.
Patients are advised to consult a doctor immediately or go to the nearest medical facility in case of acute or rapidly increasing dyspnea (shortness of breath), if additional inhalations do not provide adequate improvement. Or you may ask all your questions via firstname.lastname@example.org. Buy inhalers via Asthma Inhalers Online to provide yourself with the most effective and affordable medications.
For successful treatment it is important to use metered aerosol properly.
Before first use, shake aerosol and double press on valve.
Before each use, you must follow such rules:
- Remove protective cap.
- Before each use, shake aerosol well.
- Exhale deep.
- Keep metered aerosol, cover mouthpiece. Asthma Inhaler head and base must be directed upwards.
- Inhale as deep as possible, at the same time firmly press on base of container, thereby releasing a metered dose. Hold your breath for a few seconds, then remove mouthpiece and exhale.
- Similar steps should be repeated for another inhalation.
- After use, turn protective cap.
The container’s under pressure, it should not be opened forcely, or keep at a temperature above 50 ° C. Since container is opaque, it is impossible to see, when its contents is used, but you will shake the container, and get to know whether it contains medication left or not.
The mouthpiece should always be kept clean and rinse with warm water. If you use soap or cleaner mouthpiece should be thoroughly rinsed with clean water.
As with other products that contain beta-agonists, often occurring Combivent Inhaler adverse effects are:
- skeletal muscle tremor especially in sensitive patients.
In treatment of beta 2-agonists severe hypokalemia could potentially be observed.
As with other inhalation therapies, you may experience cough, local irritation, and rarely – asthma bronchospasm caused by inhalation.
As for other beta-mimetics, you may experience nausea, vomiting, sweating, muscle weakness and myalgia / muscle cramps. In rare cases, especially when high doses are applied, it can be observed decrease in diastolic blood pressure, systolic blood pressure, arrhythmia.
In a few cases it is reported about psychological field of inhalation therapy with beta-mimetics.
The most common non-respiratory side effects are associated with anticholinergic influence, dry mouth and dysphonia.
There are certain reports about eyes complications (ie, mydriasis, increased intraocular pressure, angle-closure glaucoma, eye pain), which arose as a result of contact with eyes, ipratropium bromide aerosol or in combination with beta 2-agonists.
Occasionally you may experience of gastrointestinal motility violation and urinary retention, which are reversible.
In some cases it is reported about reaction of allergic type, such as rash on skin, angioneurotic edema of tongue, lips, face; urticaria (including giant urticaria), laryngospasm and anaphylaxis. In many allergic patients it is described for other drugs and / or foods that contain soybeans.
Combivent Inhaler – dosed aerosol is contraindicated in patients with hypertrophic obstructive cardiomyopathy or tachyarrhythmia;
Combivent online also is not used in patients with known hypersensitivity to atropine and derivatives thereof or other preparation’s components.
Interaction with Other Drugs
Co-administration of xanthine derivatives, as well as other beta adrenergic anticholinergic may provoke side effects occurrence.
Hypokalemia induced by beta agonists may amplify simultaneous xanthine derivatives, steroids and diuretics introduction. It should be considered, especially in patients with severe respiratory failure.
Hypokalemia can lead to increased tendency for arrhythmia in patients receiving digoxin. In such situations, it is recommended to monitor the levels of potassium serum.
If concomitant administration of beta-blockers may occur serious bronchodilator effect decline.
Beta-adrenergic agonists should be used with caution in patients receiving monoamine oxidase inhibitors, tricyclic antidepressants or because action of beta-adrenergic agonists.
Inhalation of halogenation hydrocarbon anesthetics such as halothane, trichlorethylene and enflurane may enhance susceptibility to cardiovascular effects of beta-agonists.
Overdose symptoms are associated primarily with salbutamol effect, among which the most common are tachycardia, palpitations, tremor, hypertension, angina pectoris, arrhythmia, skin flushing.
There are expected overdose symptoms of ipratropium bromide (such as dry mouth, blurred visual accommodation) which are mild and transient, given wide therapeutic range and topical use.
It is necessary to apply sedatives, tranquillizers, in severe cases – intensive therapy.
As specific antidotes beta-receptor blockers, preferably beta 1-selective are suitable; however, you must take into account possible increase in bronchial disease, and in patients who suffer from asthma or chronic obstructive pulmonary disease (COPD), you need to carefully select a dose.
Combivent Inhaler Usage Features
Pregnancy and Lactation
Safety of Combivent Inhaler online use during pregnancy has not been proved.
It is necessary to adhere to preventive means, associated with drugs’ use during pregnancy, especially during the first trimester.
It is necessary to take into account Combivent inhibitory effect on uterine contractions.
Salbutamol sulphate and ipratropium bromide may get into breast milk but their effect on the newborn is unknown.
After use Combivent Inhaler – dosed aerosol may provoke hypersensitivity reactions: urticaria, angioedema, rash, bronchospasm and throat edema.
There are some reports about problems on eye (eg, mydriasis, increased intraocular pressure, angle-closure glaucoma, eye pain), which arose as a result of ipratropium bromide aerosol or in combination with beta 2-agonists contact with eyes.
Acute attack symptoms of narrow-angle glaucoma can be pain in eyes, blurred vision, aureole feeling or color spots at the same time with red eyes in the form of conjunctival or corneal congestion. If you have these symptoms in any complex you should begin treatment with eye drops, which contribute to pupil narrowing and immediately seek for specialized medical care.
Therefore patients should be instructed regarding introduction of Combivent Inhaler substance – dosed aerosol. Care should be taken not to let Combivent spray penetrate into eyes.
Patients who are prone to glaucoma should be warned specifically about need to protect the eyes.
When conditions listed below are observed Combivent may be appointed only after a balanced assessment comparing allowable benefits and possible risks: diabetes mellitus, recent myocardial infarction, severe organic heart or vascular disorders, hyperthyroidism, pheochromocytoma, angle-closure glaucoma, prostatic hypertrophy.
The result of beta 2-agonist therapy may be potentially severe hypokalemia, hypoxia may enhance hypokalemia effect on cardiac rhythm.
Patients with cystic fibrosis may be more prone to disorders of gastro-intestinal motility. In case of sudden appearance and rapid progression of dyspnea (breathing complications) you must seek for medical advice immediately.
Terms and Conditions of Storage
Keep out of reach of children, at room temperature (not above 25 ° C). Protect from direct sunlight, heat and frost. Expiry date – 36 months. Buy this inhalation via Asthma Inhalers Online https://onlineasthmainhalers.com/.