Drug Profile

Pregnancy Warning

Albuterol, a component of COMBIVENT, caused malformations in human infants. Because of the potential for serious adverse effects to the fetus, ipratropium with albuterol should not be used by pregnant women. There were no adverse effects seen in animal studies with ipratropium when used alone, and there were no human data.

Breast-Feeding Warning

No information is available from either human or animal studies. However, because many drugs are excreted in human milk, it is likely that these drugs are present in milk. Because of the potential for adverse effects in nursing infants, particularly the potential for cancer with albuterol, you should not take the combination of ipratropium and albuterol while nursing.

Anticholinergic Effects

Warning: Special Mental and Physical Adverse Effects

Older adults are especially sensitive to the harmful anticholinergic effects of these drugs. Drugs in this family should not be used unless absolutely necessary.

Mental Effects: confusion, delirium, short-term memory problems, disorientation and impaired attention

Physical Effects: dry mouth, constipation, difficulty urinating (especially for a man with an enlarged prostate), blurred vision, decreased sweating with increased body temperature, sexual dysfunction and worsening of glaucoma

Tell your doctor if you have or have had:

• allergies to ipratropium or belladonna alkaloids (ipratropium)
• allergies to ipratropium, atropine, or albuterol (ipratropium and albuterol)
• allergies to soya lecithin, soybean protein, or peanuts (when using metered-dose inhaler)
• narrow-angle glaucoma (ipratropium)
• difficulty urinating (ipratropium)
• heart problems (albuterol)
• high blood pressure (albuterol)
• pregnancy or are breast-feeding

Tell your doctor about any other drugs you take, including aspirin, herbs, vitamins, and other nonprescription products.

• Check with your doctor if symptoms do not improve within 30 minutes of use. Check immediately if using ipratropium with albuterol and breathing difficulty persists or gets worse.
• If you plan to have any surgery, including dental surgery, tell your doctor that you take this drug.

• If you miss a dose, take it as soon as you remember, and evenly space the remaining doses for that day.
• Do not share your medication with others.
• Take the drug at the same time(s) each day.
• Read instructions carefully before using.
• Avoid getting ipratropium in your eyes. Use a well-fitting mask, goggles, or T-piece extension, or at least close your eyes.[6],[7],[8] If nasal spray gets in eyes, flush eyes for several minutes with cool tap water. If you get eye pain or blurred vision, check with your doctor immediately.
• Shake canister well before using. Dilute solutions before using, according to instructions.
• If you use a spacer device or nebulizer, be sure you understand the instructions for use. Ask questions and practice until you are comfortable using the device. Ask your doctor if a paper bag can be substituted.
• Discard solutions of ipratropium stored at room temperature without a preservative within 24 hours; discard within 48 hours if refrigerated.
• Do not store in the bathroom. Do not expose to heat, moisture, or strong light. Store metered dose inhaler at room temperature. Store solutions according to instructions on the label. Keep out of reach of children.

The following drugs, biologics (e.g., vaccines, therapeutic antibodies), or foods are listed in Evaluations of Drug Interactions 2003 as causing “highly clinically significant” or “clinically significant” interactions when used together with any of the drugs in this section. In some sections with multiple drugs, the interaction may have been reported for one but not all drugs in this section, but we include the interaction because the drugs in this section are similar to one another. We have also included potentially serious interactions listed in the drug’s FDA-approved professional package insert or in published medical journal articles. There may be other drugs, especially those in the families of drugs listed below, that also will react with this drug to cause severe adverse effects. Make sure to tell your doctor and pharmacist the drugs you are taking and tell them if you are taking any of these interacting drugs:

cromolyn solution (if mixed with ipratropium a cloudy sludge will form; do not use such mixtures), GASTROCOM, INTAL, NASALCROM.

For albuterol: GLUCOPHAGE, GLUCOVANCE, METAGLIP, metformin.

Call your doctor immediately if you experience:

• constipation, or lower abdominal pain or bloating
• difficulty breathing: shortness of breath or wheezing
• chest discomfort or pain
• severe eye pain
• swelling of face, lips, or eyelids
• swelling of the mouth or throat
• dizziness
• unusually fast heartbeat (ipratropium and albuterol)
• skin rash or hives

Call your doctor if these symptoms continue:

• cough
• dry mouth or throat
• headache
• nausea
• increased nasal congestion
• nasal itching, burning, or irritation
• increased runny nose
• nervousness
• change in sense of taste
• dizziness
• trembling