Combivent Respimat Inhaler (Ipratropium / Albuterol)
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Fact Table
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| Formula | C20H30BrNO3•H2O / (C13H21NO3)2•H2SO4 |
| License | FDA approved (October 7, 2011) |
| Bioavailability | Not formally stated for the combination; ipratropium is not readily absorbed systemically after inhalation |
| Legal status | Prescription only (Rx) |
| Chemical Name | Ipratropium bromide monohydrate + albuterol sulfate |
| Elimination half-life | Ipratropium: ~2 hours; albuterol: ~3.8–5 hours (inhaled) |
| Dosage (Strength) | 20 mcg ipratropium bromide / 100 mcg albuterol per actuation; usual dose 1 inhalation 4 times daily (max 6 inhalations/24 h) |
| Pregnancy | No adequate randomized human studies; use in pregnancy only if benefits justify risks |
| Brands | Combivent Respimat |
| Protein binding | Ipratropium: 0%–9% in vitro; albuterol: low |
| PubChem CID | 24847804 |
| MedlinePlus | a601063 |
| ChEBI | 5957 / 2549 |
| ATC code | R03AL02 |
| DrugBank | DB00332 / DB01001 |
| KEGG | D10256 |
| Routes of administration | Oral inhalation (Respimat soft mist inhaler) |
Combivent Respimat is a bronchodilator that contains two drugs: ipratropium bromide and albuterol sulfate. These medicines work together to relax the muscles around the airways in the lungs. Ipratropium helps prevent the airways from tightening, while albuterol helps the airways open more quickly. Combivent Respimat is prescribed to people with chronic obstructive pulmonary disease (COPD) who already use a regular bronchodilator but still have trouble breathing and need additional treatment.
Directions
Combivent Respimat is administered by mouth using an inhaler. The usual dose is one puff, four times a day. Do not use more than six puffs in one day.
Before using the inhaler for the first time, it needs to be primed. Point it toward the ground and press the button until you see a spray come out. Then do this three more times. If you have not used the inhaler for more than 3 days, press it once before using it again. If you have not used it for more than 21 days, repeat the full setup process with four sprays before using it.
To use the inhaler:
- Hold it upright with the cap closed and turn the base in the direction of the arrows until it clicks
- Flip the cap open until it snaps fully open
- Breathe out slowly and fully
- Close lips around the mouthpiece without covering air vents
- Point the inhaler toward the back of the throat
- While taking a slow, deep breath through the mouth, press the dose-release button and continue breathing in slowly
- Hold breath for 10 seconds or as long as comfortable
- Repeat for the second inhalation
Clean the Respimat inhaler once a week by gently wiping the mouthpiece with a damp cloth or tissue.
Ingredients
The active ingredients in Combivent Respimat are ipratropium bromide and albuterol sulfate.
Cautions
Before using this medication, you may want to consult a healthcare provider about the following:
- Any existing health conditions
- Any allergies
- A list of all medications currently being taken
Do not use it more than prescribed. Taking more than the recommended dose can increase the risk of serious heart problems, and deaths have been reported with excessive use of inhaled medications like Combivent.
Breathing may worsen suddenly in rare cases. Combivent can cause paradoxical bronchospasm, meaning the airways tighten instead of relax. Stop using it and seek medical help immediately if this happens.
Heart-related side effects are possible. It may raise heart rate or blood pressure and can cause chest pain, palpitations, or irregular heart rhythms, especially in people with heart disease.
Avoid spraying it into your eyes. It can increase eye pressure and worsen narrow-angle glaucoma, causing eye pain, blurred vision, or seeing halos around lights.
Urinary retention may occur. People with prostate problems or bladder blockage should use Combivent cautiously, as it can make urination more difficult.
Serious allergic reactions can happen. Stop the medication and get emergency help if you develop rash, swelling of the face or throat, or trouble breathing.
Use caution with certain medical conditions. People with seizures, thyroid problems, or diabetes should discuss risks with their healthcare provider.
Low potassium levels are possible. Combivent can temporarily lower potassium, which may affect the heart, especially if taken at high doses.
Contraindications
Avoid taking or using this medication if you have a known hypersensitivity to ipratropium bromide, albuterol sulfate, atropine, or any ingredients in Combivent Respimat.
Side Effects
Common side effects of Combivent Respimat include:
- Cough
- Shortness of breath (dyspnea)
- Headache
- Upper respiratory infections, such as bronchitis or nasopharyngitis
These side effects were seen in people with COPD during clinical trials and are usually mild. Some people may also notice dry mouth, nausea, dizziness, or a slight tremor. Cough may happen more often with regular use.
Serious side effects are less common but possible. In rare cases, Combivent can cause worsened breathing right after use, fast or irregular heartbeat, chest pain, low potassium levels, eye problems like blurred vision, or trouble urinating.
Severe allergic reactions, including swelling of the face or throat and difficulty breathing, may require emergency care.
Frequently Asked Questions about Combivent Respimat
What is Combivent Respimat?
Combivent Respimat is an inhalation spray that combines ipratropium bromide, an anticholinergic bronchodilator, with albuterol, a short-acting beta2-agonist bronchodilator. These two medicines work together to relax and open the airways and are used in a Respimat inhaler device for oral inhalation.
What is Combivent Respimat used for?
Combivent Respimat is indicated for people with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema, who are using a regular aerosol bronchodilator and still need additional help for bronchospasm. It is not primarily an asthma controller medicine.
How is Combivent Respimat usually taken?
The usual dose is 1 inhalation four times a day. Some patients may use extra inhalations if needed, but the total should not exceed 6 inhalations in 24 hours unless a clinician specifically directs otherwise.
How quickly does it work?
Because it contains albuterol, Combivent Respimat can begin helping relieve breathing symptoms fairly quickly, while ipratropium adds another bronchodilator effect. Even though it can provide symptom relief, it is still important to use it exactly as prescribed rather than increasing doses on your own.
What are the most common side effects?
Common side effects include cough, upper respiratory tract infection symptoms, headache, and sometimes nervousness, tremor, or dry mouth. Since it contains albuterol, some people may also notice a fast heartbeat or feeling jittery.
What serious side effects should people watch for?
Serious problems can include worsening wheezing right after use, chest pain, a fast or irregular heartbeat, allergic reactions, and eye symptoms if the spray gets into the eyes. The label also warns about the risk of narrow-angle glaucoma symptoms such as eye pain, blurred vision, or halos around lights.
Are there important precautions or people who should use it carefully?
Combivent Respimat should be used cautiously in people with heart disease, arrhythmias, seizures, hyperthyroidism, diabetes, or narrow-angle glaucoma, and in people with prostate enlargement or bladder-neck obstruction because ipratropium can worsen urinary retention. Patients with a history of hypersensitivity to atropine-related drugs also need caution.
Are there important drug interactions?
Yes. Other sympathomimetic drugs can increase side effects, beta-blockers may reduce the benefit of albuterol, and monoamine oxidase inhibitors or tricyclic antidepressants can increase cardiovascular effects. Potassium-lowering effects may also be more significant when used with certain diuretics.
How do you prime and maintain the inhaler?
The Respimat inhaler must be prepared before first use and re-primed if it has not been used for a while. If it has not been used for more than 3 days, actuate it once; if it has not been used for more than 21 days, actuate until a visible mist appears and then repeat 3 more times. Each cartridge provides 120 inhalations, and the device locks when they are used up.
When should someone call their clinician about Combivent Respimat?
A clinician should be contacted if breathing symptoms worsen, the medicine seems less effective than usual, or extra doses are needed more often. That can be a sign that COPD is getting worse and the treatment plan may need to be adjusted.
