Ipratropium/Albuterol T300 26-27

Ipratropium/Albuterol

Combivent Respimat

Ipratropium/Albuterol Drug Class

Anticholinergic/Selective β₂-Agonist Combination

Ipratropium/Albuterol Dosage Forms

Inhalation Solution: (Ipratropium/Albuterol) 0.5 mg/2.5 mg/3 mL;

Spray for Oral Inhalation: (Ipratropium/Albuterol) 20 mcg/100 mcg/inhalation

Ipratropium/Albuterol Dosing By Indication

1. Chronic obstructive pulmonary disease: Adults, 1 inhalation qid (max 6 inhalations/d) or 3 mL via nebulizer q6h (max 6 doses/d)

Ipratropium/Albuterol Off Label Uses

1. Asthma exacerbation: Adults, ipratropium 0.5 mg with albuterol 2.5 mg via nebulizer every 20 min × 3 doses, then prn

Ipratropium/Albuterol MOA

Albuterol is a selective β₂-adrenergic agonist that produces bronchodilation, vasodilation, uterine relaxation, skeletal muscle stimulation, peripheral vasodilation, and tachycardia. Ipratropium is a competitive antagonist of acetylcholine at peripheral, but not central, muscarinic receptors. It appears to produce bronchodilation by inhibition of cholinergic receptors on bronchial smooth muscle.

Ipratropium/Albuterol Common Adverse Effects

Bronchitis, upper respiratory tract infections

Ipratropium/Albuterol Efficacy Monitoring Parameters

Improvement in COPD symptoms, improved PFTs. Resolution of asthma exacerbation.

Ipratropium/Albuterol Safety Monitoring Parameters

Use alternative therapy or seek emergency treatment if paradoxical bronchospasms occur. Monitor BP, HR, signs of CNS stimulation, serum glucose, serum potassium, signs/symptoms of glaucoma, urinary retention, shortness of breath.

Ipratropium/Albuterol Key Counseling Points

Instruct patient on appropriate inhaler technique and priming. If it has been more than 21 d since use, the inhaler should be re-primed. Mouthpiece should be cleaned weekly with dry tissue or damp cloth only. Store the inhaler at room temperature; avoid excessive humidity; do not freeze. Nebulizer technique: use entire vial of inhalation solution immediately after opening to avoid contamination; deliver over 5-15 min. Seek medical attention if the prescribed dose does not provide relief or if symptoms worsen.

Ipratropium/Albuterol Clinical Pearls

Because of anticholinergic effect of ipratropium, use with caution in patients with bladder neck obstruction, narrow-angle glaucoma, or BPH. Ipratropium in combination with albuterol is recommended for initial COPD exacerbation treatment per guidelines. Guidelines prefer the use of an MDI over nebulization, when possible, during an acute COPD exacerbation. Refer to current GOLD guidelines for further details on COPD clinical practice recommendations.