combivent

Combivent is a metered-dose inhaler containing a combination of albuterol and ipratropium. Albuterol and ipratropium are bronchodilators that relax muscles in the airways and increase air flow to the lungs

Combivent is used as an inhaled medication to prevent bronchospasm in people with chronic obstructive pulmonary disease (COPD) who are also using other medicines to control their condition.

Combivent may also be used for purposes not listed in this medication guide.

Important information

You should not use Combivent if you are allergic to albuterol (Proventil, Ventolin), ipratropium (Atrovent), or atropine (Atreza, Lomotil, Vi-Atro, Sal-Tropine).

Before you use this medicine, tell your doctor if you have heart disease, high blood pressure, coronary artery disease, a heart rhythm disorder, seizures, diabetes, overactive thyroid, glaucoma, an enlarged prostate, urination problems, liver disease, or kidney disease.

Seek medical attention if you think Combivent is not working as well as usual.

Before using Combivent

You should not use Combivent if you are allergic to albuterol (Proventil, Ventolin), ipratropium (Atrovent), or atropine (Atreza, Lomotil, Vi-Atro, Sal-Tropine).

To make sure Combivent is safe for you, tell your doctor about your other medical conditions, especially:

• heart disease, high blood pressure, coronary artery disease, or heart rhythm disorder;

• a seizure disorder such as epilepsy;

• diabetes;

• overactive thyroid;

• glaucoma;

• enlarged prostate, problems with urination; or

• liver or kidney disease.

FDA pregnancy category C. It is not known whether Combivent is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

See also: Pregnancy and breastfeeding warnings (in more detail)

It is not known whether albuterol and ipratropium passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using Combivent.

How should I use Combivent?

Use Combivent exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Combivent may increase the risk of asthma-related death. It is critical that you use only the prescribed dose of this medicine and follow all patient instructions for safe use of the medication.

Combivent comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

To use the Combivent inhaler:

• Insert metal canister into clear end of mouthpiece. Make sure the canister is fully and firmly inserted into the mouthpiece.

• Remove orange protective dust cap. If the cap is not on the mouthpiece, make sure there is nothing in the mouthpiece before use. For best results, the canister should be at room temperature before use.

• Shake and Test Spray. Perform this step before using for the first time, and whenever the aerosol has not been used for more than 24 hours.

• Shake the canister vigorously for at least 10 seconds. Vigorous shaking for at least 10 seconds before each spray is very important for proper performance.

• Breathe out (exhale) deeply through your mouth. Holding the canister upright, between your thumb and finger(s), put the mouthpiece in your mouth and close your lips. Keep your eyes closed so that no medicine will be sprayed into your eyes. Combivent can cause blurry vision, narrow-angle glaucoma or worsening of this condition or eye pain if the medicine is sprayed into your eyes.

• Breathe in slowly through your mouth and at the same time spray the medicine into your mouth. To spray the medicine, firmly press once on the canister against the mouthpiece. Keep breathing in deeply.

• Hold your breath for 10 seconds, remove the mouthpiece from your mouth and breathe out slowly.

• If you use more than one inhalation at a time, wait at least 2 minutes before using the second inhalation, shake the inhaler vigorously for at least 10 seconds again and repeat dose.

• Replace the orange protective dust cap after use.

• Keep track of the number of sprays used and discard after 200 sprays. Even though the canister is not empty, you cannot be sure of the amount of medicine in each spray after 200 sprays.

• Keep your inhaler clean and dry, and store it with the cap on the mouthpiece. Clean your inhaler once a week by removing the canister and placing the mouthpiece under warm running water for at least 30 seconds. Allow the parts to dry before putting the inhaler back together.

To use the Combivent Respimat:

• With the orange cap closed, press the safety catch while pulling off the clear base. Be careful not to touch the piercing element located inside the bottom of the clear base.

• Write the "discard by" date on the label of the Respimat inhaler. The discard by date is 3 months from the date the cartridge is inserted into the inhaler.

• Push the narrow end of the cartridge into the inhaler. The base of the cartridge will not sit flush with the inhaler. About 1/8 of an inch will remain visible when the cartridge is correctly inserted. The cartridge can be pushed against a firm surface to ensure that it is correctly inserted. Do not remove the cartridge once it has been inserted into the inhaler.

• Put the clear base back into place. Do not remove the clear base again. Your Combivent Respimat inhaler should not be taken apart after you have inserted the cartridge and put the clear base back.

The following steps are needed to fill the dosing system the first time you use it and will not affect the number of doses available. After preparation and initial priming, your Respimat inhaler will be able to deliver 120 doses.

• Hold the Combivent Respimat inhaler upright, with the orange cap closed, to avoid accidental release of the dose. Turn the clear base in the direction of the white arrows on the label until it clicks (half a turn).

• Flip the orange cap until it snaps fully open.

• Point the inhaler toward the ground (away from your face). Press the dose release button. Close the orange cap. Repeat until a spray is visible. Once the spray is visible, you must repeat this step three more times to make sure the inhaler is prepared for use. This process will not affect the number of doses available. After preparation and initial priming, your Combivent Respimat inhaler will be able to deliver 120 doses.

Daily dosing.

• Hold the Respimat inhaler upright with the orange cap closed, so you do not accidentally release a dose of medicine. Turn the clear base in the direction of the white arrows on the label until it clicks (half a turn).

• Flip the orange cap until it snaps fully open. Breathe out slowly and fully, and then close your lips around the end of the mouthpiece without covering the air vents.

• Point your Combivent Respimat inhaler to the back of your throat.

• While taking in a slow, deep breath through your mouth, press the dose release button and continue to breathe in slowly for as long as you can.

• Hold your breath for 10 seconds or for as long as comfortable. Close the orange cap until you use your Respimat inhaler again.

Call your doctor right away if any of your medications do not seem to work as well in preventing attacks.

To be sure Combivent is helping your condition and not causing harmful effects, your lung function will need to be tested often. You may also need blood tests at your doctor"s office. Visit your doctor regularly.

Use Combivent regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Store at room temperature away from moisture and heat. Extreme heat can cause the medicine canister to burst. Do not store Combivent Respimat in your car on hot days. Do not throw an empty canister into open flame.

Keep track of the number of sprays you have used and throw away the Combivent inhaler canister after 200 sprays, even if it feels like there is still medicine in it.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of Combivent can be fatal. Overdose symptoms may include chest pain, fast or pounding heartbeats, extreme thirst, muscle weakness or limp feeling, severe headache, buzzing in your ears, weak pulse, fainting, or slow breathing (breathing may stop).

What should I avoid?

If Combivent gets in your eyes, rinse with water and seek medical attention.

This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Combivent side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Combivent: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using Combivent and call your doctor at once if you have:

• wheezing, choking, or other breathing problems (especially after starting a new canister of this medicine);

• chest pain, pounding heartbeats or fluttering in your chest;

• dangerously high blood pressure (severe headache, anxiety, uneven heartbeats);

• swelling of your ankles or feet;

• eye pain, or seeing halos around lights;

• painful or difficult urination; or

• low potassium (confusion, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling).

Common Combivent side effects may include:

• mild headache; or

• cold symptoms such as stuffy nose, sneezing, cough, or sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect Combivent?

Tell your doctor about all medications you use, and those you start or stop using during your treatment with Combivent, especially:

• bladder or urinary medicines such as darifenacin (Enablex), tolterodine (Detrol), solifenacin (Vesicare);

• a diuretic (water pill);

• heart or blood pressure medication, such as atenolol (Tenormin, Tenoretic), metoprolol (Dutoprol, Lopressor, Toprol), propranolol (Inderal, InnoPran), and others;

• medication for Parkinson"s disease or depression;

• medication to treat excess stomach acid, stomach ulcer, motion sickness, or irritable bowel syndrome;

• other bronchodilators such as formoterol (Foradil), ipratropium (Atrovent), isoproterenol (Isuprel), metaproterenol (Alupent, Metaprel), terbutaline (Brethine, Bricanyl), or tiotropium (Spiriva); or

• a stimulant, ADHD medication, diet pills, or over-the-counter cold or allergy medicine.

This list is not complete. Other drugs may interact with Combivent, including prescription, over-the-counter, vitamin, and herbal products. Not all possible interactions are listed in this medication guide.