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Combivent (ipratropium bromide/albuterol) pharmacologic effect
Combivent (ipratropium bromide/albuterol) is available in the form of aerosol for inhalation. This is a combined preparation with marked bronchodilator effect. It is used for the prevention and long-term treatment of asthma, chronic obstructive bronchitis. 1 dose of aerosol contains ipratropium bromide and albuterol.
Ipratropium bromide is an anticholinergic agent. It can inhibit reflex bronchoconstriction and reduce the secretion of the glands of the respiratory tract. This agent effectively prevents the narrowing of the bronchi and eliminates bronchospasm induced by stimulation of the vagus nerve.
Albuterol is a beta-2 adrenergic agonist. It helps relax smooth muscles and prevent bronchospasm. When used at the recommended therapeutic doses, albuterol has no adverse effect on the cardiovascular system (it does not cause increase in blood pressure).
The combination of albuterol and ipratropium bromide is used to produce an enhanced bronchodilator effect.
Ipratropium bromide is quickly absorbed after inhalation. This agent does not penetrate the blood-brain barrier. Albuterol is rapidly and completely absorbed after inhalation. It penetrates through the BBB, producing a concentration equal to about 5% of the plasma concentration.
Guidance for children and pregnant women
Combivent (ipratropium bromide/albuterol) is not used in the II and III trimester of pregnancy and during breastfeeding (unless the expected benefit to the mother outweighs any possible risk to the fetus).
Combivent (ipratropium bromide/albuterol) interaction
Corticosteroids, anticholinergics and xanthine derivatives may enhance the effect of Combivent (ipratropium bromide/albuterol) and cause serious side effects.
MAO inhibitors and tricyclic antidepressants may enhance the effect of albuterol and lead to a sharp decrease in blood pressure.
Theophylline and other xanthines may increase the risk of tachyarrhythmia.
Diuretics and corticosteroids increase the hypokalemic effect of albuterol.
Anticholinergic drugs increase the risk of high intraocular pressure.
Combivent (ipratropium bromide/albuterol) overdose
Overdose manifestations are rare (due to the low systemic absorption following inhalation or ingestion). As a result, all the manifestations of overdose can be associated with albuterol.
Overdose symptoms include headache, nausea, vomiting, angina pectoris, hypertension, hypotension, hypokalemia, hyperkalemia, tachycardia, arrhythmia, chest pain, tremor, flushing, anxiety, hallucinations and dizziness.
Overdose treatment: symptomatic treatment is recommended.
Combivent (ipratropium bromide/albuterol) dosage
Use Combivent (ipratropium bromide/albuterol) 2 to 4 times a day. If necessary, patients may increase the multiplicity of dosing to 12 times per day (the maximum daily dose).
Combivent (ipratropium bromide/albuterol) contraindications
Do not use Combivent (ipratropium bromide/albuterol) in case of hypersensitivity to albuterol, ipratropium bromide, atropine or its derivatives, hypertrophic obstructive cardiomyopathy, tachyarrhythmia; pregnancy (I trimester). The drug is not recommended for children up to 12 years of age.
Precautions: angle-closure glaucoma, obstruction of the urinary tract (including benign prostatic hyperplasia), pheochromocytoma, hyperthyroidism, diabetes mellitus, cystic fibrosis, myocardial infarction, pregnancy (II-III trimesters), lactation.
Combivent (ipratropium bromide/albuterol) side effects
CNS: headache, dizziness, fatigue, tremor, paresthesia, insomnia, nervousness, incoordination, dysphoria, impaired memory, anxiety, depression. Cardiovascular system: palpitation, tachycardia, arrhythmia. Digestive tract: dry mouth, nausea, vomiting, diarrhea. Metabolism: hypokalemia, hyperglycemia. Respiratory system: cough, dysphonia, nasal congestion, paradoxical bronchospasm, dyspnea. Musculoskeletal system: tremor, myalgia, muscle cramps, muscle weakness, arthralgia. Genitourinary system: urinary retention, dysuria. Allergic reactions: angioedema, skin rash, laryngospasm, bronchospasm, pruritus, anaphylactic shock. Other reactions: mydriasis, angle-closure glaucoma, alopecia.
Combivent (ipratropium bromide/albuterol) cautions
Do not exceed the maximum daily dose to prevent overdose. Patients should be instructed on the correct use of the drug. Patients with asthma or COPD (moderate forms) should choose symptomatic treatment. It is necessary to analyze the further anti-inflammatory therapy to control airway inflammation in patients with steroid-dependent asthma and COPD.
Regular use of high doses of Combivent medication may worsen the disease. Patients should review the treatment plan to prevent life-threatening complication of the disease.