What is albuterol and ipratropium inhaler, and how does it work (mechanism of action)?
Albuterol/ipratropium is a combination
product consisting of two bronchodilators,
albuterol (Proventil; Ventolin) and
ipratropium (Atrovent) that is used in the treatment of chronic obstructive
pulmonary disease (bronchitis and emphysema) when there is evidence of spasm
(narrowing) of the airways (bronchi). Bronchodilators dilate or enlarge the
airways by relaxing the muscles surrounding the airways. Albuterol and
ipratropium work by different mechanisms, but both cause the muscles of the
airways to relax. Albuterol is a bronchodilator of the beta-2 agonist type.
Beta-2 agonists are medications that stimulate beta-2 receptors on the smooth
muscle cells that line the airways, causing these muscle cells to relax and
thereby opening airways. Ipratropium blocks the effect of acetylcholine in
airways and nasal passages. Acetylcholine is a chemical that nerves use to
communicate with muscle cells. In chronic obstructive pulmonary disease
(COPD),
cholinergic nerves going to the lungs cause narrowing of airways by stimulating
muscles surrounding airways to contract. The "anti-cholinergic" effect of
ipratropium blocks the effect of cholinergic nerves, causing the muscles to
relax and airways to dilate. The FDA approved albuterol/ipratropium in October
1996.
What brand names are available for albuterol and ipratropium inhaler?
Combivent Respimat
Is albuterol and ipratropium inhaler available as a generic drug?
Yes
Do I need a prescription for albuterol and ipratropium inhaler?
Yes
What are the uses for albuterol and ipratropium inhaler?
Albuterol and ipratropium inhaler (Combivent Respimat) is prescribed for the treatment of bronchospasm or narrowing of the airways caused by emphysema or bronchitis in individuals who require a second bronchodilator.
What are the side effects of albuterol and ipratropium inhaler?
Side effects of albuterol/ipratropium combination
products are due to the component drugs. Side effects of albuterol include
nervousness, tremor, headache, palpitations, fast heart rate, elevated blood
pressure, nausea, dizziness, and heartburn. Throat irritation and
nosebleeds
also can occur. Worsening of diabetes and lowering of potassium also have been
reported.
The most common side effects associated with ipratropium are:
Because of its anticholinergic effect, ipratropium may worsen symptoms of benign prostatic
hyperplasia, and narrow-angle glaucoma.
Other important side effects include allergic reactions, which may rarely occur and
may manifest as:
- rash,
- hives,
- swelling,
- bronchospasm, or
- anaphylaxis (shock).
In rare patients, albuterol/ipratropium can paradoxically precipitate life-threatening bronchospasm.
What is the dosage for albuterol and ipratropium inhaler?
The recommended dosing for albuterol/ipratropium is 2
inhalations 4 times daily and as needed not to exceed 12 inhalations per day.
The dose of Combivent Respimat is 1 inhalation 4 times daily not to exceed 6
inhalations per day.
Which drugs or supplements interact with albuterol and ipratropium inhaler?
Use with other anticholinergic drugs (for example,
atropine) may increase the occurrence of side effects.
Tricyclic
antidepressants, for example, amitriptyline (Elavil, Endep), monoamine oxidase
inhibitors, for example, tranylcypromine, should not be combined with albuterol/ipratropium
because of their additive effects on the vascular system (increased blood
pressure, heart rate, etc.). A period of two weeks should elapse between
treatment with albuterol/ipratropium and tricyclic antidepressants or monoamine
oxidase inhibitors.
Use of albuterol/ipratropium with other stimulant
medications is discouraged because of their combined effects on heart rate,
blood pressure, and the potential for causing chest pain in patients with
underlying coronary heart disease. Beta blockers, for example, propranolol (Inderal,
Inderal LA) block the effect of albuterol and may induce bronchospasm in
asthmatics.
Albuterol/ipratropium may cause hypokalemia (low potassium).
Therefore, combining albuterol/ipratropium with loop diuretics which reduce
potassium in the body, for example, furosemide (Lasix) may increase the
likelihood of hypokalemia.
Is albuterol and ipratropium inhaler safe to take if I’m pregnant or breastfeeding?
There are no adequate studies of albuterol/ipratropium use
during pregnancy. Some reports indicate that beta-agonists may interfere with
uterine contractility.
It is not known whether albuterol/ipratropium is
excreted in human milk.
What else should I know about albuterol and ipratropium inhaler?
What preparations of albuterol and ipratropium inhaler are available?
Aerosol inhaler: 90/18 mcg or 100/20 mcg (albuterol/ipratropium)
per actuation of the inhaler.
How should I keep albuterol and ipratropium inhaler stored?
The inhaler should be stored at room temperature, 15 C – 30 C
(59 F – 86 F) and kept away from moisture.