Top 300 Pharmacy Drug Cards

IPRATROPIUM/ALBUTEROL: Combivent, Various

Class: Anticholinergic/Selective α2-Agonist Combination

Dosage Forms. Metered Dose Inhaler: 18 mcg/90 mcg ipratropium/albuterol per actuation; Inhalation Solution: 0.5 mg/3 mg ipratropium/albuterol per 3 mL

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Common FDA Label Indication, Dosing, and Titration.

1. Chronic obstructive pulmonary disease: Adults: 2 inhalations qid (max 12 inhalations/d), 3 mL via nebulizer qid (max 6 doses/d)

Off-Label Uses.

1. Asthma exacerbation: Adults: ipratropium 0.5 mg with albuterol 2.5 mg via nebulized usually given once

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.

Drug Characteristics: Ipratropium/Albuterol

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Medication Safety Issues:Ipratropium/Albuterol

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Drug Interactions: Ipratropium/Albuterol

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Adverse Reactions: Ipratropium/Albuterol

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Efficacy Monitoring Parameters. Resolution of COPD symptoms, improved pulmonary function tests.

Toxicity Monitoring Parameters. Use alternative therapy or seek emergency treatment if paradoxical bronchospasms occur.

Key Patient Counseling Points. Instruct patient on appropriate inhaler technique. Wash the mouthpiece in warm water and air dry thoroughly daily (may cease to deliver medication if mouthpiece becomes blocked). Store the inhaler at room temperature; avoid excessive humidity; do not freeze. Each canister contains 200 inhalations. Keep track of number of inhalations administered and discard canister after 200 inhalations have been used. 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.

Clinical Pearls. Due to anticholinergic effect of ipratropium, use with caution in patients with bladder neck obstruction, narrow angle glaucoma, or BPH.