Generic Name: albuterol and ipratropium (inhalation) (al BUE ter ol and IP ra TRO pee um)
Brand Names: Combivent, Combivent Respimat, DuoNeb

What is DuoNeb?

DuoNeb is a sterile inhalation solution 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.

DuoNeb 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.

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

Important information

You should not use DuoNeb if you are allergic to albuterol (Proventil, Ventolin), ipratropium (Atrovent), or atropine (Atreza, Lomotil, Vi-Atro, Sal-Tropine). Do not use Combivent if you are allergic to soybeans, peanuts, or other food products that contain soya lecithin.

Slideshow: Flashback: FDA Drug Approvals 2013

Before you use DuoNeb, 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 DuoNeb is not working as well as usual.

Before using DuoNeb

You should not use DuoNeb if you are allergic to albuterol (Proventil, Ventolin), ipratropium (Atrovent), or atropine (Atreza, Lomotil, Vi-Atro, Sal-Tropine). Do not use Combivent if you are allergic to soybeans, peanuts, or other food products that contain soya lecithin.

To make sure DuoNeb 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;

  • liver or kidney disease; or

  • if you are allergic to soybeans, peanuts, or other food products that contain soya lecithin.

FDA pregnancy category C. It is not known whether DuoNeb 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 DuoNeb.

How should I use DuoNeb?

Use DuoNeb 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.

DuoNeb 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.

DuoNeb 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 Duoneb solution with a nebulizer:

  • Open the foil pouch and remove one vial. Squeeze all of the medicine out into the chamber of the nebulizer.

  • Attach the mouthpiece or face mask to the drug chamber. Then, attach the drug chamber to the compressor. Sit upright in a comfortable position. Place the mouthpiece into your mouth or put the face mask on, covering your nose and mouth.

  • Breathe in slowly and evenly until you have inhaled all of the DuoNeb solution (usually 5 to 15 minutes). The treatment is complete when no more mist is formed by the nebulizer and the drug chamber is empty.

  • Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

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

To be sure DuoNeb 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 DuoNeb regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Store Duoneb at room temperature away from moisture, heat, and light. Keep each vial in its foil pouch until you are ready to use 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 albuterol and ipratropium 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 this medication gets in your eyes, rinse with water and seek medical attention.

DuoNeb 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.

DuoNeb side effects

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

Stop using DuoNeb and call your doctor at once if you have a serious side effect such as:

  • 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).

Other common DuoNeb 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 DuoNeb?

Tell your doctor about all medications you use, and those you start or stop using during your treatment with DuoNeb, 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 DuoNeb, including prescription, over-the-counter, vitamin, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about DuoNeb.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use DuoNeb only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.

Copyright 1996-2014 Cerner Multum, Inc. Version: 6.04. Revision Date: 2012-11-13, 3:59:38 PM.

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