Albuterol / Ipratropium Dosage
Applies to the following strength(s): 2.5 mg-0.5 mg/3 mL ; 103 mcg-18 mcg/inh ; 100 mcg-20 mcg/inh
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Usual Adult Dose for:
Additional dosage information:
Usual Adult Dose for Chronic Obstructive Pulmonary Disease - Maintenance
Combivent(R) inhalation aerosol: 2 inhalations 4 times a day
Patients may take additional inhalations as required; however, the total number of inhalations should not exceed 12 in 24 hours.
Combivent(R) Respimat(R) inhalation spray: 1 inhalation 4 times a day
Patients may take additional inhalations as required; however, the total number of inhalations should not exceed 6 in 24 hours.
DuoNeb(R) inhalation solution: One 3 mL vial by nebulization 4 times a day with up to 2 additional 3 mL doses allowed per day
The maximum recommended dose is 6 vials (18 mL)/day.
Renal Dose Adjustments
The manufacturer recommends caution when administering this drug to patients with renal insufficiency.
Liver Dose Adjustments
The manufacturer recommends caution when administering this drug to patients with hepatic insufficiency.
Albuterol-ipratropium is contraindicated in patients with history of hypersensitivity to atropine or its derivatives. Combivent(R) inhalation aerosol is also contraindicated in patients with history of hypersensitivity to soya lecithin or related food products such as soybean and peanut.
Inhaled albuterol-ipratropium can produce paroxysmal bronchoconstriction that can be life-threatening. If this occurs, albuterol-ipratropium therapy should be stopped at once and alternative therapy should be instituted.
Albuterol can produce a clinically significant cardiovascular effect in some patients, as measured by pulse rate, blood pressure, and/or symptoms. If such symptoms occur, albuterol-ipratropium may need to be discontinued. Electrocardiogram changes, such as flattening of T wave, prolongation of QTc interval, and ST segment depression have been reported with beta-adrenergic agents. Albuterol-ipratropium should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension.
Albuterol-ipratropium should be used with caution in patients with narrow-angle glaucoma, prostatic hyperplasia, bladder neck obstruction, convulsive disorders, hyperthyroidism, or diabetes mellitus, and in patients who are unusually responsive to sympathomimetic amines.
Patients should avoid getting albuterol-ipratropium into the eyes as this may result in precipitation or worsening of narrow-angle glaucoma, increased intraocular pressure, acute eye pain or discomfort, temporary blurring of vision, mydriasis, visual halos, or colored images in association with red eyes from conjunctival or corneal congestion. Patients should be advised to contact their physician at once if any such symptoms develop while using albuterol-ipratropium.
Hypersensitivity reactions may occur after administration of ipratropium bromide or albuterol sulfate. If such a reaction occurs, albuterol-ipratropium therapy should be stopped at once and alternative treatment should be considered.
Safety and effectiveness of additional doses of Combivent(R) inhalation aerosol beyond 12 inhalations/24 hours or of Combivent(R) Respimat(R) inhalation spray beyond 6 inhalations/24 hours have not been established. Safety and effectiveness of additional doses of DuoNeb(R) inhalation solution beyond 6 vials (18 mL)/24 hours have not been established.
Safety and effectiveness of extra doses of albuterol or ipratropium in addition to the recommended doses of albuterol-ipratropium have not been established.
Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).
Data not available
It is recommended to "test spray" Combivent(R) inhalation aerosol 3 times before using for the first time and in cases where the aerosol has not been used for more than 24 hours. Patients should be instructed to shake the canister vigorously for at least 10 seconds before use.
Combivent(R) Respimat(R) inhalation spray should be primed before initial use by actuating the inhaler toward the ground until an aerosol cloud is visible and then repeating the process 3 more times. If not used for more than 3 days, patients should actuate the inhaler once to prepare it for use. If not used for more than 21 days, patients should actuate the inhaler until an aerosol cloud is visible and then repeat the process 3 more times to prepare it for use.
A Pari-LC-Plus(TM) nebulizer (with face mask or mouthpiece) connected to a Proneb(TM) compressor was used to deliver DuoNeb(R) in a clinical study. Safety and effectiveness of DuoNeb(R) delivered by other nebulizers and compressors have not been established. DuoNeb(R) should be administered via jet nebulizer connected to an air compressor with an adequate air flow, equipped with a mouthpiece or suitable face mask.
Dizziness, accommodation disorder, mydriasis, and blurred vision may occur with use of albuterol-ipratropium inhalation aerosol or spray; patients should be cautioned about engaging in activities requiring balance and visual acuity such as driving a car or operating appliances or machinery.
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