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

The DuoNeb brand name has been discontinued in the U.S. If generic versions of this product have been approved by the FDA, there may be generic equivalents available.

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 inhalation solution is used 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

Seek medical attention if you think DuoNeb inhalation solution is not working as well as usual. Overuse of albuterol and ipratropium may increase the risk of death. It is critical that you use only the prescribed dose of this medicine.

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.

You should not use DuoNeb if you are allergic to albuterol (Proventil, Ventolin), ipratropium (Atrovent), or atropine (Atreza, Lomotil, Vi-Atro, Sal-Tropine).

Before taking this medicine

You should not use DuoNeb if you are allergic to albuterol (Proventil, Ventolin), ipratropium (Atrovent), or atropine.

To make sure DuoNeb is safe for you, tell your doctor if you have ever had:

  • heart disease, high blood pressure, coronary artery disease, or heart rhythm disorder;

  • a seizure disorder such as epilepsy;

  • diabetes;

  • overactive thyroid;

  • glaucoma;

  • liver or kidney disease; or

  • enlarged prostate, problems with urination.

It is not known whether DuoNeb will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Albuterol and ipratropium inhalation can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

DuoNeb is not approved for use by anyone younger than 18 years old.

How should I use DuoNeb?

Use DuoNeb exactly as prescribed by your doctor. Follow the directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

DuoNeb is usually used 4 times per day. Follow your doctor's dosing instructions very carefully.

Overuse of albuterol and ipratropium may increase the risk of death. It is critical that you use only the prescribed dose of this medicine.

DuoNeb inhalation comes with patient instructions for safe and effective use, and directions for priming the inhaler device. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

To use DuoNeb inhalation solution:

  • 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, then attach the drug chamber to the compressor.

  • Sit upright in a comfortable position. Place the mouthpiece into your mouth or put on the face mask, covering your nose and mouth. Turn on the compressor.

  • Breathe in slowly and evenly until 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.

Use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Seek medical attention if you think this medication is not working as well as usual.

While using DuoNeb, you may need medical tests.

Store at room temperature away from moisture, heat, and light. Keep each Duoneb vial in its foil pouch until you are ready to use it. Do not store Combivent Respimat in your car on hot days. Extreme heat can cause the medicine canister to burst. Do not throw an empty canister into open flame.

DuoNeb dosing information

Usual Adult Dose for Chronic Obstructive Pulmonary Disease -- Maintenance:

DuoNeb 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.

See also: Dosage Information (in more detail)

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.

Do not use more than 6 inhalations in a 24-hour period.

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, tremors, dry mouth, extreme thirst, muscle weakness or limp feeling, severe headache, pounding in your neck or ears, or feeling like you might pass out.

What should I avoid while using DuoNeb?

If this medication gets in your eyes, rinse with water and seek medical attention.

This medication 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 signs of an allergic reaction to DuoNeb: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • wheezing, choking, or other breathing problems after using DuoNeb;

  • chest pain;

  • fast or pounding heartbeats, fluttering in your chest;

  • tremors, nervousness;

  • swelling of your ankles or feet;

  • blurred vision, tunnel vision, eye pain, or seeing halos around lights;

  • painful or difficult urination; or

  • low potassium - leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling.

Common DuoNeb side effects may include:

  • headache;

  • trouble breathing; 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 your current medicines and any you start or stop using, especially:

  • a diuretic or "water pill";

  • heart or blood pressure medicine;

  • other beta-blockers; or

  • an antidepressant.

This list is not complete. Other drugs may interact with albuterol and ipratropium, including prescription and over-the-counter medicines, vitamins, 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 by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. 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. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2017 Cerner Multum, Inc. Version: 7.01.

Date modified: October 05, 2017
Last reviewed: August 25, 2017

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