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Albuterol / ipratropium Side Effects

For the Consumer

Applies to albuterol / ipratropium: inhalation aerosol liquid, inhalation aerosol powder, inhalation solution, inhalation spray

Along with its needed effects, albuterol/ipratropium may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking albuterol/ipratropium:

More common
  • Body aches or pain
  • chills
  • cough
  • cough producing mucus
  • difficulty with breathing
  • ear congestion
  • fever
  • headache
  • loss of voice
  • runny nose
  • sneezing
  • sore throat
  • stuffy nose
  • tightness in the chest
  • unusual tiredness or weakness
Less common
  • Bladder pain
  • bloody or cloudy urine
  • blurred vision
  • burning while urinating burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chest pain
  • congestion
  • diarrhea
  • difficult, burning, or painful urination
  • dizziness
  • fainting
  • fast, slow, irregular, pounding, or racing heartbeat or pulse
  • frequent urge to urinate
  • general feeling of discomfort or illness
  • hoarseness
  • increased sputum
  • joint pain
  • loss of appetite
  • lower back or side pain
  • muscle aches and pains
  • nausea
  • nervousness
  • noisy breathing
  • pain
  • pain or tenderness around the eyes and cheekbones
  • pounding in the ears
  • shakiness in the legs, arms, hands, or feet
  • shivering
  • sweating
  • swelling
  • tender, swollen glands in the neck
  • trembling or shaking of the hands or feet
  • trouble sleeping
  • trouble swallowing
  • voice changes
  • vomiting
  • Skin rash or hives
  • swelling of the face, lips, eyelids, mouth, or throat
Incidence not known
  • Chest discomfort
  • decrease in the frequency of urination
  • decrease in urine volume
  • difficulty in passing urine (dribbling)
  • itching skin
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • pain or discomfort in the arms, jaw, back, or neck
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • redness of the skin
  • welts

Some side effects of albuterol / ipratropium may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common
  • Acid or sour stomach
  • bad, unusual, or unpleasant (after) taste
  • belching
  • change in taste
  • diarrhea
  • difficulty with moving
  • dry mouth
  • heartburn
  • indigestion
  • muscle pain or stiffness
  • stomach discomfort, upset, or pain
  • voice changes
Incidence not known
  • Bigger, dilated, or enlarged pupils (black part of the eye)
  • blindness
  • change in near or distance vision
  • decreased vision
  • difficulty in focusing eyes
  • dry throat
  • eye pain
  • increased sensitivity of the eyes to light
  • itching, redness, tearing, or other sign of eye irritation not present before use of this medicine or becoming worse during use
  • lack or loss of strength
  • noisy breathing
  • redness of the white part of the eyes or inside of the eyelids
  • swelling of the eye
  • swelling or inflammation of the mouth
  • tearing

For Healthcare Professionals

Applies to albuterol / ipratropium: inhalation aerosol, inhalation solution


The combination of ipratropium and albuterol has been generally well tolerated. Systemic effects have occurred with albuterol; however, due to the poor oral and mucosal absorption of ipratropium, it typically has not exhibited systemic effects when administered by oral inhalation.[Ref]


Respiratory side effects have included bronchitis (up to 12.3%), upper respiratory tract infection (up to 10.9%), lung disease (6.4%), cough (up to 6.4%), dyspnea (up to 4.5%), pharyngitis (up to 4.4%), nasopharyngitis (up to 4%), respiratory disorders (2.5%), sinusitis (2.3%), pneumonia (up to 1.4%), rhinitis (1.1%), and voice alterations (more than 1%). Dysphonia, increased sputum, pharyngolaryngeal pain, wheezing, and bronchospasm have been reported in less than 2% of patients. Hoarseness, throat irritation, bronchospasm (including paradoxical bronchospasm), wheezing, exacerbation of COPD symptoms, upper respiratory tract infection, sinusitis, sore throat, nasal congestion, and pharyngeal edema have been reported during postmarketing experience.[Ref]

Nervous system

Nervous system side effects have included headache (up to 5.6%). Dizziness, paresthesia, tremor, taste perversion, and insomnia have been reported in less than 2% of patients. Drowsiness, coordination difficulty, and taste perversion have been reported during postmarketing experience.[Ref]


Other side effects have included chest pain (up to 2.6%), pain (up to 2.5%), and influenza (1.4%). Asthenia, influenza-like illness, chest discomfort, edema, and fatigue have been reported in less than 2% of patients. Mucosal ulcers, irritation from aerosol, flushing, edema, back pain, aching, and asthenia have been reported during postmarketing experience.


Cardiovascular side effects have included hypertension, palpitations, tachycardia, angina, and arrhythmia in less than 2% of patients. Palpitations, hypotension, elevated heart rate, myocardial ischemia, decreased diastolic blood pressure, and increased systolic blood pressure have been reported during postmarketing experience. Postmarketing experience has included a 5-year placebo-controlled trial, in which hospitalizations for supraventricular tachycardia and/or atrial fibrillation occurred with an incidence rate of 0.5% in COPD patients receiving ipratropium inhalation aerosol.[Ref]


Hypersensitivity side effects associated with the inhalation solution have included immediate hypersensitivity reactions as demonstrated by rare cases of rash, urticaria, angioedema, pruritus, bronchospasm, anaphylaxis, and oropharyngeal edema. Allergic-type reactions such as skin reactions including rash, pruritus, urticaria (including giant urticaria), angioedema (including that of tongue, lips, and face), laryngospasm, and anaphylactic reaction have been reported with the inhalation aerosol. Hypersensitivity has been reported during postmarketing experience.[Ref]


Ocular side effects have included eye pain (less than 2%), acute angle-closure glaucoma, and aggravation of narrow-angle glaucoma. Glaucoma, precipitation or worsening of narrow-angle glaucoma, acute eye pain, blurred vision, conjunctival hyperemia, halo vision, accommodation disorder, ocular irritation, corneal edema, increased intraocular pressure, and mydriasis have been reported during postmarketing experience.[Ref]

There are numerous case reports in the literature of precipitation of glaucoma with the use of ipratropium and albuterol via nebulized solution. This is thought to occur through direct contact with the eyes, and is seen with the combination since both beta agonists and anticholinergics can increase intraocular pressure. There is one report of glaucoma associated with the use of nebulized albuterol and ipratropium aerosol in an emergency department. Caution is warranted when the combination is used in patients predisposed to glaucoma. Extra care should be taken to avoid contact with the eyes.[Ref]


Gastrointestinal side effects have included nausea (greater than or equal to 2%). Diarrhea, dry mouth, constipation, dyspepsia, and vomiting have been reported in less than 2% of patients. Drying of secretions, gastrointestinal motility disorder, stomatitis, dry throat, heartburn, gastrointestinal distress (diarrhea, nausea, vomiting), constipation, and mouth edema have been reported during postmarketing experience.


Musculoskeletal side effects have included arthralgia, muscle spasms, and myalgia in less than 2% of patients. Leg cramps (1.4%) have been reported. Muscle spasms, muscular weakness, and myalgia have been reported during postmarketing experience.


Psychiatric side effects have included nervousness (less than 2%). Central nervous system stimulation and mental disorder have been reported during postmarketing experience.


Metabolic side effects have included hypokalemia (less than 2%). Hypokalemia and metabolic acidosis have been reported during postmarketing experience.


Dermatologic side effects have included pruritus and rash in less than 2% of patients. Angioedema, hyperhidrosis, alopecia, and skin reaction have been reported during postmarketing experience.


Genitourinary side effects have included urinary tract infection and dysuria in less than 2% of patients. Urinary retention has been reported during postmarketing experience.


1. "Product Information. Combivent (albuterol-ipratropium)." Boehringer-Ingelheim, Ridgefield, CT.

2. Hall SK "Acute angle-closure glaucoma as a complication of combined beta- agonist and ipratropium bromide therapy in the emergency department." Ann Emerg Med 23 (1994): 884-7

Some side effects of albuterol / ipratropium may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

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. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. 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 substances you are taking, check with your doctor, nurse, or pharmacist.