Generic
Ipratropium Bromide + Salbutamol
22 brands available in the market
At a glance
Ipratropium Bromide + Salbutamol combination is used for bronchospasm in patients with COPD who continue to have evidence of bronchospasm on a regular aerosol bronchodilator.
Description
Ipratropium Bromide + Salbutamol is a combination inhalation aerosol containing Salbutamol (short-acting beta2-adrenergic bronchodilator) and Ipratropium Bromide (anticholinergic bronchodilator). It is an HFA-based environment friendly inhaler without CFC. Both drugs reduce bronchospasm through different mechanisms - anticholinergic (parasympatholytic) and sympathomimetic - producing greater bronchodilatory effect than either drug alone.
Indications
- Bronchospasm in COPD patients (who continue to have evidence of bronchospasm on a regular aerosol bronchodilator)
Therapeutic class
Combined bronchodilators
Pharmacological class
Anticholinergic + Beta2-agonist (Bronchial)
Pharmacology
This combination inhalation aerosol contains Salbutamol (short-acting beta2-adrenergic bronchodilator) and Ipratropium Bromide (anticholinergic bronchodilator). Ipratropium Bromide prevents increase in intracellular cyclic GMP caused by interaction of acetylcholine with muscarinic receptor on bronchial smooth muscle. Salbutamol stimulates beta2-adrenergic receptors to relax bronchial smooth muscle. This combination maximizes treatment response in COPD patients by reducing bronchospasm through two distinct mechanisms.
Mechanism of action
Ipratropium Bromide blocks acetylcholine action and Salbutamol stimulates beta2-receptors to relax bronchial smooth muscle, causing bronchodilation and making breathing easier.
Dosage
Adult Dose (Inhalation):
- Metered-dose inhaler: 100 mcg/20 mcg (1 actuation) every 6 hours; not to exceed 6 actuations/day
- Nebulizer solution: Initially, 3 mL every 6 hours; Max: 3 mL every 4 hours; 3-4 ampoules daily
- One ampoule as required or as directed
Child Dose: Safety and efficacy not established
Administration
For inhalation only; do not swallow tablets; use in dose and duration as advised by doctor; check label for directions; for nebulizer, twist off top of respule/transpule and squeeze all liquid into nebulizer; use immediately after opening.
Missed dose
If you miss a dose, take it as soon as possible; if it is almost time for your next dose, skip the missed dose and go back to regular schedule; do not double the dose.
Side effects
Common Side Effects:
- Dryness in mouth
- Breathlessness
- Cough
- Tremor
- Headache
- Palpitations
- Muscle cramp
Uncommon: Angioedema, Urticaria, Bronchospasm, Hypotension, Nausea, Sinusitis, Pharyngitis, Influenza
Precautions & warnings
Precautions:
- For inhalation only; do not swallow tablets
- Do not use to relieve sudden breathing problems (use rescue inhaler)
- Take first dose under medical supervision (may cause bronchospasm)
- Gargle with warm water after each inhalation (to avoid fungal infections)
- Caution in narrow-angle glaucoma, prostatic hypertrophy or bladder-neck obstruction
- Hypokalemia may occur; monitor potassium levels
Contraindications
Contraindications:
- Hypertrophic obstructive cardiomyopathy
- Tachyarrhythmia
- Hypersensitivity to atropine or its derivatives
- Hypersensitivity to soya lecithin, soybean or peanut
Drug interactions
Drug Interactions:
- May have additive anticholinergic effects with psychotropics
- May decrease effect of propranolol
- Increased cardiovascular effects (tachycardia, palpitations) with MAOIs, TCAs and amphetamines
Food interactions
Food Interactions: It is not known whether it is safe to consume alcohol with Ipratropium Bromide + Salbutamol; consult your doctor.
Use in pregnancy
Use in Pregnancy: May be unsafe; animal studies have shown harmful effects; doctor will weigh benefits and risks.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Probably safe; limited human data suggests drug does not represent significant risk to baby; it is not known whether salbutamol and ipratropium bromide are excreted in breast milk.
Pediatric use
Safety and efficacy not established in pediatric patients.
Geriatric use
No specific data for elderly; however caution advised.
Renal / hepatic impairment
No interaction found/established for renal or hepatic impairment.
Overdose effects
Overdose: Effects are expected to be related primarily to Salbutamol; manifestations include anginal pain, hypertension, hypokalemia, tachycardia; symptomatic treatment.
Storage conditions
Avoid storage in direct sunlight or heat; store in a cool and dry place; keep away from children; keep away from eyes.
Chemical structure
Ipratropium Bromide + Salbutamol