Combivent
Combivent Respimat is an inhaler that's used to treat chronic obstructive pulmonary disease (COPD) in adults. It's a combination medication that contains two different bronchodilators: ipratropium, a short-acting muscarinic antagonist (SAMA), and albuterol, a short-acting beta agonist (SABA). The medication is inhaled through the mouth 4 times a day, but up to 6 times per day if instructed. Combivent Respimat (ipratropium / albuterol) isn't a rescue inhaler; it's used regularly rather than as needed for sudden breathing problems. Side effects aren't common but can include upper respiratory tract infections and cough.
What is Combivent Respimat (ipratropium / albuterol)?
What is Combivent Respimat (ipratropium / albuterol) used for?
- Maintenance treatment for chronic obstructive pulmonary disease (COPD) in adults who need more than one bronchodilator
How Combivent Respimat (ipratropium / albuterol) works
Combivent Respimat (ipratropium / albuterol) is a combination of two medications that work together to make it easier to breathe.
- Ipratropium is a short-acting muscarinic antagonist (SAMA), a type of anticholinergic medication. It works to prevent the airways in your lungs from tightening up.
- Albuterol is a short-acting beta agonist (SABA). It works by relaxing the muscles in your lungs to open up your airways.
Drug facts
Side effects of Combivent Respimat (ipratropium / albuterol)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Common cold symptoms (4%)
- Upper respiratory infection (3%)
- Cough (3%)
- Bronchitis (3%)
- Headache (3%)
Less Common Side Effects
- Shortness of breath
- Dizziness
- Shakiness
- Dry mouth
- Flu-like symptoms
- Chest discomfort
- Racing heart
Combivent Respimat (ipratropium / albuterol) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Sudden narrowing of your airways: difficulty breathing, wheezing, cough, chest pain or tightness
- Heart problems: dizziness, fatigue, weakness, tremor, irregular heartbeat, worsening symptoms of heart problem that you already have
- Serious allergic reaction: hives; swelling of your face, lips, or tongue; difficulty breathing
The following Combivent Respimat (ipratropium / albuterol) side effects have also been reported
Along with its needed effects, a medicine 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:
More common
Body aches or pain
chills
cough producing mucus
difficulty with breathing
ear congestion
headache
loss of voice
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
congestion
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
nervousness
noisy breathing
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
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 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
difficulty with moving
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
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
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Combivent Respimat (ipratropium / albuterol)
Pros
- Combines two different bronchodilators within a single inhaler for convenience
- Can start to work in about 15 minutes to help with breathing for some people
- Doesn't require shaking before use
- Don't need to rinse your mouth after use
Cons
- Not a rescue inhaler
- Might need to use up to 6 times per day, depending on the severity of your COPD symptoms
- Might not be a good option for people with heart problems
- No lower-cost generic; only available as a brand-name medication
Pharmacist tips for Combivent Respimat (ipratropium / albuterol)
- Use Combivent Respimat (ipratropium / albuterol) regularly 4 times daily. If needed, your prescriber might recommend for you to use the medication up to 6 times per day. You don't need to shake the inhaler before you use it.
- Call your prescriber if your breathing gets worse or if it doesn't improve after you use Combivent Respimat (ipratropium / albuterol). Also contact them if you're using Combivent Respimat (ipratropium / albuterol) more often than usual. These could be signs that you need a change in your treatment plan for your COPD.
- Don't start any new medications while you're taking Combivent Respimat (ipratropium / albuterol) without asking your prescriber or pharmacist first. Combivent Respimat (ipratropium / albuterol) can interact with other medications. Some interactions can make your medications work less well or put you at risk for side effects. Examples include anticholinergics, beta blockers, and tricyclic antidepressants. Your care team can make sure it's safe to take them together.
How to use Combivent Respimat (ipratropium / albuterol)
- Carefully read the instructions on how to set up and use the Combivent Respimat (ipratropium / albuterol) inhaler to make sure you get the complete dose. Ask your prescriber or pharmacist if you have any questions about using the inhaler.
- To use the inhaler, remember TOP: Turn the base in the direction of the arrows on the inhaler until you hear a click (half a turn). Open the cap. Then, breathe out slowly and fully before you place your lips around the mouthpiece; don't cover the air vents. Press the dose-release button while you take a slow, deep breath through your mouth. Hold your breath for 10 seconds, or as long as you comfortably can.
- You'll need to "prime" each new Combivent Respimat (ipratropium / albuterol) inhaler before you use it. Prime the inhaler by completing the TOP steps to release 4 visible streams of mist from the inhaler and towards the ground.
- If you haven't used your Combivent Respimat (ipratropium / albuterol) for more than 3 days, prime the inhaler by releasing 1 visible stream of mist towards the ground before you use it. And if you haven't used your inhaler for more than 3 weeks, prime the inhaler as if it were new.
- After you've inserted a new cartridge into a Combivent Respimat (ipratropium / albuterol) inhaler, throw the entire inhaler away after 3 months, even if it still contains unused medication. Always place a new cartridge into a new inhaler device.
- Be sure to clean the mouthpiece (including the metal part inside) with a damp cloth or tissue at least once a week. It's okay if the mouthpiece gets a little discolored.
Common questions about Combivent
No, Combivent isn't a rescue inhaler. One of the ingredients in Combivent Respimat is albuterol, which on its own is available as a rescue inhaler that helps treat sudden shortness of breath within a few minutes. But studies show that Combivent starts to work to help with breathing in about 15 minutes after an inhalation for some people. This might take longer than how fast a rescue inhaler can work. Be sure to use Combivent regularly every day to help with your breathing rather than as a rescue inhaler.
Ask your primary care provider or pulmonologist about taking albuterol (Ventolin) and Combivent together. Combivent Respimat already contains albuterol, and taking too much albuterol raises your risk for side effects like fast heart rate.
Combivent is typically taken regularly 4 times per day. If needed, your prescriber might allow you to take 2 additional puffs each day. But Combivent isn't typically used as needed for shortness of breath or wheezing, like how albuterol (Ventolin) is. This is because Combivent isn't a rescue inhaler.
No, Combivent isn't a steroid and it doesn't lessen inflammation in the lungs to help you breathe better. Instead, the medication contains a short-acting muscarinic antagonist (SAMA) called ipratropium and a short-acting beta-agonist (SABA) called albuterol. Both ipratropium and albuterol are bronchodilators that help open up your airways. Your primary care provider or pulmonologist might prescribe an inhaled steroid for you to use in addition to Combivent if you're still having breathing problems.
Each Combivent inhaler contains 120 puffs. Sample inhalers contain 60 puffs. There's a dose indicator on the inhaler that shows how much medication is left inside. When the dose indicator gets to the red area, this means that there are 7 days of medication left in a regular Combivent inhaler and 3 days of medication left in a sample inhaler. At this point, be sure to contact your pharmacy for a refill if you don't have any new inhalers left. When the inhaler completely runs out of the medication, it'll lock.
Combivent is FDA approved for COPD only. But there have been studies showing that as-needed use of Combivent might be a safe option that works well for people with asthma. Keep in mind that this would be an off-label use of Combivent. Speak with your primary care provider or pulmonologist about your treatment options if you have asthma.
No, don't use Combivent with a spacer. Spacers are only used for a certain types of inhalers called pressurized metered-dose inhalers (pMDIs) or HFA (hydrofluoroalkane) inhalers, like albuterol (Ventolin). Metered-dose inhalers release the medication quickly, and you have to breathe in quickly to get as much medication as possible. This technique can be difficult for some people. So spacers are used to make it easier to inhale the medication. But Combivent isn't a metered-dose inhaler. Instead, it's a soft-mist inhaler that releases the medication slowly, making it easier to breathe in.
No. You don't need to rinse your mouth after you use Combivent. This is because it doesn't contain a steroid, which typically raises your risk for oral thrush (a yeast infection in the mouth or throat).
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Risks and warnings for Combivent Respimat (ipratropium / albuterol)
Combivent Respimat (ipratropium / albuterol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Narrowing of the airways (bronchospasm)
Although extremely rare, Combivent Respimat (ipratropium / albuterol) can sometimes cause a muscle spasm in your lungs (bronchospasm). This can lead to difficulty breathing, wheezing, cough, and chest discomfort. Get medical attention right away if you suddenly become short of breath after you use Combivent Respimat (ipratropium / albuterol).
Effects on the heart and blood pressure
- Risk factors: High blood pressure | Heart failure | Heart rate or rhythm problems | Using more Combivent Respimat (ipratropium / albuterol) than recommended
Although rare, it's possible for Combivent Respimat (ipratropium / albuterol) to cause changes in your blood pressure, heart rate, and sometimes heart rhythm. If you have high blood pressure or other heart problems, Combivent Respimat (ipratropium / albuterol) can make your medical condition worse, especially if you take the medication more often than instructed. Watch out for worsening signs and symptoms of your heart condition. Tell your prescriber if you develop dizziness, fatigue, tremor, rapid heartbeat, or weakness while you're using Combivent Respimat (ipratropium / albuterol).
Eye problems
- Risk factors: History of glaucoma | Accidentally getting Combivent Respimat (ipratropium / albuterol) into the eye | Using the nebulizer machine incorrectly
Though not common, using Combivent Respimat (ipratropium / albuterol) can raise the pressure in the eyes. Sometimes, this can cause or worsen glaucoma. Let your optometrist or ophthalmologist know that you're taking Combivent Respimat (ipratropium / albuterol) if you have glaucoma or other eye problems. Also speak with them if you notice any changes to your vision while you're using the medication. Don't spray Combivent Respimat (ipratropium / albuterol) in your eyes because this could cause eye pain, discomfort, blurry vision, and other vision changes.
Trouble urinating
- Risk factors: Enlarged prostate | Bladder-neck obstruction (blockage)
Use Combivent Respimat (ipratropium / albuterol) with caution in people who have urinary or prostate problems. This medication can cause difficulty urinating, which can worsen urinary problems. Contact your prescriber if you notice difficulty urinating while you're taking this medication.
Severe allergic reaction
Severe allergic reactions to Combivent Respimat (ipratropium / albuterol) are possible, including life-threatening reactions like facial swelling, shock, and anaphylaxis (closing of the throat). Get medical help right away if you notice hives; rash; swelling of the face, lips, or tongue; or difficulty breathing after you use Combivent Respimat (ipratropium / albuterol).
Low potassium in the blood
- Risk factors: Taking too much Combivent Respimat (ipratropium / albuterol)
Combivent Respimat (ipratropium / albuterol) can sometimes cause the potassium levels in your blood to drop too low. This is more likely to happen if you take too much Combivent Respimat (ipratropium / albuterol). Symptoms of low potassium include tiredness, weakness, muscle cramps, and a racing heart. Don't take more Combivent Respimat (ipratropium / albuterol) than prescribed. Seek medical help right away if Combivent Respimat (ipratropium / albuterol) isn't helping your breathing get better.
Combivent Respimat (ipratropium / albuterol) dosage
Respimat inhaler| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 120 doses of 20mcg/100mcg | 1 respimat inhaler | $488.67 | $488.67 |
Typical dosage for Combivent Respimat (ipratropium / albuterol)
Each inhalation delivers 20 mcg of ipratropium and 120 mcg of albuterol sulfate.
The usual dose is 1 inhalation (puff) through the mouth 4 times per day. Your prescriber might instruct you to take more puffs if needed. The maximum dose is 6 puffs within a 24-hour period.
More on Combivent Respimat (ipratropium / albuterol) dosage
Interactions between Combivent Respimat (ipratropium / albuterol) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acebutolol
- Amineptine
- Amitriptyline
- Amitriptylinoxide
- Amoxapine
- Arotinolol
- Atenolol
- Atomoxetine
- Befunolol
- Betaxolol
- Bevantolol
- Bisoprolol
- Bopindolol
- Bucindolol
- Bupranolol
- Carteolol
- Carvedilol
- Celiprolol
- Clomipramine
- Clozapine
- Desipramine
- Dibenzepin
- Dilevalol
- Doxepin
- Esmolol
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Imipramine
- Iobenguane I 123
- Labetalol
- Landiolol
- Levalbuterol
- Levobunolol
- Lofepramine
- Melitracen
- Mepindolol
- Methacholine
- Metipranolol
- Metoprolol
- Nadolol
- Nebivolol
- Nortriptyline
- Opipramol
- Oxprenolol
- Penbutolol
- Pindolol
- Practolol
- Propranolol
- Protriptyline
- Quetiapine
- Revefenacin
- Scopolamine
- Secretin Human
- Sotalol
- Talinolol
- Tertatolol
- Tianeptine
- Timolol
- Tiotropium
- Trimipramine
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Betel Nut
- Digoxin
How much does Combivent Respimat (ipratropium / albuterol) cost?
$488.67
Combivent Respimat (ipratropium / albuterol) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Combivent Respimat (ipratropium / albuterol) will not be safe for you to take.
- Allergy to atropine or other similar medications (e.g., anticholinergic)
- Allergy to ipratropium or albuterol
What are alternatives to Combivent Respimat (ipratropium / albuterol)?
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