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.
Maintenance treatment for chronic obstructive pulmonary disease (COPD) in adults who need more than one bronchodilator
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.
Source:Â DailyMed
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.
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
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
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.
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.
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).
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).
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.
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 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).
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.
| Dosage | Quantity | Price as low as | Price per unit | 
|---|---|---|---|
| 120 doses of 20mcg/100mcg | 1 respimat inhaler | $496.12 | $496.12 | 
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.
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.
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.
Allergy to atropine or other similar medications (e.g., anticholinergic)
Allergy to ipratropium or albuterol
Maintenance treatment for chronic obstructive pulmonary disease (COPD) in adults who need more than one bronchodilator
Maintenance treatment of chronic obstructive pulmonary disease (COPD) in adults
Treatment of shortness of breath in people with chronic obstructive pulmonary disease (COPD) who need more than one bronchodilator
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Boehringer Ingelheim Pharmaceuticals, Inc. (2021). Combivent Respimat- ipratropium bromide and albuterol spray, metered [package insert]. DailyMed.
Boehringer Ingelheim Pharmaceuticals, Inc. (2021). Welcome to your Respimat quick start guide.
Donohue, J. F., et al. (2016). Efficacy and safety of ipratropium bromide/albuterol compared with albuterol in patients with moderate-to-severe asthma: A randomized controlled trial. BioMed Central Pulmonary Medicine.
Holt, T., et al. (2017). A patient’s guide to aerosol medication delivery. American Association for Respiratory Care.
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