Salbutamol and ipratropium belong to the family of medications known as bronchodilators. Together, they are used to treat chronic obstructive pulmonary disease (COPD), a chronic lung disease that makes it difficult to breathe. These medications work in different ways to open the airways and make breathing easier.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended adult dose of ipratropium – salbutamol using the Respimat® inhalation device is 1 actuation, inhaled four times daily. Your doctor may recommend additional inhalations as needed. The maximum number of inhalations in a 24-hour period is 6.

To use the Respimat® inhaler, insert the Respimat® cartridge into the inhaler device. After the cartridge has been inserted into the inhaler, the device must be primed by loading a dose and pressing the dose release button with the inhaler pointed towards the ground, until a cloud of medication is released. Repeat 3 more times to ensure that the inhaler is ready for use. When the device is used regularly, the inhaler does not need to be re-primed. If more than 3 days have passed since last using the inhaler, it must be re-primed by actuating the inhaler once. If more than 21 days have passed since last using the inhaler, it should be primed as though it were new.

Your doctor or another health care professional, such as your pharmacist, should teach you how to use the Respimat® inhalation device. If you are unsure of how to use the device, contact your doctor or pharmacist.

After 3 months of use, safely discard the device and canister, even if there is still medication remaining in the canister.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to use this medication on a regular schedule as prescribed by your doctor. If you miss a dose of this medication, and no respiratory symptoms occur, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you miss a dose and respiratory symptoms occur, then take the missing dose and continue with your regular dosing schedule. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Cartridge
Each actuation of aqueous solution contains 20 µg of ipratropium and 100 µg of salbutamol. Nonmedicinal ingredients: benzalkonium chloride, disodium edetate, hydrochloric acid, and purified water.

Inhalation device
The Respimat® inhalation device is a grey reusable plastic device with an orange cap that is specially designed for administering Combivent solution via oral inhalation.

Do not use ipratropium - salbutamol inhalation solution if you:

• are allergic to salbutamol, ipratropium, or any ingredients of this medication
• are allergic to atropine or related medications
• have certain types of abnormal heart rhythms (tachyarrhythmias)
• have certain types of heart disease (hypertrophic obstructive cardiomyopathy)

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• change in taste sensation or a bad taste in the mouth
• common cold (runny nose, nasal congestion, sore throat)
• constipation
• coughing
• diarrhea
• dizziness
• dry mouth
• headache
• nausea
• nervousness
• sweating
• throat irritation
• tremor
• voice changes
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• changes in blood pressure (e.g., dizziness, fainting, lightheadedness)
• difficult or painful urination
• feeling nervous
• muscle pain, weakness, or spasms
• severe dizziness
• symptoms of glaucoma (e.g., blurred vision, seeing halos of bright colours around lights, red eyes, increased pressure in your eyes, eye pain or discomfort)
• symptoms of a respiratory infection (e.g., shortness of breath, cough, chest pain)
• wheezing after inhalation

Stop taking the medication and seek immediate medical attention if any of the following occur:

• sudden blurred vision or eye pain
• fast or irregular heartbeat
• increased shortness of breath or wheezing
• signs of heart attack (e.g., sudden chest pain or pain radiating to back, down arm, jaw; sensation of fullness of the chest; nausea; vomiting; sweating; anxiety)
• chest pain
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• skin rash or hives

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Cystic fibrosis: People with cystic fibrosis may be more likely to have stomach discomfort (due to changes in how quickly food moves through the stomach and intestines) while using this medication.

Diabetes: Ipratropium – salbutamol inhalation solution may cause an increase in blood sugar levels (may cause a loss of blood glucose control) and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dizziness/blurred vision: Ipratropium - salbutamol may cause dizziness or blurred vision, affecting your ability to safely drive or operate machinery. Avoid these and other hazardous tasks until you know how this medication affects you.

Heart conditions: This medication can cause increased heart rate and blood pressure, making certain heart conditions worse. If you have heart disease, high blood pressure, irregular heart beat, heart failure, or have had a recent heart attack, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Inhalation-induced bronchospasm: Inhaled forms of medications may cause spasms of the airways, which make breathing difficult. If you experience this problem when using ipratropium - salbutamol, stop using this medication immediately. Speak to your doctor if you experience any problems with breathing while taking this or other inhaled medications.

Pheochromocytoma: If you have been diagnosed with pheochromocytoma (a tumour of the adrenal gland), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Potassium levels: Decreases in blood levels of potassium may occur with the use of this medication. This rarely causes problems, but potassium levels should be monitored by your doctor. If you experience unexplained muscle cramps, weakness, fatigue, or constipation, contact your doctor.

Thyroid disease: People who have an over-active thyroid gland may be more sensitive to the effects of ipratropium - salbutamol. If you have thyroid disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Urinary tract problems: Ipratropium – salbutamol inhalation solution can cause difficulty with starting urine flow. If you have an enlarged prostate or bladder retention, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Vision concerns: This medication may cause symptoms of glaucoma or cause existing glaucoma to become worse. Avoid spraying this medication into your eyes. If this happens, rinse your eyes with clear water immediately. Report any changes in your vision, including blurred vision, halos, and eye pain, to your doctor immediately.

Worsening symptoms: If this medication does not begin to help your symptoms quickly, or you find that you have increased difficulty breathing, or you need to use this medication more frequently, contact your doctor immediately.

Pregnancy: The safety of ipratropium – salbutamol inhalation solution use during pregnancy has not been determined. Although this medication should not be used during pregnancy unless the benefits outweigh the risks, sometimes the benefit to the mother does outweigh risks to the developing baby. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if ipratropium – salbutamol inhalation solution passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

There may be an interaction between ipratropium – salbutamol inhalation solution and any of the following:

• aclidinium
• amantadine
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• antihistamines (e.g., azelastine, bilastine, cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine, rupatadine)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• atomoxetine
• atropine
• belladonna
• benztropine
• beta-blockers (e.g., acebutolol, propranolol, labetalol, nadolol)
• fast-acting bronchodilators (e.g., salbutamol, terbutaline)
• long-acting bronchodilators (e.g., formoterol, salmeterol)
• buprenorphine
• butorphanol
• caffeine
• cannabis
• clidinium
• cyclobenzaprine
• darifenacin
• decongestant cold medications (e.g., phenylephrine, pseudoephedrine)
• decongestant eye drops and nose sprays (e.g., naphazoline, oxymetazoline, xylometazoline)
• dexmethylphenidate
• disopyramide
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• domperidone
• donepezil
• dronedarone
• epinephrine
• fesoterodine
• flavoxate
• galantamine
• glucagon
• glycopyrrolate
• ketotifen
• linezolid
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• meclizine
• methadone
• methylphenidate
• metoclopramide
• midodrine
• mirabegron
• modafinil
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, rasagiline, selegiline, tranylcypromine)
• nabilone
• narcotics (e.g., codeine, morphine, oxycodone, tapentadol, tramadol)
• orphenadrine
• oxybutynin
• ozanimod
• potassium chloride
• procainamide
• quinidine
• quinine
• rivastigmine
• scopolamine
• solifenacin
• solriamfetol
• sotalol
• theophyllines (e.g., aminophylline, theophylline)
• tiotropium
• tolterodine
• topiramate
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• trihexyphenidyl
• trospium
• umeclidinium

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.