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Combivent Inhaler and/or Equivalent Ipratropium / Albuterol Prescription Information

The Combivent inhaler is classified as a Bronchodilator Drug. It contains the active ingredients Albuterol Sulfate (also known as Salbutamol) and ipratropium bromide, and delivers its contents via a metered dose inhaler (MDI). Albuterol and Ipratropium both act on Bronchospasm and produce bronchial muscle relaxation and increased air flow in the lungs. Combivent is a prescription medication approved for usage for Chronic Obstructive Pulmonary Disease (COPD) in patients who have failed on other medications. It is manufactured by Boehringer Ingelheim Pharmaceuticals. Individuals with chronic obstructive pulmonary disease, or COPD, may rely on a Combivent inhaler to improve their breathing. It is available as a metered-dose inhaler that most people use up to four times per day. Combivent is a combination of two ingredients that help to prevent the occurrence of bronchospams and improve the flow of air to the lungs. Albuterol, a beta-adrenergic receptor agonist, and the anticholinergic medication ipratropium treat the symptoms associated with COPD by promoting the opening of the airways through relaxing the muscles in the lungs. When used as directed, this inhaler can reduce wheezing coughing, chest tightness and problems breathing.

Indication/Usage:

Combivent is used to treat Chronic Obstructive Pulmonary Disease (COPD) patients who have a long history of bronchospasm. Also effective in the treatment of other lung problems such as chronic bronchitis and emphysema, Combivent can also be used in the prevention or treatment of symptoms like wheezing and shortness of breath.

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Dose, Administration and Dosage forms

Combivent is available in an aerosol formulation which delivers its active ingredients via metered dose inhalation. The starting dose of Combivent aerosol is two inhalations four times per day. Patients may administer a higher number of inhalations per day, but should not exceed 12 inhalations daily as safety and efficacy profiles at doses over 12 inhalations daily have not been studied. Guidelines for the appropriate administration of Combivent inhalers are as follows:

• Combivent should be test-sprayed by spraying product into the air about three times prior to first use.
• For optimum dosage, shake the container for about 10 seconds before each spray.
• Patients should inhale the spray into the lungs, rather than swallowing it into the stomach.
• For proper administration, patients should be given appropriate training on how to inhale the spray. The best practice is to hold the breath for about 10 seconds between sprays so that the maximum drug can be absorbed into the lungs.
• Patients should allow two minutes between each spray.

Mechanism of action:

Combivent aerosol has a dual mechanism of action due to its formulation of two bronchodilators. Ipratropium bromide is an anti-cholinergic bronchodilator, while albuterol sulfate is a beta-2 adrenergic bronchodilator.

Ipratropium bromide: Ipratropium bromide antagonizes acetylcholine by inhibiting vagally mediated reflexes in the lungs. It inhibits acetylcholine from binding to muscarinic receptors of bronchial smooth muscles resulting in suppressed intracellular Ca++ levels. This suppressed intracellular concentration of Ca++ in the lung muscles results in the relaxation of bronchial smooth muscle.

Albuterol sulfate:Albuterol sulfate relaxes bronchial smooth muscle by activating beta-2 adrenergic receptors present in the lungs, which increases the intracellular concentration of cyclic AMP. This increased cyclic AMP level activates protein kinase A and blocks phosphorylation of myosin, thus suppressing intracellular Ca++ concentrations. The decrease of intracellular Ca++ concentration leads to bronchial smooth muscle relaxation from the trachea to the terminal bronchioles.

In additional benefit of Albuterol is that as it increases cyclic AMP levels, it blocks the release of mast cell mediators which cause bronchoconstriction.

Side-effects and Safety profile

Various non-serious side-effects which may be caused by Combivent include headache, nervousness, dizziness, weakness, sleep issues, nausea, dry mouth, dryness in throat, coughing, or runny nose. These side effects can be easily treated. Serious side-effects which may occur with the use of Combivent include rapid heartbeat, muscle cramping, urination problems, ocular pain, and visual alteration. Rare but life-threatening side-effects like chest pain, arrhythmia, asthma, and sudden worsening of breathing may occur while taking Combivent. Patients experiencing any of these conditions should seek immediate medical care.

Warnings/Contraindications:

• Combivent aerosol is contraindicated in those patients who have a history of allergic reactions to soya or drugs containing atropine or its derivatives.
• Combivent aerosol can cause a life-threatening condition called paradoxical bronchospasm.
• Since Combivent can cause significant cardiovascular events like myocardial ischemia and QTc interval prolongation, prescription to cardiac patients should be given only after a careful weighing of the risk-to-benefit ratio.
• Excessive inhalation of Combivent could cause death, especially in asthmatic patients.
• Any allergic reactions to Combivent must be immediately reported to a specialist.
• Patients with glaucoma, benign prostatic hyperplasia (BPH) and bladder-neck obstruction should be closely monitored while taking Combivent.

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