Ipratropium/albuterol (By breathing)


Albuterol Sulfate (al-BUE-ter-ol SUL-fate), Ipratropium Bromide (ip-ra-TROE-pee-um BROE-mide)

Treats chronic obstructive pulmonary disease (COPD).

Brand Name(s)

Combivent, Combivent Respimat, Duoneb

When This Medicine Should Not Be Used

How to Use This Medicine


  • Take your medicine as directed. This medicine comes in more than one form. It can be given with an aerosol inhaler, a spray inhaler, or a nebulizer.
  • Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
  • Aerosol inhaler:
    • You will use this medicine with a device called a metered-dose inhaler. The inhaler fits on the medicine canister and turns the medicine into a fine spray that you breathe in through your mouth and to your lungs. You may be told to use a spacer, which is a tube that is placed between the inhaler and your mouth. Your caregiver will show you how to use your inhaler and the spacer (if needed).
    • Shake the inhaler well just before each use. Avoid spraying this medicine into your eyes.
    • Remove the cap and look at the mouthpiece to make sure it is clean.
    • Test spray in the air before using for the first time or if the inhaler has not been used for a while. Spray the medicine 3 times into the air and away from your face.
    • To inhale this medicine, breathe out fully, trying to get as much air out of the lungs as possible. Put the mouthpiece just in front of your mouth with the canister upright.
    • Open your mouth and breathe in slowly and deeply (like yawning), and at the same time firmly press down on the top of the canister once.
    • Hold your breath for about 5 to 10 seconds, and then breathe out slowly.
    • If you are supposed to use more than one puff, wait 1 to 2 minutes before inhaling the second puff. Repeat these steps for the next puff, starting with shaking the inhaler.
    • When you have finished all your inhalations, rinse your mouth out with water.
    • Clean the inhaler mouthpiece daily with warm water.
  • Spray inhaler:
    • You need to prime the spray inhaler to get it ready the first time you use it. You also need to prime it when you don't use the inhaler for more than 3 days in a row.
    • Prime the spray inhaler: Make sure the inhaler is pointed away from your face. Press the button a few times until some medicine is sprayed out. Then spray the medicine 3 more times, to make sure the correct amount of medicine comes out each time.
    • Follow the instructions that came with the medicine if it has been more than 3 days since you used the medicine.
    • Use the medicine: Breathe out, and try to get as much air out of your lungs as possible. Place your lips on the mouthpiece, but do not cover the air vents.
    • Slowly breathe in through your mouth, and press the button at the same time. Keep breathing in for as long as possible. Hold your breath for about 10 seconds.
    • Clean the mouthpiece with a damp cloth or a tissue. Do this at least once a week.
  • A nebulizer turns the medicine into a fine mist that you can breathe in through your mouth to your lungs. Your caregiver will show you how to use your nebulizer.

If a dose is missed:

  • Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.

How to Store and Dispose of This Medicine

  • Use all of the nebulizer liquid in the vial right away or throw it away. Keep the medicine in the foil pouch until you are ready to use it. Store at room temperature, away from heat and direct light. Do not freeze.
  • Store the canister at room temperature, away from heat and direct light. Do not freeze. Do not keep this medicine inside a car where it could be exposed to extreme heat or cold. Do not poke holes in the canister or throw it into a fire, even if the canister is empty.
  • Ask your pharmacist, doctor, or health caregiver about the best way to dispose of the used medicine container and any leftover medicine. You will also need to throw away old medicine after the expiration date has passed.
  • Keep all medicine out of the reach of children. Never share your medicine with anyone.

Drugs and Foods to Avoid

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

  • Make sure your doctor knows if you also use digoxin (Lanoxin®), blood pressure medicines (such as atenolol, metoprolol, propranolol, Tenormin®), or diuretics (water pills, such as furosemide, hydrochlorothiazide, torsemide, Lasix®). Tell your doctor if you have used medicine for depression (such as amitriptyline, doxepin, nortriptyline, Elavil®) or an MAO inhibitor (such as Eldepryl®, Marplan®, Nardil®, Parnate®) within the past 2 weeks.
  • This medicine should not be used together with similar inhaled medicines such as albuterol (Ventolin®), isoproterenol (Isuprel®), levalbuterol (Xopenex?), metaproterenol (Alupent®), pirbuterol (Maxair®), or terbutaline (Brethaire®).
  • Tell your doctor if you also use medicine to treat incontinence, or other medicine that can cause dry mouth or constipation (such as atropine, dicyclomine, glycopyrrolate, scopolamine, Bentyl®, Robinul®, Transderm Scop®).

Warnings While Using This Medicine

  • Make sure your doctor knows if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, diabetes, blood vessel problems, heart disease, heart rhythm problems, high blood pressure, low potassium, an overactive thyroid, narrow-angle glaucoma, an enlarged prostate, problems with urination, or seizures.
  • Stop using this medicine and check with your doctor right away if you have coughing, trouble breathing, shortness of breath, or wheezing after you use this medicine. This medicine may cause paradoxical bronchospasm, which may be life-threatening.
  • Tell your doctor right away if you feel chest pain, notice any changes in your blood pressure (such as feeling lightheaded), or notice your heart beating faster or slower.
  • If any of your COPD medicines do not seem to be working as well as usual, call your doctor right away. Take all of your COPD medicines as instructed. Do not use more medicine or change your dose without asking your doctor.
  • Do not spray the medicine near your eyes. If the medicine gets in your eyes, it can cause pain, enlarged pupils, red eyes, blurred vision, halos, or odd colors when you look at things. If the medicine does get in your eyes, rinse your eyes with cool water and call your doctor.
  • This medicine may make you dizzy or drowsy, or it might cause trouble seeing clearly. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert or not able to see well.
  • Call your doctor if your symptoms do not improve or if they get worse.

Possible Side Effects While Using This Medicine

Call your doctor right away if you notice any of these side effects:

  • Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
  • Chest pain, fast, pounding, or uneven heartbeat
  • Decrease in how much or how often you urinate
  • Dry mouth, increased thirst, muscle cramps, nausea, vomiting
  • Fever, chills, cough, sore throat, stuffy or runny nose, and body aches
  • Lightheadedness or fainting
  • Seizures
  • Trouble breathing

If you notice these less serious side effects, talk with your doctor:

  • Blurred vision
  • Headache
  • Nervousness, shaking

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Version Info

  • Last reviewed on 8/4/2014

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