Albuterol and ipratropium are bronchodilators that relax muscles in the airways and increase air flow to the lungs.

Albuterol and ipratropium inhalation is used to prevent bronchospasm in people with chronic obstructive pulmonary disease (COPD) who are also using other medicines to control their condition.

Albuterol and ipratropium inhalation may also be used for purposes not listed in this medication guide.

Seek medical attention if your breathing problems get worse quickly, or if you think your medications are not working as well. Overuse of albuterol and ipratropium may increase the risk of death. It is critical that you use only the prescribed dose of this medicine.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Albuterol and ipratropium inhalation is usually used 4 times per day. Follow your doctor's dosing instructions very carefully. Do not use more than 6 inhalations in a 24-hour period.

Overuse of this medicine may increase the risk of death. It is critical that you use only the prescribed dose of this medicine.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

Always use the new inhaler device provided with your refill.

To use the inhaler:

• You do not need to shake the inhaler before use.

• Uncap the mouthpiece of the inhaler. Breathe out fully. Put the mouthpiece into your mouth and close your lips. Keep your eyes closed to prevent spraying any medicine into your eyes. Breathe in slowly while pressing the dose-release button on the inhaler. Hold your breath for 10 seconds, then breathe out slowly.

• Close the cap until you use your inhaler again.

• Carefully follow all directions for cleaning your specific inhaler device once per week.

Keep track of the number of sprays you have used. Throw away the Combivent Respimat inhaler canister after 3 months or 120 sprays, whichever comes first.

To use the solution with a nebulizer:

• Open the foil pouch and remove one vial. Empty the medicine into the chamber of the nebulizer. Attach the mouthpiece or face mask, then attach the drug chamber to the compressor.

• Sit upright in a comfortable position. Place the mouthpiece into your mouth or put on the face mask, covering your nose and mouth. Turn on the compressor.

• Breathe in slowly and evenly until no more mist is formed by the nebulizer and the drug chamber is empty.

• Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

Seek medical attention if your breathing problems get worse quickly, or if you think your medications are not working as well.

To make sure this medicine is not causing harmful effects on your lungs, you may need to have chest X rays or other frequent lung function tests.

Store at room temperature away from moisture, heat, and light. Do not freeze. Keep each vial in its foil pouch until you are ready to use it.

Keep the cover on your inhaler when not in use. Keep away from open flame or high heat. The canister may explode if it gets too hot. Do not puncture or burn an empty inhaler canister.

Usual Adult Dose for Chronic Obstructive Pulmonary Disease -- Maintenance:

Inhalation Aerosol:
1 inhalation (albuterol-ipratropium bromide 100 mcg-20 mcg) orally four times a day. Additional inhalations can be taken as required.
Maximum dose: 6 inhalations in 24 hours

Inhalation solution:
One 3 mL vial (albuterol-ipratropium bromide 2.5 mg-0.5 mg) four times a day via nebulization
Maximum dose: Up to 2 additional 3 mL doses per day, if needed

Comments:
-The inhalation solution can be continued as medically indicated to control recurring bouts of bronchospasm.
-If a previously effective regimen fails to provide the usual relief, medical advice should be sought immediately, as this is often a sign of worsening COPD and may require reassessment of therapy.

Use: In patients with chronic obstructive pulmonary disease (COPD) on a regular aerosol bronchodilator who continue to have evidence of bronchospasm and who require a second bronchodilator

You should not use albuterol and ipratropium if you are allergic to albuterol, ipratropium, or atropine.

Tell your doctor if you have ever had:

• heart disease, high blood pressure, coronary artery disease, or heart rhythm disorder;

• a seizure disorder such as epilepsy;

• diabetes;

• overactive thyroid;

• glaucoma;

• liver or kidney disease; or

• enlarged prostate, problems with urination.

Tell your doctor if you are pregnant or breastfeeding.

This medicine is not approved for use by anyone younger than 18 years old.

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

Get your prescription refilled before you run out of medicine completely.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of albuterol and ipratropium can be fatal. Overdose symptoms may include chest pain, fast or pounding heartbeats, tremors, dry mouth, extreme thirst, muscle weakness or limp feeling, severe headache, pounding in your neck or ears, or feeling like you might pass out.

If this medication gets in your eyes, rinse with water and seek medical attention.

Avoid driving or hazardous activity until you know how albuterol and ipratropium will affect you. Your vision or reactions could be impaired.

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Albuterol and ipratropium may cause serious side effects. Call your doctor at once if you have:

• wheezing, choking, or other breathing problems after using albuterol and ipratropium;

• chest pain;

• fast or pounding heartbeats, fluttering in your chest;

• tremors, nervousness;

• swelling of your ankles or feet;

• blurred vision, tunnel vision, eye pain, or seeing halos around lights;

• painful or difficult urination; or

• low potassium--leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling.

Common side effects of albuterol and ipratropium may include:

• headache;

• trouble breathing; or

• cold symptoms such as stuffy nose, sneezing, cough, or sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Tell your doctor about all your other medicines, especially:

• a diuretic or "water pill";

• heart or blood pressure medicine;

• other beta-blockers; or

• an antidepressant.

This list is not complete. Other drugs may affect albuterol and ipratropium, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.