DuoNeb is a sterile inhalation solution containing a combination of albuterol and ipratropium. Albuterol and ipratropium are bronchodilators that relax muscles in the airways and increase air flow to the lungs.

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

DuoNeb may also be used for purposes not listed in this medication guide.

Seek medical attention if you think DuoNeb inhalation solution is not working as well as usual. Overuse of DuoNeb may increase the risk of death. It is critical that you use only the prescribed dose of this medicine.

Before you use DuoNeb, tell your doctor if you have heart disease, high blood pressure, coronary artery disease, a heart rhythm disorder, seizures, diabetes, overactive thyroid, glaucoma, an enlarged prostate, urination problems, liver disease, or kidney disease.

You should not use DuoNeb if you are allergic to albuterol (Proventil, Ventolin), ipratropium (Atrovent), or atropine (Atreza, Lomotil, Vi-Atro, Sal-Tropine).

Use DuoNeb exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

DuoNeb 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 DuoNeb 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.

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.

Usual Adult Dose for Chronic Obstructive Pulmonary Disease -- 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 DuoNeb if you are allergic to albuterol, ipratropium, or atropine.

To make sure DuoNeb is safe for you, 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 DuoNeb 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 DuoNeb will affect you. Your vision or reactions could be impaired.

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

Call your doctor at once if you have:

• wheezing, choking, or other breathing problems after using this medicine;

• 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 DuoNeb side effects 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 interact with DuoNeb, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.