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albuterol/ipratropium (Combivent, DuoNeb)
albuterol sulfate & ipratropium bromide.
Indications:
- COPD patients on a regular aerosolized bronchodilator who continue to have bronchospasm & require a 2nd agent
Contraindications:
- allergy to peanuts [3]
- Combivent Respimat is NOT contraindicated in patients with soybean or peanut allergy [4]
pregnancy-category C
safety in lactation ?
Dosage:
- 2 puffs QID, plus PRN, not to exceed 12 puffs/24 hours
- Combivent Respimat: 1 puff QID [4]
Pharmacokinetics: elimination: liver
Adverse effects:
1) paradoxical bronchospasm
2) adverse effects of sympathomimetics
3) adverse effects of anticholinergic agents
a) avoid getting in eyes which may cause blurred vision
b) dry mouth
4) bad taste
5) coughing
6) hoarseness
Notes:
- chlorofluorocarbon-free Combivent Respimat (2012)
- cost (2012): $250 for 30 days of treatment
General
pharmacologic combination
References
- Boehringer Ingelheim Pharmaceuticals, Ridgefield CT
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998. - not on National VA formulary
- Prescriber's Letter 16(6): 2009
Drug Therapy Considerations for Patients with Peanut Allergy
Detail-Document#: 250608
(subscription needed) http://www.prescribersletter.com
- Prescriber's Letter 19(9): 2012
New Formulation: Combivent Respimat
Detail-Document#: 280909
(subscription needed) http://www.prescribersletter.com
- Veterans Administration, Pharmacy
Components
albuterol (Salbutamol, Ventolin, Proventil)
ipratropium (Atrovent)