Ipratropium Bromide + Salbutamol

Indications

Ipratropium Bromide + Salbutamol is used for: Chronic obstructive pulmonary disease, Asthma

Adult Dose

Inhalation Chronic obstructive pulmonary disease Adult: Inhalation: 100 mcg/20 mcg (1 actuation of metered-dose inhaler) q6hr; not to exceed 6 actuations/day Nebulizer solution: Initially, 3 ml every 6 hr. Max: 3 ml every 4 hr. One ampoule as required for the relief of symptoms or as directed. Up to three to four ampoules daily.

Child Dose

Safety and efficacy not established

Renal Dose

Administration

Contra Indications

The combination of Salbutamol & Ipratropium Bromide is contraindicated in patients with hypertrophic obstructive cardiomyopathy and tachyarrhythmia and in patients with a history of hypersensitivity to atropine or its derivatives, or to any other component of the product.

Precautions

May cause paradoxical bronchospasm. Caution when used in patients who are sensitive to sympathomimetic agents. Caution when used in patients with CV disease as beta-agonists may increase BP, heart rate and risk of arrhythmias. Monitor blood glucose in diabetics. Monitor serum potassium levels especially in patients who are on concurrent treatment with xanthine derivatives, steroids or diuretics. Caution when used in patients with narrow angle glaucoma, hyperthyroidism, prostatic hyperplasia, bladder neck obstruction, seizure disorders, renal or hepatic impairment. Safety and efficacy have not been established in children <12 yr. Increased risk of GI motility disturbance in patients with cystic fibrosis. Pregnancy and lactation. Lactation: Unknown whether drug is excreted in breast milk

Pregnancy-Lactation

Pregnancy category: C Lactation: Unknown whether drug is excreted in breast milk

Interactions

May have additive anticholinergic effects when used with psychotropics; may decrease effect of propranolol. Increased CV effects (tachycardia, palpitations) when used with MAOIs, TCAs and amphetamines.

Adverse Effects

Side effects of Ipratropium Bromide + Salbutamol : >10% Bronchitis (2-12%) 1-10% Upper respiratory tract infection (1-10%), Lung disease (6%), Headache (3-6%), Dyspnea (2-5%), Nasopharyngitis (4%), Cough (3-4%), Pharyngitis (2-4%), Pain (1-3%), Chest pain (2.6%), Sinusitis (2.3%), Nausea (1-2%), Diarrhea (1.8%), Urinary tract infection (1.6%), Influenza (1.4%), Leg cramps (1.4%), Nausea (1.4%), Pneumonia (1.4%), Rhinitis (1.1%) <1% Allergic-type reactions, such as skin reactions (eg, rash, pruritus, urticaria [including giant urticaria]), angioedema (eg, of tongue, lips, face), laryngospasm, and anaphylaxis Angina, Arrhythmia, Arthralgia, Dizziness, Dry mouth, Dyspepsia, Dysphonia, Edema, Fatigue, Hypertension, Insomnia, Nervousness, Palpitation, Paresthesia, Tachycardia, Tremor, Vomiting Potentially Fatal: Anaphylactic reactions such as angioedema of tongue, lips or face and laryngospasm.

Mechanism of Action

Ipratropium bromide is an anticholinergic agent that inhibits vagally-mediated reflexes by antagonising the action of acetylcholine. It prevents the increases in intracellular concentration of cyclic guanosine monophosphate (cyclic GMP) which are brought about by interaction of acetylcholine with the muscarinic receptors on bronchial smooth muscle. Salbutamol is a direct-acting beta 2-adrenergic agent. It acts on the airway smooth muscle resulting in bronchodilation.