WHAT IS THIS MEDICINE?
Combivent Unit Dose Vials contain a combination of
ipratropium bromide (an anticholinergic bronchodilator) and salbutamol (a
beta-2 agonist bronchodilator). Together, these two complementary mechanisms
open the airways more effectively than either drug alone, making it
particularly useful for acute COPD and asthma exacerbations.
2. HOW TO TAKE THIS MEDICINE
Pour the contents of one vial into the nebuliser chamber.
Inhale the mist through a mouthpiece or face mask over approximately 5–15
minutes. Use a compressor-driven nebuliser as directed.
Asthma, acute moderate to severe exacerbations (management in
primary or acute care settings) (off-label use):
Soft-mist inhaler (ipratropium bromide 20 mcg/albuterol 100
mcg per actuation):
Oral inhalation: 4 to 8 inhalations every 20 minutes for 3
doses, then as needed.
Nebulization solution (ipratropium bromide 0.5 mg/albuterol
2.5 mg per 3 mL vial):
Oral inhalation: 1 vial (3 mL) every 20 minutes for 3 doses,
then as needed
In acute exacerbations, may be used more frequently under
medical supervision. Do not inject or swallow.
COPD acute exacerbation: Nebulization solution - oral
inhalation 1 vial every 1-2 hours (up to 3 doses), then every 2-4 hours as
needed.
3. POSSIBLE SIDE EFFECTS
Common side effects include the following. Contact your
doctor or pharmacist if any side effect worries you.
|
Side Effect |
Frequency |
What To Do |
|
Dry mouth |
Very common |
Sip water frequently; rinse mouth after use |
|
Tremor (hands) |
Common |
Usually mild; subsides with regular use |
|
Tachycardia |
Common |
Report a persistent rapid heartbeat |
|
Headache |
Common |
Usually mild; paracetamol if needed |
|
Throat irritation |
Common |
Use a mouthpiece rather than face mask where
possible |
|
Paradoxical bronchospasm |
Rare |
Stop and use rescue inhaler; seek medical help |
|
Urinary retention |
Uncommon |
Particularly in elderly men with BPH; report
difficulty urinating |
|
⚠ IMPORTANT WARNING |
|
Keep the nebulised mist away from your eyes —
ipratropium can cause pupil dilation and worsen narrow-angle glaucoma. If you
wear contact lenses or have eye problems, use a mouthpiece rather than a face
mask. |
4. WHO SHOULD NOT TAKE THIS MEDICINE
Contraindicated in hypersensitivity to ipratropium,
salbutamol, atropine, or peanut/soya products (formulation note). Use with
caution in cardiovascular disease (ischaemic heart disease, arrhythmias,
hypertension), hyperthyroidism, diabetes, and prostatic hypertrophy.
5. DRUG INTERACTIONS
Other beta-2 agonists and theophylline increase the risk of
hypokalaemia and cardiac side effects. Anticholinergics (e.g. tiotropium,
tricyclic antidepressants) increase the risk of urinary retention, dry mouth,
and constipation. Non-selective beta-blockers reduce salbutamol effectiveness.
6. HOW TO STORE
Store below 25°C in the original foil sachet. Protect from light.
Once the sachet is opened, use within the manufacturer's specified timeframe.
Do not refrigerate or freeze the vials. Single-use vials — discard after one
use.
7. PRESCRIPTION STATUS
Prescription Only Medicine (POM). For acute COPD management,
initiation should be by or under the supervision of a respiratory physician.
|
💚 PATIENT TIP |
|
After each nebulisation, rinse your mouth with
water and spit it out. This reduces the risk of oral thrush (from inhaled
corticosteroids if used concurrently) and relieves dry mouth caused by
ipratropium. |
8. PHARMACIST'S NOTE
Ensure patients have a functioning, clean compressor
nebuliser. Combivent vials contain a preservative — if the patient has known
preservative sensitivity, a preservative-free formulation should be considered.
Counsel on inhaler/nebuliser technique and the importance of rinsing the
nebuliser after each use.
9. FREQUENTLY ASKED QUESTIONS
|
FREQUENTLY ASKED QUESTIONS |
|
Q: Why are two drugs
combined in one vial? A: Ipratropium and salbutamol work via
different mechanisms. Together they open airways more effectively than either
alone, reducing the need for higher doses of a single drug and lowering side
effects. |
|
Q: How do I clean my
nebuliser? A: After each use, rinse the nebuliser cup with
sterile water. Once daily, wash it with warm soapy water, rinse thoroughly,
and allow to air dry. A clean nebuliser prevents bacterial contamination. |
|
Q: Why can't I use it if
I have glaucoma? A: Ipratropium can raise eye pressure if it
enters the eyes. Patients with narrow-angle glaucoma are at particular risk.
Always use a mouthpiece and keep mist away from eyes. |
|
Q: Is Combivent safe for
elderly patients? A: Yes, but with caution. Elderly men with
prostate problems may experience urinary retention, and elderly patients with
heart conditions should be monitored for heart rate changes. |
|
Q: What if one vial is
not enough to control my breathing? A: Do not use extra vials without consulting
your doctor. If your breathing is not controlled, you may need additional
treatment or a hospital assessment. |