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Sharing of ipratropium bromide and salbutamol sulphate does not contribute to systemic absorption of single additive component and therefore combivent activity metered aerosol is conditioned by combined local influence on lungs.
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Postmarketing reportsThroat irritationparadoxical bronchospasmnasal congestionpharyngeal edemaRef]
Albuterol has been shown in most clinical trials to have more bronchial smooth muscle relaxation effect than isoproterenol at comparable doses while producing fewer cardiovascular effectsHoweverall beta-adrenergic drugsincluding albuterol sulfatecan produce a significant cardiovascular effect in some patientssee PRECAUTIONS
Albuterol has been shown in most clinical trials to have more bronchial smooth muscle relaxation effect than isoproterenol at comparable doses while producing fewer cardiovascular effectsHoweverall beta-adrenergic drugsincluding albuterol sulfatecan produce a significant cardiovascular effect in some patientssee PRECAUTIONS
The effects of overdosage are expected to be related primarily to albuterol sulfateAcute overdosage with ipratropium bromide by inhalation is unlikely since ipratropium bromide is not well absorbed systemically after aerosol or oral administrationOral median lethal doses of ipratropium bromide were greater than 1001 mg/kg in miceapproximately 19,000 times the maximum recommended daily inhalation dose in adults on a mg/m 2 basis1663 mg/kg in ratsapproximately 62,000 times the maximum recommended daily inhalation dose in adults on a mg/m 2 basisand 400 mg/kg in dogsapproximately 50,000 times the maximum recommended daily inhalation dose in adultson a mg/m 2 basisWhereas the oral median lethal dose of albuterol sulfate in mice and rats was greater than 2000 mg/kgapproximately 6600 and 13,000 times the maximum recommended daily inhalation doserespectivelyin adults on a mg/m 2 basisthe inhalational median lethal dose could not be determinedManifestations of overdosage with albuterol may include anginal painhypertensionhypokalemiatachycardia with rates up to 200 beats per minutemetabolic acidosisand exaggeration of the pharmacologic effects listed in ADVERSE REACTIONSAs with all sympathomimetic aerosol medicationscardiac arrest and even death may be associated with abuseDialysis is not appropriate treatment for overdosage of albuterol as an inhalation aerosolthe judicious use of a cardiovascular beta-receptor blockersuch as metoprolol tartrate may be indicated.
1Insert metal canister into clear end of mouthpiecesee Figure 1Make sure the canister is fully and firmly inserted into the mouthpieceThe COMBIVENT Inhalation Aerosol canister is to be used only with the COMBIVENT Inhalation Aerosol mouthpieceThis mouthpiece should not be used with other inhaled medicines.
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avoid coadministration of combivent respimatand other sympathomimetic agents 7.