Salbutamol with ipratropium bromide nebulised
- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Solution for nebulisation containing salbutamol with ipratropium
Chronic obstructive pulmonary disease
One unit dose three or four times a day.
Children over 12 years
One unit dose three or four times a day.
Children under 12 years
Hypertrophic obstructive cardiomyopathy
Precautions and Warnings
Benign prostatic hyperplasia
Bladder outflow obstruction
Narrow angle glaucoma
Recent myocardial infarction
Severe cardiac disorder
Severe vascular disorder
Adjustment of hypoglycaemic therapy may be necessary in diabetes mellitus
May decrease glucose tolerance in patients with diabetes mellitus
Advise ability to drive/operate machinery may be affected by side effects
Do not allow solution or mist to enter eyes
Risk of glaucoma if preparation enters eye
Monitor for development of lactic acidosis
Monitor serum K+ in patients on high dose steroids/xanthines/diuretics
Monitor serum potassium in hypoxic patients
Advise patient to report any chest pain
May reduce serum potassium levels
Discontinue if paradoxical bronchospasm occurs
Start treatment at lowest recommended dose
Advise patient on need for adequate dental hygiene & regular dental checks
Advise patient to consult physician if condition worsens / does not improve
Pregnancy and Lactation
Use salbutamol with ipratropium bromide with caution during pregnancy.
The manufacturer does not recommend the use of salbutamol with ipratropium during pregnancy, especially the first trimester, unless the expected benefit is thought to outweigh any possible risk to the foetus.
Available reports indicate no increased risk of teratogenic or developmental effects.
Inhaled salbutamol is considered a drug of choice for pregnant women (Schaefer 2015).
Salbutamol has not been shown to cause structural abnormalilities but prolonged use of salbutamol during pregnancy has been associated with neurobehavioural toxicity (Briggs, 2015).
Adverse effects seen in both mother and foetus are largely secondary to the drugs cardiovascular and metabolic profile, including tachycardia, hypotension which may lead to foetal distress, cardiac failure, pulmonary oedema and death; hyperglycaemia followed by an increase in serum insulin which is more pronounced in diabetic patients. Other effects reported are: increased growth hormone levels, retinopathy of prematurity and a decreased incidence of neonatal respiratory distress syndrome.
Use salbutamol with ipratropium bromide with caution during breastfeeding.
The manufacturer notes that this medication should not be administered to breastfeeding mothers unless the expected benefit is thought to outweigh any possible risk to the neonate.
The presence of ipratropium in human breast milk is unknown.
Inhaled salbutamol is likely to be present in human breast milk.
Angioedema of tongue, lips and face
Blood pressure changes
Blurred vision (transient)
Disturbances in accommodation
Gastro-intestinal motility disturbances
Glaucoma (closed angle)
Hyperactivity in children
Increase in dental caries
Increased intra-ocular pressure
Loss of mental acuity
Effects on Laboratory Tests
Use of salbutamol with ipratropium bromide may cause a positive doping test.
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: July 2016
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Combiprasal 0.5mg / 2.5mg nebuliser solution. TriOn Pharma Ltd. Revised December 2019.
Summary of Product Characteristics: Combivent UDVs. Boehringer Ingelheim Limited. Revised September 2015.
Summary of Product Characteristics: Ipramol Steri-Neb 0.5 mg / 2.5 mg pre 2.5ml Nebuliser Soluiton. Ivax Pharmaceuticals UK. Revised April 2010.
Summary of Product Characteristics: Salipraneb 0.5mg/2.5mg per 2.5ml Nebuliser Solution. Actavis UK Ltd. Revised March 2016.
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