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This product is used to treat and prevent symptoms (wheezing and shortness of breath) caused by ongoing lung disease (chronic obstructive pulmonary disease-COPD which includes bronchitis and emphysema). This product contains 2 medications: ipratropium and albuterol (also known as salbutamol). Both drugs work by relaxing the muscles around the airways so that they open up and you can breathe more easily. Controlling symptoms of breathing problems can decrease time lost from work or school.
Read the Patient Information Leaflet if available from your pharmacist before you start using this product and each time you get a refill. This medication is used with a special machine called a nebulizer that changes the solution to a fine mist that you inhale. Learn how to prepare the solution and use the nebulizer properly. If a child is using this medication, a parent or other responsible adult should supervise the child. If you have any questions, ask your doctor, pharmacist, or respiratory therapist.
This product should be clear and colorless. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid.
Inhale this medication into your lungs using the nebulizer as directed by your doctor, usually 4 times a day. Avoid getting this medication into your eyes. It may cause eye pain/irritation, temporary blurred vision, and other vision changes. Therefore, it is recommended that you use a mouthpiece rather than a face mask with the nebulizer or that you close your eyes during use. Each treatment usually takes about 5 to 15 minutes. Use this medication only through a nebulizer. Do not swallow or inject the solution. To prevent infections, clean the nebulizer and mouthpiece/face mask according to the manufacturer's directions.
The US brand does not require any mixing before use. The Canadian brand can be used unmixed or if directed, may be mixed with sterile saline just before use. Once a vial is opened, throw away any unused solution.
The dosage is based on your medical condition and response to treatment. Do not increase your dose or use this drug more often than prescribed without your doctor's approval. Using too much of this medication will increase your risk of serious (possibly fatal) side effects.
Rinse your mouth after treatment to prevent dry mouth and throat irritation.
Use this medication regularly to get the most benefit from it. This medication works best if used at evenly spaced intervals. To help you remember, use it at the same times each day.
Learn which of your inhalers/medications you should use every day and which you should use if your breathing suddenly worsens (quick-relief drugs). Ask your doctor ahead of time what you should do if you have new or worsening cough or shortness of breath, wheezing, increased sputum, waking up at night with trouble breathing, if you use your quick-relief inhaler more often, or if your quick-relief inhaler does not seem to be working well. Learn when you can treat sudden breathing problems by yourself and when you must get medical help right away.
Tell your doctor if your symptoms do not improve or if they worsen.
See also How to Use section.
Headache, dizziness, nausea, dry mouth, shaking (tremors), nervousness, or constipation may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.
Infrequently, this medication may cause severe sudden worsening of breathing problems right after use. If you have sudden worsening of breathing, get medical help right away.
Tell your doctor right away if you have any serious side effects, including: difficult/painful urination, muscle cramps.
Get medical help right away if you have any serious side effects, including: chest pain, fast/pounding/irregular heartbeat, rapid breathing, confusion, eye pain/swelling/redness, vision changes (such as seeing rainbows around lights at night, blurred vision).
A very serious allergic reaction to this product is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
Before using this product, tell your doctor or pharmacist if you are allergic to ipratropium or albuterol (salbutamol); or to tiotropium; or to atropine or other belladonna-type drugs; or to levalbuterol; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: high blood pressure, heart disease (such as chest pain, heart attack, irregular heartbeat), personal or family history of glaucoma (angle-closure type), difficulty urinating (for example, due to enlarged prostate), seizure, overactive thyroid (hyperthyroidism), diabetes.
This drug may make you dizzy or blur your vision or cause vision changes. Alcohol or marijuana can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
Older adults may be more sensitive to the side effects of this drug, especially problems urinating or constipation.
During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.
It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.
Store the US product between 36-77 degrees F (2-25 degrees C). Store the Canadian product at room temperature. The vials should be stored away from light in the foil pouch or carton until ready for use. Do not store in the bathroom. Keep all medications away from children and pets.
Albuterol is very similar to levalbuterol. Do not use medications containing levalbuterol while using albuterol.
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: chest pain, fast/irregular heartbeat, seizures.
If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
Do not share this medication with others.
Laboratory and/or medical tests (such as lung function tests, blood pressure) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.