Medically reviewed on October 1, The DuoNeb brand name has been discontinued in the U. If generic versions of this product have been approved by the FDA, there may be generic equivalents available. The active components in Ipratropium Bromide and Albuterol Sulfate Inhalation Solution are albuterol sulfate and ipratropium bromide. It has a molecular weight of It is a white crystalline powder, soluble in water and slightly soluble in ethanol.
The World Health Organization recommended name for albuterol base is salbutamol. Ipratropium bromide is albuterol indications and contraindications anticholinergic bronchodilator chemically described as 8-azoniabicyclo [3. It is a white crystalline substance, freely soluble in water and lower alcohols, and insoluble in lipophilic solvents such as ether, chloroform, and fluorocarbons.
Each 3 mL Sterile Unit-dose Vial contains 0. It does not require dilution prior to administration by nebulization. For Ipratropium Bromide and Albuterol Sulfate Inhalation Solution, like all other nebulized treatments, the amount delivered to the lungs will depend on patient factors, the jet nebulizer utilized, and compressor performance. The mean nebulization time was 15 minutes or less.
The cAMP thus formed mediates the cellular responses, albuterol indications and contraindications. The precise function of these receptors, however, is not yet established.
Albuterol has been shown in most controlled clinical trials to have more effect on the respiratory tract, in the form of bronchial smooth muscle relaxation, than isoproterenol at comparable doses while producing fewer cardiovascular effects.
Albuterol sulfate is longer acting than isoproterenol in most patients by any route of administration, because it is not a substrate for the cellular uptake processes for catecholamine nor for the metabolism of catechol-O-methyl transferase.
In structures outside of the blood-brain barrier pineal and pituitary glandsalbuterol concentrations were found to be times those found in whole brain, albuterol indications and contraindications.
Studies in laboratory animals minipigs, rodents, and dogs have demonstrated the occurrence of cardiac arrythmias and sudden death with histological evidence of myocardial necrosis when beta-agonists and albuterol indications and contraindications are administered concurrently. The clinical significance of these findings is unknown.
Ipratropium bromide is an anticholinergic parasympatholytic agent, albuterol indications and contraindications, which blocks the muscarinic receptors of acetylcholine, and, based on animal studies, appears to inhibit vagally mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released from the vagus nerve, albuterol indications and contraindications.
Anticholinergics prevent the increases in intracellular concentration of cyclic guanosine monophosphate cGMPresulting from the interaction of acetylcholine with the muscarinic receptors of bronchial smooth muscle, albuterol indications and contraindications. The bronchodilation following inhalation of ipratropium is primarily a local, site-specific effect, not a systemic one. Much of an inhaled dose is swallowed as shown by fecal excretion studies.
It is partially metabolized to inactive ester hydrolysis products. Following intravenous administration, approximately one-half is excreted unchanged in the urine. The half-life of elimination is about 1.
Ipratropium bromide that reaches the systemic circulation is reportedly removed by the kidneys rapidly at a rate that exceeds the glomerular filtration rate.
Autoradiographic studies in rats have shown that ipratropium does not penetrate the blood-brain barrier. Ipratropium Bromide and Albuterol Sulfate Inhalation Solution is expected to maximize the response to treatment in patients with chronic obstructive pulmonary disease COPD by reducing bronchospasm through two distinctly different mechanisms: In day studies in Sprague-Dawley rats and Beagle dogs, subcutaneous doses of up to In a double blind, double period, crossover study, 15 male and female subjects were administered single doses of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution or albuterol sulfate inhalation solution at two times the recommended single doses as two inhalations separated by 15 minutes.
The total nebulized dose of albuterol sulfate from both treatments was 6 mg and the total dose of ipratropium bromide from Ipratropium Bromide and Albuterol Sulfate Inhalation Solution was 1 mg. Peak albuterol plasma concentrations occurred at 0. The mean peak albuterol concentration following administration of albuterol sulfate alone was 4.
Mean AUC values for the two treatments were A mean of 8. There were no statistically significant differences in the pharmacokinetics of albuterol between the two treatments. For ipratropium, a mean of 3, albuterol indications and contraindications. In a 12 week, randomized, double-blind, positive-control, crossover study of albuterol sulfate, ipratropium bromide, and Ipratropium Bromide and Albuterol Sulfate Inhalation Solution, COPD patients were evaluated for bronchodilator efficacy comparing ipratropium bromide and albuterol sulfate with albuterol sulfate and ipratropium bromide alone.
Ipratropium Bromide and Albuterol Sulfate Inhalation Solution demonstrated significantly better changes in FEV 1as measured from baseline to peak response, when compared with either albuterol sulfate or ipratropium bromide. Ipratropium Bromide and Albuterol Sulfate Inhalation Solution was also shown to have the rapid onset associated with albuterol sulfate, with a mean time to peak FEV 1 of 1.
This study demonstrated that each component of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution contributed to the improvement albuterol indications and contraindications pulmonary function, especially during the first 4 to 5 hours after dosing, and that Ipratropium Bromide and Albuterol Sulfate Inhalation Solution was significantly more effective than albuterol sulfate or ipratropium bromide alone.
Ipratropium Bromide and Albuterol Sulfate Inhalation Solution is indicated for the treatment of bronchospasm associated with COPD in patients requiring more than one bronchodilator.
Ipratropium Bromide and Albuterol Sulfate Inhalation Solution is contraindicated in patients with a history of hypersensitivity to any of its components, or to atropine and its derivatives. In the clinical study of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution, paradoxical bronchospasm was not observed. However, paradoxical bronchospasm has been observed with both inhaled ipratropium bromide albuterol indications and contraindications albuterol products and can be life-threatening.
If this occurs, Ipratropium Bromide and Albuterol Sulfate Inhalation Solution should be discontinued immediately and alternative therapy instituted. Fatalities have been reported in association with excessive use albuterol indications and contraindications inhaled products containing sympathomimetic amines and with the home albuterol indications and contraindications of nebulizers. Although such effects are uncommon for Ipratropium Bromide and Albuterol Sulfate Inhalation Solution at recommended doses, if they occur, the drug may need to be discontinued.
In addition, beta agonists have been reported to produce ECG changes, such as flattening of the T-wave, prolongation of the QTc interval, and ST segment depression, albuterol indications and contraindications. Therefore, Ipratropium Bromide and Albuterol Sulfate Inhalation Solution, like other sympathomimetic amines, should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension, albuterol indications and contraindications.
As with all products containing sympathomimetic amines, Ipratropium Bromide and Albuterol Sulfate Inhalation Solution should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension; in patients with convulsive disorders, hyperthyroidism, or diabetes mellitus; and in patients who are unusually responsive to do air conditioners affect asthma amines.
Large doses of intravenous albuterol have been reported to aggravate pre-existing diabetes mellitus and ketoacidosis. The decrease is usually transient, not requiring supplementation. Due to the presence of ipratropium bromide in Ipratropium Bromide and Albuterol Sulfate Diabetes alert pin Solution, it should be used with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder-neck obstruction.
Ipratropium Bromide and Albuterol Sulfate Inhalation Solution has not been studied in patients with hepatic or renal insufficiency. It should be used with caution in these patient populations. Ipratropium Bromide and Albuterol Sulfate Inhalation Solution should not be used more frequently than recommended.
Patients should be instructed not to increase the dose or frequency of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution without consulting their healthcare provider. If symptoms worsen, patients should be instructed to seek medical consultation.
Patients must avoid exposing their eyes to this product as temporary pupillary dilation, blurred vision, eye pain, or precipitation or worsening of narrow-angle glaucoma may occur, and therefore proper nebulizer technique should be assured, particularly if a mask is used.
If a patient becomes pregnant or begins nursing while on Ipratropium Bromide and Albuterol Sulfate Inhalation Solution, they should contact their healthcare provider about use of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution.
Although ipratropium bromide is minimally absorbed into the systemic circulation, there is some potential for an additive interaction with concomitantly used anticholinergic medications. Caution is, therefore, advised in the co-administration of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution with other drugs having anticholinergic properties.
Caution is advised in the co-administration of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution and other sympathomimetic agents due to the increased risk of adverse cardiovascular effects. These agents and albuterol albuterol indications and contraindications inhibit the effect of each other, albuterol indications and contraindications. Ipratropium Bromide and Albuterol Sulfate Inhalation Solution should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents because the action of albuterol sulfate on the cardiovascular system may be potentiated.
In another study, albuterol indications and contraindications, this effect was blocked by the coadministration of propranolol, a non-selective beta-adrenergic antagonist.
Albuterol sulfate was not mutagenic in the Ames test or a mutation test in yeast. Albuterol sulfate was not clastogenic in a human peripheral lymphocyte assay or in an AH1 strain mouse micronucleous assay. Ipratropium bromide was not mutagenic in the Ames test and mouse dominant lethal test. Ipratropium bromide was not clastogenic in a mouse micronucleous assay. Albuterol sulfate has been shown to be teratogenic in mice. A study in CD-1 mice given albuterol sulfate subcutaneously showed cleft palate formation in 5 of 4.
The drug did not induce cleft palate formation when administered subcutaneously at a dose of 0. Cleft palate formation also occurred in 22 of 72 A study in which pregnant rats were dosed with radiolabeled albuterol sulfate demonstrated that drug-related material is transferred from the maternal circulation to the fetus.
During worldwide marketing experience, various congenital anomalies, including cleft palate and limb defects, have been reported in the offspring of patients being treated with albuterol. Some of the mothers were taking multiple medications during their pregnancies. Because no consistent pattern of defects can be discerned, a relationship between albuterol use and congenital anomalies has not been established. Reproduction studies in rats and rabbits demonstrated no evidence of teratogenicity at inhalation doses up to 1.
There are no adequate and well-controlled studies of the use of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution, albuterol sulfate, or ipratropium bromide in pregnant women. Ipratropium Bromide and Albuterol Sulfate Inhalation Solution should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Oral albuterol sulfate has been shown to delay preterm labor in some reports.
Because of the potential of albuterol to interfere with uterine contractility, use cipro south africa Ipratropium Bromide and Albuterol Sulfate Albuterol indications and contraindications Solution during labor should be restricted to those patients in whom the benefits clearly outweigh the risks.
It is not known whether the components of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution are excreted in human milk. Although lipid-insoluble quaternary bases pass into breast milk, it is unlikely that ipratropium bromide would reach the infant to an important extent, especially when taken as a nebulized solution.
Because of the potential for tumorigenicity shown for albuterol sulfate in some animals, a decision should be made whether to discontinue nursing or discontinue Ipratropium Bromide and Albuterol Sulfate Inhalation Solution, taking into account the importance of the drug to the mother.
The safety and effectiveness of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution in patients below 18 years of age have not albuterol indications and contraindications established. Of the total number of subjects in clinical studies of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution, 62 percent were 65 and over, while 19 percent were 75 and over.
No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Adverse reaction information concerning Ipratropium Bromide and Albuterol Sulfate Inhalation Solution was derived from the week controlled clinical trial. In the clinical trial, there was a 0.
Additional information derived from the published literature on the use of albuterol sulfate and ipratropium bromide singly or in combination includes precipitation or worsening of narrow-angle glaucoma, acute eye pain, blurred vision, mydriasis, paradoxical bronchospasm, wheezing, exacerbation albuterol indications and contraindications COPD symptoms, albuterol indications and contraindications, drowsiness, aching, flushing, upper respiratory tract infection, palpitations, albuterol indications and contraindications, taste perversion, elevated heart rate, sinusitis, back pain, sore throat and metabolic acidosis.
Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. The effects of overdosage with Ipratropium Bromide and Albuterol Sulfate Inhalation Solution are expected to be related primarily to albuterol sulfate, since ipratropium bromide is not well-absorbed systemically after oral or aerosol administration.
Hypokalemia may also occur. As with all sympathomimetic aerosol medications, cardiac arrest and even albuterol indications and contraindications may be associated with abuse of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution, albuterol indications and contraindications.