Ipratropium with albuterol

Ipratropium with albuterol MDI 1 8 mcg/puff of ipratropium bromide and 90 mcg/puff of albuterol 2-3 puffs every 6 hours 1-2 puffs every 8 hours... 

Solution incompatibility Advise patients that ipratropium inhalation solution can be mixed in the nebulizer with albuterol or metaproterenol if used within 1 hour. 

Inhaled antichohnergic therapies have an important role in the management of COPD. Ipratropium is available as an MDl (individually and in combination with albuterol) dehvermg 18 meg per puff and as a solution for nebuhzation at 200 mcg/mL. Tiotropinm is available as a DPI at 18 meg per dose. Tiotropinm became available in rnid-2004. However, based on efficacy and convenience, it hkely will play a major role in COPD management. 

Consensus guidelines indicate that bronchodilator therapy is the focus of pharmacotherapy for COPD. However, there is no clear choice for the initial agent. For patients with daily but not persistent symptoms, either ipratropium or albuterol offers advantages as initial therapy. Both also have limitations if chosen as the initial therapy. 

Friedman M, Serby CW, Menjoge SS, et al. Pharmacoeconomic evaluation of a combination of ipratropium plus albuterol compared with ipratropium alone and albuterol alone in COPD. Chest 1999 115 635-641. 

Ipratropium bromide (Atrovent) is an antichoMnergic dmg that inhibits vagal-mediated response by reversing the action of acetylchoMne, producing smooth muscle relaxation. It is a newer medication that dilates bronchioles with few systemic effects. Ipratropium bromide (Atrovent) is used five minutes before glucocorticoid (steroid) or cromolyn are inhaled so the bronchioles dilate enabling the steroids to be deposited in the bronchioles. Sometimes ipratropium bromide is combined with albuterol sulfate (Combivent) to treat chronic bronchitis for more effective and longer duration than if each is used alone. 

Albuterol is the preferred bronchodilator for treatment of acute exacerbations because of its rapid onset of action. Ipratropium can be added to allow for lower doses of albuterol, thus reducing dose-dependent adverse effects such as tachycardia and tremor. Delivery can be through metered-dose inhaler (MDI) and spacer or nebulizer. The nebulizer route is preferred in patients with severe dyspnea and/or cough that would limit delivery of medication through an MDI with spacer. If response is inadequate, theophylline can be considered however, clinical evidence supporting its use is lacking. 

Ipratropium bromide has a slower onset of action than short-acting /J2-agonists (15 to 20 minutes vs. 5 minutes for albuterol). For this reason, it may be less suitable for as-needed use, but it is often prescribed in this manner. Ipratropium has a more prolonged bronchodilator effect than short-acting /l2-agonists. Its peak effect occurs in 1.5 to 2 hours and its duration is 4 to 6 hours. The recommended dose via MDI is two puffs four times a day with upward titration often to 24 puffs/day. It is also available as a solution for nebulization. The most frequent patient complaints are dry mouth, nausea, and, occasionally, metallic taste. Because it is poorly absorbed systemically, anticholinergic side effects are uncommon (e.g., blurred vision, urinary retention, nausea, and tachycardia). 

CD is a 70-year-old man who resides in a nursing home. His PMH is significant for Parkinson s disease and COPD. His medications include carbidopa/levodopa, and amantadine, as well as ipratropium, albuterol, and triamcinolone inhalers. One of the residents is diagnosed with influenza A and all the residents now require prophylaxis for influenza A with rimantadine. Which of the following would be the most appropriate therapy for prevention of influenza A in CD ... 

The combination of albuterol sulfate and ipratropium bromide is available commercially in a metered-dose inhaler device for humans. In human patients with chronic obstructive pulmonary disease, this anticholinergic p2 agonist combination provides more complete bronchodilatation than... 

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