Salbutamol/ Ipratropium Bromide

Registered South African indications: 

• Bronchospasm

Contraindications

Inhaler

• Hypersensitivity to the active ingredients or any of the excipients in this combination product
• Patients who previously displayed hypersensitivity to soya lecithin or related food products, such as soybean and peanut
• Known hypersensitivity to atropine or its derivatives
• Hypertrophic obstructive cardiomyopathy
• Tachydysrhythmias
• Pregnancy
• Lactation
• Children under 12 years

Solution for inhalation

• Hypersensitivity to the active ingredients or any of the excipients in this combination product
• Known hypersensitivity to atropine or its derivatives
• Hypertrophic obstructive cardiomyopathy
• Tachydysrhythmias
• Children under 12 years

Cautions

• Pregnancy (neb)
• Breastfeeding (neb)
• Diabetes mellitus
• Recent myocardial infarction
• Organic cardiac or vascular disorders
• Hyperthyroidism
• Phaeochromocytoma
• Prostatic hypertrophy
• Bladder outflow obstruction
• Narrow angle glaucoma
• Cystic fibrosis
• Gastrointestinal motility disturbances
• May impair ability to drive and operate machinery

Forms avail. in SA and covered in this monograph: neb, inh

Relief of bronchospasm associated with chronic obstructive pulmonary disease

Salbutamol/ Ipratropium Bromide
2500/500 (μg/2.5ml)

• Respule (neb): Initial: 1 respule immediately, May be repeated if no relief; Maintenance: 1 respule, 6-8hrly 

100/20 (μg)

• Inhaled (inh): 2 inhalations, 6hrly; Max: 12 inhalations/24hrs

Respule: To be used in a nebulizer or intermittent positive pressure ventilator

Paed. forms avail. in SA and covered in this monograph: neb, inh

Relief of bronchospasm associated with chronic obstructive pulmonary disease

Salbutamol/ Ipratropium Bromide
2500/500 (μg/2.5ml)
100/20 (μg)

Younger than 12 years

• Not established for use (see Contraindications)

Older than 12 years

• See adult dosage

Pregnancy

Inhaler

• Contraindicated

Solution for inhalation

• Caution

Breastfeeding

Inhaler

• Contraindicated

Solution for inhalation

• Caution

Renal Impairment

• No dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended

Elderly

• No dose adjustment recommended

Porphyria Information

• Probably not porphyrinogenic (PNP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Nervousness
• Restlessness 
• Memory disorders
• Anxiety
• Depression
• Hyperactivity
• Headache
• Dizziness
• Tremor

Cardiovascular Disorders

• Palpitations
• Tachycardia
• Increased systolic blood pressure
• Arrhythmias
• Reduced diastolic blood pressure 
• Peripheral vasodilatation
• Myocardial ischaemia

Respiratory Disorders

• Coughing
• Dysphonia
• Bronchospasm
• Laryngospasm
• Dyspnea
• Paradoxical bronchospasm

Gastrointestinal Disorders

• Dry mouth 
• Nausea and vomiting 
• Mouth and throat irritation
• Motility disorders
• Dental caries

Genitourinary Disorders

• Urinary retention

Endocrine and Metabolic Disorders

• Hypokalaemia

Musculoskeletal Disorders

• Myalgia
• Muscular cramp
• Muscular weakness

Skin and Subcutaneous Tissue Disorders

• Rash
• Itching
• Urticaria
• Angioedema

Sensory Disorders

• Accommodation disorders
• Pain in the eyes
• Mydriasis
• Increased intraocular pressure
• Closed angle glaucoma

• Beta-2 agonists
• Corticosteroids
• Anticholinergics
• Xanthine derivatives
• Beta-blockers
• Monoamine oxidase inhibitors
• Tricyclic antidepressants 
• Halogenated hydrocarbons
• Diuretics
• Digoxin

None routine. Specific cases may require

• Serum potassium levels

Salbutamol
Salbutamol is a selective beta-2 agonist which acts on the beta-2 adrenoceptors of the bronchial muscle. Stimulation results in relaxation of bronchial smooth muscle in the lungs, resulting in bronchodilation, increased vital capacity, decreased residual volume and reduced airway resistance. Salbutamol has little or no effect on cardiac receptors, but causes uterine smooth muscle relaxation and is thus used to help suppress premature labour.

Ipratropium Bromide
Ipratropium bromide is a quaternary ammonium compound with anticholinergic properties. It inhibits vagally-mediated reflexes by antagonising the action of acetylcholine in bronchial smooth muscle cells, facilitating bronchodilation.

COMBINATION PREPARATIONS

Salbutamol/Ipratropium Bromide Anhydrous

Inhaler 100μg/20μg

• Duolin HFA (Cipla Medpro)

Nebulising solution U.D.V (per 2.5ml) 2.5mg/0.5mg

• Combivent (Boehringer) originator
• Duolin Respules (Cipla Medpro)
• Sabax Combineb (Adcock)
• Salipra (Medivision)

Nebulising solution U.D.V (per 2.5ml) 3mg/0.5mg

• Co-Iprasal solution (Arrow)