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Ipratropium bromide is an anticholinergic bronchodilator chemically described as 8-azoniabicyclo[3.2.1octane33-hydroxy-1-oxo-2-phenylpropoxy8-methyl-81-methylethylbromide monohydrate3-endo8-syna synthetic quaternary ammonium compound chemically related to atropineIpratropium bromide is a white to off-white crystalline substancefreely soluble in water and methanolsparingly soluble in ethanoland insoluble in lipophilic solvents such as etherchloroformand fluorocarbons.
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Combivent Inhalation Aerosol is a combination of the anticholinergic bronchodilatoripratropium bromideand the beta 2adrenergic bronchodilatoralbuterol sulfate.
The effects of overdosage are expected to be related primarily to albuterol sulfateAcute overdosage with ipratropium bromide by inhalation is unlikely since ipratropium bromide is not well absorbed systemically after aerosol or oral administrationOral median lethal doses of ipratropium bromide were greater than 1001 mg/kg in miceapproximately 19,000 times the maximum recommended daily inhalation dose in adults on a mg/m 2 basis1663 mg/kg in ratsapproximately 62,000 times the maximum recommended daily inhalation dose in adults on a mg/m 2 basisand 400 mg/kg in dogsapproximately 50,000 times the maximum recommended daily inhalation dose in adultson a mg/m 2 basisWhereas the oral median lethal dose of albuterol sulfate in mice and rats was greater than 2000 mg/kgapproximately 6600 and 13,000 times the maximum recommended daily inhalation doserespectivelyin adults on a mg/m 2 basisthe inhalational median lethal dose could not be determinedManifestations of overdosage with albuterol may include anginal painhypertensionhypokalemiatachycardia with rates up to 200 beats per minutemetabolic acidosisand exaggeration of the pharmacologic effects listed in ADVERSE REACTIONSAs with all sympathomimetic aerosol medicationscardiac arrest and even death may be associated with abuseDialysis is not appropriate treatment for overdosage of albuterol as an inhalation aerosolthe judicious use of a cardiovascular beta-receptor blockersuch as metoprolol tartrate may be indicated.
2Remove orange protective dust capIf the cap is not on the mouthpiecemake sure there is nothing in the mouthpiece before useFor best resultsthe canister should be at room temperature before use.
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