Drug Name

Combivent (Ipratropium bromide and Albuterol sulfate)

Pharmacological action

Combined bronchodilator. Ipratropium bromide blocks m-cholinoreceptors of smooth muscles of tracheobronchial tree (mainly large and medium bronchi), suppresses reflex bronchoconstriction, reduces secretion of glands of mucous membrane of airways. Having structural similarity with acetylcholine molecule, it is its competitive antagonist. It effectively prevents bronchial constriction resulting from inhalation of cigarette smoke, cold air, the action of various bronchospasmodic agents, as well as eliminates bronchial spasm associated with the influence of n.vagus.

It has practically no resorptive action (it has little effect on HR and BP - inhalation of about 500 doses is necessary to develop tachycardia), only 10% reaches small bronchi and alveoli, and the rest is deposited in the throat or oral cavity and swallowed.

Salbutamol in therapeutic doses has a pronounced stimulatory effect on beta2-adrenoreceptors of the bronchi, blood vessels and myometrium. It has practically no effect on the beta1-adrenoreceptors of the heart. Suppresses release from mast cells of histamine, leukotrienes and PgD2 and other biologically active substances for a long time. Reduces early and late bronchial reactivity. It has a pronounced bronchodilator effect, preventing or terminating bronchospasm, reduces resistance in the airways, increases GFR. It has a positive effect on mucociliary clearance (in chronic bronchitis increases it by 36%), stimulates mucus secretion, activates the function of the atrial friction epithelium. It has a number of metabolic effects: reduces plasma K+ content, affects glycogenolysis and insulin release, has hyperglycemic (especially in patients with bronchial asthma) and lipolytic effects, increases the risk of acidosis. In the recommended therapeutic doses, it has no adverse effect on the cardiovascular system and does not cause an increase in BP. Compared with the drugs of this group, it has a positive chrono- and inotropic effect to a lesser extent. Causes dilatation of coronary arteries.

Contraindications

Hypersensitivity (including to atropine). Closed-angle glaucoma, urinary obstruction (prostatic hypertrophy), CHD, arterial hypertension, CHF, tachyarrhythmia, epileptic syndrome, thyrotoxicosis, diabetes, hypokalemia, hepatic and/or renal failure, pregnancy, lactation, childhood (safety and effectiveness not established).

Special precautions

To avoid overdose, it is not recommended to exceed the maximum daily dose.

In case of paradoxical bronchospasm the drug administration should be stopped immediately. It should be borne in mind that the development of bronchospasm may be associated with switching to a new vial of the drug.

It should be remembered that during the treatment tachycardia, increased BP, changes on ECG (smoothing of T wave, prolongation of Q-T interval, decreased S-T segment) may occur, so caution should be exercised when using with CHF, tachyarrhythmia, arterial hypertension.

Eye contact should be avoided.

If it is necessary to prescribe the drug during lactation, breastfeeding should be stopped.

Indications

Bronchospastic syndrome (including COPD and bronchial asthma, with acute respiratory infections, during surgery).

How to use: dosage and course of treatment

Inhaled. Dosed aerosol - 2 doses 4 times a day; if necessary, it is possible to increase the dosing frequency to 12 times a day.