Version May 2024
Note: Initiate therapy under medical supervision (eg, hospital setting). May consider home administration in exceptional cases (eg, severe symptoms or experienced patients requiring higher doses) when rapid acting beta-agonist bronchodilator therapy is ineffective.
Bronchospasm due to acute severe exacerbation of bronchial asthma or COPD: Nebulization: Usual dose: 4 mL (ipratropium bromide 0.5 mg/fenoterol hydrobromide 1.25 mg in normal saline); subsequent dosing is individualized based on clinical response; if symptoms are not relived within 10 minutes of administration, if effects of treatment last <3 hours, or if prior effective dosage fails to provide adequate relief, reassess therapy as this may indicate seriously worsening of asthma.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
Children ≥12 years and Adolescents: Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Cardiovascular: Atrial fibrillation, cardiac arrhythmia, hypertension, hypotension, ischemic heart disease, palpitations, prolonged QT interval on ECG, supraventricular tachycardia, tachycardia
Central nervous system: Dizziness, headache, nervousness, psychological disorder
Dermatologic: Diaphoresis
Endocrine & metabolic: Hyperglycemia, hypokalemia
Gastrointestinal: Constipation, diarrhea, nausea, vomiting, xerostomia
Genitourinary: Urinary retention
Hypersensitivity: Hypersensitivity reaction (anaphylaxis, angioedema, bronchospasm, laryngospasm, oropharyngeal edema, skin rash, urticaria)
Neuromuscular & skeletal: Muscle cramps, myalgia, tremor, weakness
Ophthalmic: Accommodation disturbance, acute angle-closure glaucoma, eye pain, increased intraocular pressure, mydriasis
Respiratory: Bronchospasm (inhalation-induced), cough, pharyngitis, throat irritation
Hypersensitivity to ipratropium, fenoterol, sympathomimetic amines, atropine (and its derivatives), or any component of the formulation; tachyarrhythmias; hypertrophic obstructive cardiomyopathy
Concerns related to adverse effects:
• Bronchospasm: Rarely, paradoxical bronchospasm may occur with the use of inhaled bronchodilating agents; this should be distinguished from inadequate response. Discontinue use if paradoxical bronchospasm occurs.
• Cardiovascular: Serious adverse events, including fatalities, have been associated with excessive use of inhaled sympathomimetics. Concomitant use with other sympathomimetic amines is not recommended; closely monitor patients receiving concomitant therapy with other sympathomimetics.
• CNS effects: Adverse effects such as dizziness, tremor, blurred vision, and/or accommodation disorder may occur; caution patients about performing dangerous tasks (eg, driving, operating heavy machinery).
• Hypersensitivity reactions: Immediate hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm) have been reported.
• Hypokalemia: Fenoterol may cause hypokalemia; use caution, particularly in severe asthmatic patients receiving concomitant therapy (eg, steroids, xanthine derivatives) capable of potentiating hypokalemia.
Disease-related concerns:
• Asthma: Appropriate use: Ipratropium is not indicated for the initial treatment of acute episodes of bronchospasm.
• Cardiovascular disease: Use with caution in patients with cardiovascular disease (eg, recent MI, arrhythmia, hypertension, HF, vascular disorders); beta-agonists may cause elevation in blood pressure and heart rate and may result in CNS stimulation/excitation. Beta2-agonists may also increase the risk of arrhythmias and myocardial ischemia.
• Cystic fibrosis: Use with caution in patients with cystic fibrosis; may increase the risk of gastrointestinal motility disturbances.
• Diabetes: Use with caution in patients with diabetes mellitus; beta2-agonists may increase serum glucose.
• Glaucoma: Use with caution in patients with narrow-angle glaucoma. Avoid getting nebulizer solution in eye(s); patients presenting with, blurred vision, eye pain/discomfort, visual halos, or colored images in association with red eye from conjunctival congestion and corneal edema should receive an immediate ophthalmic evaluation and be treated as clinically indicated.
• Hyperthyroidism: Use with caution in hyperthyroidism; may stimulate thyroid activity.
• Pheochromocytoma: Use with caution in patients with pheochromocytoma.
• Prostatic hyperplasia/bladder neck obstruction: Use with caution in patients with prostatic hyperplasia or bladder neck obstruction.
• Seizure disorder: Use with caution in patients with seizure disorders; beta-agonists may result in CNS stimulation/excitation.
Other warnings/precautions:
• Appropriate use: Asthma: Symptom relief of <3 hours following an administered dose or failure of previous dosage regimen to provide relief indicates worsening of asthma and requires therapy adjustment; patients should be instructed to notify healthcare provider immediately and not to exceed recommended dose. Anti-inflammatory therapy should be administered to patients receiving beta2-agonist inhalation therapy on a routine basis.
• Intermittent positive-pressure ventilation (IPPV): Use of ipratropium/fenoterol in conjunction with IPPV may be ineffective in severe airway obstruction; fatal episodes of hypoxia and pneumothorax have been associated with the use of ipratropium/fenoterol in conjunction with IPPV in acute asthma attacks.
Not available in the US
May be product dependent
Inhalation: Nebulization: Wash hands before and after treatment. Wash and dry nebulizer after each treatment. Twist open the top of one unit dose vial and squeeze the contents into the nebulizer reservoir. Gently swirl the nebulizer reservoir and connect it to the face mask. Avoid leakage around the mask (temporary blurring of vision, worsening of narrow-angle glaucoma, or eye pain may occur if mist gets into eyes). Use of swimming goggles or a mouthpiece is recommended to prevent nebulized solution from contacting the eye(s). Connect nebulizer to compressor. Sit in a comfortable, upright position. Put on the face mask and turn on the compressor. If wall oxygen is available, administer the solution at a flow rate of 6 to 8 liters per minute. Breathe calmly and deeply until no more mist is formed in the nebulizer (about 10 to 15 minutes). At this point, treatment is finished.
Inhalation: Nebulization: Wash hands before and after treatment. Wash and dry nebulizer after each treatment. Twist open the top of one unit dose vial and squeeze the contents into the nebulizer reservoir. Gently swirl the nebulizer reservoir and connect it to the face mask. Avoid leakage around the mask (temporary blurring of vision, worsening of narrow-angle glaucoma, or eye pain may occur if mist gets into eyes). Use of swimming goggles or a mouthpiece is recommended to prevent nebulized solution from contacting the eye(s). Connect nebulizer to compressor. Sit in a comfortable, upright position. Put on the face mask and turn on the compressor. If wall oxygen is available, administer the solution at a flow rate of 6 to 8 liters per minute. Breathe calmly and deeply until no more mist is formed in the nebulizer (about 10 to 15 minutes). At this point, treatment is finished.
Note: Not approved in the US
Bronchospasm: Treatment of bronchospasm associated with acute severe exacerbation of COPD or bronchial asthma in patients ≥12 years of age
Duovent UDV may be confused with Combivent UDV, DuoNeb
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Risk C: Monitor therapy
Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Anticholinergic Agents: Ipratropium (Oral Inhalation) may enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Atomoxetine: May enhance the tachycardic effect of Beta2-Agonists. Risk C: Monitor therapy
Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Atosiban: Beta2-Agonists may enhance the adverse/toxic effect of Atosiban. Specifically, there may be an increased risk for pulmonary edema and/or dyspnea. Risk C: Monitor therapy
Beta2-Agonists (Short-Acting): May enhance the adverse/toxic effect of other Beta2-Agonists (Short-Acting). Risk X: Avoid combination
Beta-Blockers (Beta1 Selective): May diminish the bronchodilatory effect of Beta2-Agonists. Of particular concern with nonselective beta-blockers or higher doses of the beta1 selective beta-blockers. Risk C: Monitor therapy
Beta-Blockers (Nonselective): May diminish the bronchodilatory effect of Beta2-Agonists. Risk X: Avoid combination
Botulinum Toxin-Containing Products: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Risk C: Monitor therapy
Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Risk C: Monitor therapy
Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Risk X: Avoid combination
Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider therapy modification
Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy
Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Risk X: Avoid combination
Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Risk C: Monitor therapy
Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor therapy
Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Risk X: Avoid combination
Glycopyrronium (Topical): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy
Inhalational Anesthetics: May enhance the arrhythmogenic effect of Fenoterol. Risk C: Monitor therapy
Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Risk C: Monitor therapy
Kratom: May enhance the adverse/toxic effect of Sympathomimetics. Risk X: Avoid combination
Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Risk X: Avoid combination
Levothyroxine: May enhance the adverse/toxic effect of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Levothyroxine may enhance the therapeutic effect of Sympathomimetics. Sympathomimetics may enhance the therapeutic effect of Levothyroxine. Risk C: Monitor therapy
Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider therapy modification
Loop Diuretics: Beta2-Agonists may enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy
Loxapine: Agents to Treat Airway Disease may enhance the adverse/toxic effect of Loxapine. More specifically, the use of Agents to Treat Airway Disease is likely a marker of patients who are likely at a greater risk for experiencing significant bronchospasm from use of inhaled loxapine. Management: This is specific to the Adasuve brand of loxapine, which is an inhaled formulation. This does not apply to non-inhaled formulations of loxapine. Risk X: Avoid combination
Methacholine: Ipratropium (Oral Inhalation) may diminish the therapeutic effect of Methacholine. Management: Hold ipratropium for 12 hours before methacholine use. Risk D: Consider therapy modification
Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Risk C: Monitor therapy
Monoamine Oxidase Inhibitors: May enhance the adverse/toxic effect of Beta2-Agonists. Risk C: Monitor therapy
Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Risk C: Monitor therapy
Opioid Agonists: Anticholinergic Agents may enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. Risk C: Monitor therapy
Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy
Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid combination
Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium citrate. Risk X: Avoid combination
Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Risk X: Avoid combination
Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Risk C: Monitor therapy
Revefenacin: Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. Risk X: Avoid combination
Rivastigmine: Anticholinergic Agents may diminish the therapeutic effect of Rivastigmine. Rivastigmine may diminish the therapeutic effect of Anticholinergic Agents. Management: Use of rivastigmine with an anticholinergic agent is not recommended unless clinically necessary. If the combination is necessary, monitor for reduced anticholinergic effects. Risk D: Consider therapy modification
Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Risk D: Consider therapy modification
Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy
Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Theophylline Derivatives: Beta2-Agonists may enhance the adverse/toxic effect of Theophylline Derivatives. Specifically, sympathomimetic effects may be increased. Theophylline Derivatives may enhance the hypokalemic effect of Beta2-Agonists. Risk C: Monitor therapy
Thiazide and Thiazide-Like Diuretics: Beta2-Agonists may enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy
Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy
Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Risk X: Avoid combination
Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Risk C: Monitor therapy
Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Adverse events were not observed in animal reproduction studies using this combination via inhalation. Adverse events were observed in animal reproduction studies using oral formulations of each component.
Nonclinical studies have shown that fenoterol is excreted in breast milk. It is not known if ipratropium is excreted in breast milk. The manufacturer recommends caution be exercised when administered to nursing women.
Spirometry (FEV, FVC); potassium
Ipratropium: Blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation
Fenoterol: Relaxes bronchial smooth muscle by action on beta2-receptors
Onset of action:
Ipratropium: Bronchodilation: Within 15 minutes; Peak effect: 1 to 2 hours
Fenoterol: Bronchodilation: 5 minutes; Peak effect: 30 to 60 minutes
Duration:
Ipratropium: 4 to 8 hours
Fenoterol: 6 to 8 hours
Absorption:
Ipratropium: Inhalation: Estimated bioavailability: 7% to 28%
Fenoterol: Inhalation: Estimated bioavailability: 7%.
Distribution: Ipratropium/fenoterol: 10% to 39% of dose is deposited in lungs following inhalation
Protein binding:
Ipratropium: <20%
Fenoterol: ~40%
Half-life elimination:
Ipratropium: 1.6 hours
Fenoterol: ~3 hours
Excretion: Urine, feces
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
