DuoNeb (Ipratropium/Salbutamol)

Follow the directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Overuse of this medicine may increase the risk of death. It is critical that you use only the prescribed dose of this medicine.

This medication comes with patient instructions for safe and effective use, and directions for priming the inhaler device. Duoneb and Combivent Respimat have different patient instructions. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

To use the inhaler (Combivent Respimat):

• You do not need to shake Combivent Respimat before use.
• Uncap the mouthpiece of the inhaler. Breathe out fully. Put the mouthpiece into your mouth and close your lips. Keep your eyes closed to prevent spraying any medicine into your eyes. Breathe in slowly while pushing down on the canister. Hold your breath for 10 seconds, then breathe out slowly.
• If you use more than one inhalation at a time, wait at least 2 minutes before using the second inhalation.
• Carefully follow all directions for cleaning your specific inhaler device once per week.

To use the solution with a nebulizer (Duoneb):

• Open the foil pouch and remove one vial. Squeeze all of the medicine out into the chamber of the nebulizer.
• Attach the mouthpiece or face mask to the drug chamber. Then, attach the drug chamber to the compressor. Sit upright in a comfortable position. Place the mouthpiece into your mouth or put the face mask on, covering your nose and mouth.
• Breathe in slowly and evenly until you have inhaled all of the medicine (usually 5 to 15 minutes). The treatment is complete when no more mist is formed by the nebulizer and the drug chamber is empty.
• Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

Keep track of the number of sprays you have used. Throw away the Combivent Respimat inhaler canister after 3 months or 120 sprays, whichever comes first.

Seek medical attention if you think this medication is not working as well as usual.

While using DUONEB, you may need frequent blood tests at your doctor's office.

Use DUONEB regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Store at room temperature away from moisture, heat, and light. Keep each Duoneb vial in its foil pouch until you are ready to use it. Do not store Combivent Respimat in your car on hot days. Extreme heat can cause the medicine canister to burst. Do not throw an empty canister into open flame.

Seek emergency medical attention or call the Poison Help line. An overdose of DUONEB can be fatal. Overdose symptoms may include chest pain, fast or pounding heartbeats, extreme thirst, muscle weakness or limp feeling, severe headache, buzzing in your ears, weak pulse, fainting, or slow breathing (breathing may stop).

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using DUONEB inhalation and call your doctor at once if you have:

• wheezing, choking, or other breathing problems (especially after starting a new canister of this medicine);
• chest pain, pounding heartbeats or fluttering in your chest;
• dangerously high blood pressure (severe headache, anxiety, uneven heartbeats);
• swelling of your ankles or feet;
• eye pain, or seeing halos around lights;
• painful or difficult urination; or
• low potassium (confusion, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling).

Common side effects may include:

• mild headache; or
• cold symptoms such as stuffy nose, sneezing, cough, or sore throat.

You should not use this medication if you are allergic to albuterol (Proventil, Ventolin), ipratropium (Atrovent), or atropine (Atreza, Lomotil, Vi-Atro, Sal-Tropine).

Seek medical attention if you think this medication is not working as well as usual.

You should not use this medication if you are allergic to albuterol (Proventil, Ventolin), ipratropium (Atrovent), or atropine (Atreza, Lomotil, Vi-Atro, Sal-Tropine).

To make sure DUONEB inhalation is safe for you, tell your doctor if you have:

• heart disease, high blood pressure, coronary artery disease, or heart rhythm disorder;
• a seizure disorder such as epilepsy;
• diabetes;
• overactive thyroid;
• glaucoma;
• liver or kidney disease; or
• enlarged prostate, problems with urination.

It is not known whether this medication is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether DUONEB passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using this medication.

If this medication gets in your eyes, rinse with water and seek medical attention.

This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Tell your doctor about all medications you use, and those you start or stop using during your treatment with DUONEB, especially:

• heart or blood pressure medication--penbutolol, pindolol, propranolol, sotalol, timolol, and others.

This list is not complete. Other drugs may interact with DUONEB, including prescription, over-the-counter, vitamin, and herbal products. Not all possible interactions are listed in this medication guide.