In the following conditions COMBIVENT UDVs should only be used after careful risk/benefit assessment: insufficiently controlled diabetes mellitus, recent myocardial infarction and/or severe organic heart or vascular disorders, hyperthyroidism, pheochromocytoma, risk of narrow-angle glaucoma, prostatic hypertrophy or bladder-neck obstruction.Cardiovascular effects may be seen with sympathomimetic drugs including COMBIVENT.There is some evidence from post-marketing data and published literature of rare occurrences of myocardial ischaemia associated with salbutamol. Increase in lactate levels may lead to dyspnoea and compensatory hyperventilation, which could be misinterpreted as a sign of asthma treatment failure and lead to inappropriate intensification of short-acting beta-agonist treatment. Following this single inhaled administration, approximately 27% of the estimated mouthpiece dose is excreted unchanged in the 24-hour urine. It is strongly recommended not to mix COMBIVENT UDVs with other drugs in the same nebuliser. Patients with underlying severe heart disease (e.g. 7th ed. Dosage Forms and Strengths. in the context of athletic performance enhancement (doping).The chronic co-administration of COMBIVENT with other anticholinergic drugs has not been studied. The concurrent administration of other beta-mimetics, systemically absorbed anticholinergics and xanthine derivatives may increase the severity of side effects. 4.6 Pregnancy and lactation Ipratropium bromide has been in general use for several years and there is no definite evidence of ill-consequence during pregnancy; animal studies have shown no hazard. Metabolic acidosis has also been observed with overdosage of salbutamol, including lactic acidosis which has been reported in association with high therapeutic doses as well as overdoses of short-acting beta-agonist therapy, therefore monitoring for elevated serum lactate and consequent metabolic acidosis (particularly if there is persistence or worsening of tachypnea despite resolution of other signs of bronchospasm such as wheezing) may be indicated in the setting of overdose. Administration should be stopped when sufficient symptom relief is achieved. mydriasis, blurring of vision, narrow-angle glaucoma and eye pain) when the contents of metered aerosols containing ipratropium bromide have been sprayed inadvertently into the eye. Patients must be instructed in the correct use of COMBIVENT UDVs and warned not to allow the solution or mist to enter the eyes. It can help treat a range of bacterial infections that affect the lungs, sinuses, skin, and other parts of the body.
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The stage of pregnancy Concurrent morbidities; It is important to recognise that antibiotics should be administered during pregnancy at the upper end of their suggested dosing ranges, as pregnant women have an increased GFR and volume of distribution ranges are higher e.g.
Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm208302.htm. Treatment with COMBIVENT should be discontinued. This is particularly important in patients who may be pre-disposed to glaucoma.
There have been rare cases of ocular complications (i.e. It is therefore recommended that patients are monitored for the development of elevated serum lactate and consequent metabolic acidosis in this setting.The use of COMBIVENT may lead to positive results with regards to salbutamol in tests for non clinical substance abuse, e.g. COMBIVENT UDVs are intended for inhalation only and may be administered from a suitable nebuliser or an intermittent positive pressure ventilator.
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