Ipratropium-Albuterol

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Dec 14, 2023

Warnings

Albuterol and Ipratropium Risks, Warnings, and Complications

Albuterol sulfate and ipratropium bromide can cause or worsen health problems in some people. Talk to your doctor or pharmacist about other treatments for your lung condition if you are at an increased risk of adverse effects from this combination medication. Some of the risks of taking albuterol and ipratropium include:

PARADOXICAL BRONCHOSPASM: Albuterol and ipratropium usually widen the airways, but they can sometimes cause paradoxical bronchospasm (narrowing of the airways), leading to wheezing, cough, difficulty breathing, and chest discomfort. Stop using albuterol and ipratropium and seek emergency medical attention if your symptoms are worse instead of getting better after taking a dose of the medicine.
CARDIOVASCULAR EFFECTS: Rarely, albuterol and ipratropium can cause a clinically significant elevation in pulse rate and blood pressure. Beta adrenergic agonists such as albuterol can also lead to ECG changes such as QTC interval prolongation. You may need to discontinue albuterol and ipratropium if this happens. Before starting this medicine, tell your healthcare provider if you have any heart problems, such as high blood pressure, coronary heart disease, or cardiac arrhythmias.
EYE PROBLEMS: Ipratropium can cause elevation of intraocular pressure (pressure inside the eyes). This can cause or worsen an eye condition called narrow angle glaucoma. Tell your doctor if you have glaucoma or other eye problems before starting treatment. Avoid getting ipratropium and albuterol into your eyes. Seek immediate medical care if you develop eye pain, redness, discomfort, blurry vision, or vision changes.
URINARY RETENTION: Ipratropium bromide is an anticholinergic drug and can cause urinary retention. It should be used with caution in people with an enlarged prostate gland or bladder neck obstruction. Tell your doctor without delay if you develop problems urinating while on this medication.
SERIOUS ALLERGIC REACTIONS: In a small number of people, ipratropium bromide and albuterol sulfate can cause severe adverse drug reactions, including life-threatening skin rashes and anaphylaxis (throat closing). Stop taking ipratropium and albuterol and seek emergency medical attention if you develop signs of severe allergic reactions, such as skin rash, hives, itching, swelling, and difficulty breathing or swallowing.
HYPOKALEMIA: Beta-2-adrenergic agonists such as albuterol sulfate can lead to significant hypokalemia (low serum potassium levels), which can have effects on the heart. The decrease in serum potassium is usually temporary and does not typically require potassium supplementation. Tell your doctor if you are on diuretics (water pills), which can also cause low potassium.

Precautions Before Starting Albuterol and Ipratropium

Tell your doctor if you have ever had an allergic reaction to ipratropium bromide (Atrovent), albuterol sulfate (Ventolin HFA, Proventil HFA, Vospire ER), atropine (Atropen), levalbuterol (Xopenex), any of the active or inactive substances in ipratropium and albuterol formulations, or any other drugs. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a list of all the medicines you are taking, including prescription medications, over-the-counter medicines, vitamins, supplements, and herbal remedies. This can help avoid possible interactions between albuterol and ipratropium and your other medications.

Albuterol and ipratropium may not be safe for people with certain medical conditions. Tell your doctor if you have a medical condition such as glaucoma, prostatic hypertrophy (enlarged prostate gland), urinary problems, blockage in the urinary bladder, seizures, hyperthyroidism (overactive thyroid gland), diabetes mellitus, high blood pressure, irregular heartbeat, heart disease, liver disease, or kidney disease.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breast-feeding.

Precautions During Use of Albuterol and Ipratropium

Keep all your healthcare appointments during treatment with albuterol and ipratropium. Tell your doctor if you have symptoms of worsening COPD. Call your doctor immediately if you develop paradoxical bronchospasm, i.e., your symptoms worsen after taking a dose of the medicine instead of the usual relief. If this happens, do not use albuterol and ipratropium again unless your doctor tells you to.

Call your doctor if you become pregnant while on albuterol and ipratropium.

Tell all your healthcare providers you are on albuterol and ipratropium, especially before any surgery, including dental procedures.

Albuterol and Ipratropium Drug Interactions

Certain other drugs can affect how albuterol and ipratropium work. Possible drug interactions with other medicines can increase the risk of severe adverse effects. Tell your doctor if you are currently taking the following medications or have taken them within the last 14 days:

Tricyclic antidepressants such as amoxapine, amitriptyline, nortriptyline (Pamelor), imipramine (Tofranil), clomipramine (Anafranil), doxepin (Silenor), desipramine (Norpramin), protriptyline (Vivactil), and trimipramine (Surmontil)

Monoamine oxidase (MAO) inhibitors such as tranylcypromine (Parnate), isocarboxazid (Marplan), selegiline (Emsam, Eldepryl, Zelapar), and phenelzine (Nardil)

Certain nonprescription products can also interact with albuterol and ipratropium, for example, medications used to treat the common cold.

Give your doctor or pharmacist a complete list of all the medicines you are taking, including prescription drugs, nonprescription drugs, dietary supplements, and herbal remedies. Do not start any new medications while you are using albuterol and ipratropium without checking with your provider. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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