How does this medication work? What will it do for me?

This medication belongs to the group of medications called bronchodilators. It is used to treat severe, acute attacks of asthma or chronic obstructive lung conditions, such as emphysema and chronic bronchitis. It contains two ingredients that work by opening the airways.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each mL of clear, colourless solution contains ipratropium bromide 0.125 mg and fenoterol hydrobromide 0.3125 mg. Nonmedicinal ingredients: hydrochloric acid to adjust the pH and sodium chloride.

How should I use this medication?

This medication is used in a nebulizer. The usual adult dose (for those 12 years and over) is 4 mL (one unit dose vial) of ipratropium - fenoterol solution inhaled via a nebulizer. Treatment may be repeated after 6 hours if necessary. If less than 4 mL of solution is to be used at one time as prescribed by your doctor, use a syringe to transfer the necessary amount to the nebulizer chamber. Discard any solution left in the plastic vial, as the solution does not contain preservatives.

If less than 2 mL of solution is to be nebulized, a sterile, preservative-free saline or another suitable nebulizer solution should be used to make up the total volume to between 2 mL and 5 mL. Follow the instructions found with the medication and with your nebulizer for proper treatment, care, maintenance, and equipment cleaning procedures. It is very important to adjust the face mask, if required, to prevent the mist from getting into your eyes.

If this medication does not relieve your symptoms within 10 minutes after the nebulization is finished, if the dosage of medication does not provide relief for longer than 3 hours, or if you experience a worsening of your symptoms, contact your doctor or go to the nearest hospital, as these are signs that your condition may be worsening and that you need to be reassessed by a doctor.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor. If you miss a dose, use it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double a dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Ipratropium - fenoterol should not be used by anyone who:

  • is allergic to ipratropium, fenoterol, or to any of the ingredients of the medication
  • is allergic or sensitive to sympathomimetic or atropinic medications
  • has abnormal heart rhythms associated with fast heart rate
  • has the heart condition called hypertrophic obstructive cardiomyopathy

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • change in taste sensation
  • coughing
  • dizziness
  • dryness of mouth
  • headache
  • nausea
  • nervousness
  • tremor

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • chest discomfort or pain
  • fast or irregular heartbeat
  • shortness of breath or wheezing
  • skin rash or hives
  • swelling of the face, lips, eyelids, mouth, or throat

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Additional treatment: Like other inhalation solutions that contain beta agonists, ipatropium - fenoterol solution should not be used on a regular basis for the treatment of asthma without using appropriate inhaled anti-inflammatory medication (such as budesonide or fluticasone) at the same time.

Eye concerns: Take care to ensure that the nebulizer mask fits your face properly and that nebulized solution does not escape into the eyes. For people who have glaucoma or narrow anterior chambers, avoid using a combined ipratropium and beta-2-agonist solution by nebulizer unless you take measures (e.g., use of swimming goggles or use of a nebulizer with a mouthpiece) to ensure that nebulized solution does not reach the eye. There have been reports of eye complications (e.g., mydriasis, increased eye pressure, angle-closure glaucoma) when nebulized ipratropium either alone or in combination with an adrenergic beta-2-agonist solution come into contact with the eyes.

Medical conditions: People who have had a recent heart attack or who have reduced heart function, abnormal heart rhythms, high blood pressure, overactive thyroid, or diabetes mellitus should take care in using ipratropium - fenoterol. This medication should be used with caution by people who have glaucoma, enlarged prostate, or urinary retention; by people with asthma or emphysema who also have acute and recurring congestive heart failure; and by patients sensitive to sympathomimetic amines.

Worsening of symptoms: Some people who receive inhaled beta-agonists have developed severe worsening of breathing. The cause of this is unknown. If it occurs, stop using this medication immediately and talk to your doctor about an alternative therapy as soon as possible.

Pregnancy and breast-feeding: The safety of this medication for use while pregnant or breast-feeding has not been established. It should be used with caution.

Children: Ipratropium - fenoterol is not currently recommended for use by children under 12 years of age, as its safety and dosing regimen for this age group have not been established.

What other drugs could interact with this medication?

There may be an interaction between ipratropium - fenoterol inhalation solution and any of the following:

  • anticholinergic medications (e.g., atropine)
  • beta-adrenergic medications (e.g., salbutamol)
  • beta-blockers (e.g., bisoprolol)
  • corticosteroids (e.g., prednisone)
  • diuretics that reduce potassium levels (e.g., furosemide)
  • MAO inhibitors (e.g., tranlcypramine)
  • theophylline
  • tricyclic antidepressants (e.g., amitriptyline, imipramine)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.