SAMA + SABA nebule Pregnancy: Ipratropium bromide has been in general use for several years with no definite evidence of ill-consequence during pregnancy and animal studies have shown no hazard. Salbutamol has been in widespread use for many years without apparent ill-consequence, but there is inadequate published evidence of safety in early human pregnancy and animal studies showed some harmful foetal effects at very high doses. Should not be used in pregnancy, especially the first trimester, unless the expected benefit is thought to outweigh any possible risk to the foetus. Similarly should not be given to breast-feeding mothers unless the expected benefit outweighs any possible risk to the neonate (§4.6).

Ipratropium with salbutamol

Brand names: Combivent, Ipramol Steri-Neb

Used in: COPD Asthma

A combination short-acting bronchodilator delivering the antimuscarinic ipratropium with the beta-2 agonist salbutamol, used for COPD and acute bronchospasm. Combining the two classes gives additive bronchodilation from a single preparation.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 1 single dose unit (one UDV nebuliser solution unit dose vial)

Route: Inhalation only — administered from a suitable nebuliser or an intermittent positive pressure ventilator. The single dose units must NOT be taken orally or administered parenterally. — source product: Combivent UDVs

Frequency: Three or four times daily

SOURCE: eMC UK SPC, productName 'Combivent UDVs' (https://www.medicines.org.uk/emc/product/1423/smpc), §4.2. VERBATIM: 'The recommended dose is: Adults (including elderly patients and children over 12 years): 1 single dose unit three or four times daily.' STRENGTH NOT STATED IN THE FETCHED TEXT: §4.2 as retrieved does not give the ipratropium bromide / salbutamol content of one UDV — the clinician must read the strength off the product SPC section 2 before publishing, as this page carries no mg/microgram figure from the source. STARTING DOSE / TITRATION: 'The treatment with the nebuliser solution in UDVs should always be started with the lowest recommended dose (1 UDV). In very severe cases two unit dose vials may be required for symptom relief. Administration should be stopped when sufficient symptom relief is achieved.' SETTING: 'Treatment should be initiated and administered under medical supervision, e.g. in the hospital setting. Home based treatment can be recommended in exceptional cases (severe symptoms or experienced patients requiring higher doses) when a low dose rapid acting beta-agonist bronchodilator has been insufficient in providing relief after consultation with an experienced physician.' PAEDIATRIC: 'Children under 12 years: There is no experience of the use of COMBIVENT UDVs in children under 12 years' — no numeric paediatric dose is given, hence paedDose is null. Children OVER 12 years are dosed as adults per the quote above. ADMINISTRATION: the single dose units contain no preservatives, so the contents must be used immediately after opening and a fresh vial used for each administration to avoid microbial contamination; partly used, open or damaged single dose units should be discarded. 'It is strongly recommended not to mix COMBIVENT UDVs with other drugs in the same nebuliser.' SECTION COVERAGE: §4.5 was not retrieved in this bundle; the interaction entries below are drawn from §4.4 and are not a complete interactions list. §4.4 and §4.8 were truncated at the source-fetch limit.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypertrophic obstructive cardiomyopathy (§4.3)
Tachyarrhythmia (§4.3)
History of hypersensitivity to ipratropium bromide, salbutamol sulfate, or to atropine or its derivatives (§4.3)

Side effects

Headache, throat irritation and cough — among the most frequent side effects reported in clinical trials (uncommon in the tabulated list)
Dry mouth, nausea and gastrointestinal motility disorders including constipation, diarrhoea and vomiting
Dizziness, tremor and nervousness (uncommon); sleep disturbances (rare)
Palpitations and tachycardia (uncommon); arrhythmia, atrial fibrillation, supraventricular tachycardia and myocardial ischaemia (rare)
Ocular complications when the solution or mist enters the eye — mydriasis, blurred vision, narrow-angle glaucoma, eye pain, raised intraocular pressure, corneal oedema (rare); also hypokalaemia, paradoxical bronchospasm, urticaria, angioedema and anaphylactic reaction (rare)

Interactions

Xanthine derivatives, steroids and diuretics — potentially serious hypokalaemia may result from beta2-agonist therapy and this effect may be potentiated by concomitant treatment with these agents; particular caution in severe airway obstruction (§4.4; §4.5 was not retrieved in this bundle)
Digoxin — hypoxia may aggravate the effects of hypokalaemia on cardiac rhythm, especially in patients receiving digoxin; monitoring of serum potassium is recommended (§4.4)

Clinical monograph

How it works

Salbutamol stimulates beta-2 receptors to relax airway smooth muscle for rapid bronchodilation, while ipratropium blocks muscarinic receptors to reduce cholinergic bronchoconstriction, producing complementary effects.

Prescribing in practice

When nebulised, shield the eyes from the mist because the ipratropium component can trigger acute angle-closure glaucoma if it contacts the eyes.
Use cautiously in cardiovascular disease and arrhythmia given salbutamol's cardiac effects, and in prostatic or bladder outflow obstruction given the antimuscarinic component.
Salbutamol can lower serum potassium, so caution is needed with concurrent hypokalaemia, particularly during acute severe attacks.

Monitoring

Monitor respiratory response, heart rate, tremor and, in acute or high-dose use, serum potassium, while watching for any visual symptoms during nebulisation.

Counselling the patient

Keep the nebulised mist away from your eyes and report eye pain or blurred vision.
Mild tremor or a faster heartbeat can occur and usually settles; seek help if symptoms persist or worsen.

Evidence & guidelines

Combining a short-acting antimuscarinic with a short-acting beta-2 agonist is well established in UK practice for COPD and acute airflow obstruction.

Reference: BTS/SIGN; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways