From the Research
Symbiont (glycopyrrolate and formoterol fumarate) should not be given to a patient already on Duoneb (ipratropium bromide and albuterol) due to the risk of additive anticholinergic effects and excessive beta-stimulation. The primary concern with combining these medications is the potential for increased side effects. Both Symbiont and Duoneb contain components that work in similar ways, with Symbiont containing glycopyrrolate, an anticholinergic agent similar to the ipratropium in Duoneb, and both containing beta-agonists (formoterol in Symbiont and albuterol in Duoneb) 1. Using both medications together could lead to increased side effects such as dry mouth, urinary retention, constipation, and potentially more serious anticholinergic toxicity, as well as excessive beta-stimulation causing tremors, tachycardia, and other cardiovascular effects.
Some key points to consider:
- The combination of ipratropium bromide and albuterol has been shown to be more effective than either agent alone in patients with chronic obstructive pulmonary disease (COPD) 2, 3, 4.
- However, the addition of ipratropium bromide to albuterol for the prehospital treatment of suspected reactive airways disease does not appear to result in clinical outcome improvements 5.
- The most recent and highest quality study is not directly applicable to the question of combining Symbiont and Duoneb, but the principles of avoiding additive anticholinergic effects and excessive beta-stimulation still apply.
In terms of management, if a patient requires both types of medications, their healthcare provider should adjust the regimen to avoid this duplication, possibly by switching completely from one medication to the other or by using individual components strategically timed throughout the day. Any change in respiratory medication should be done under close medical supervision to ensure adequate symptom control and minimize adverse effects.