Contraindications for Combivent (ipratropium bromide and albuterol sulfate)
Combivent is contraindicated in patients with a history of hypersensitivity to ipratropium bromide, albuterol, or any of their components, as well as in patients with hypersensitivity to atropine and its derivatives. 1, 2
Primary Contraindications
- Hypersensitivity to ipratropium bromide - Patients with known allergic reactions to ipratropium should not use Combivent 2
- Hypersensitivity to atropine or its derivatives - Due to the structural similarity between ipratropium and atropine, cross-sensitivity can occur 2
- Hypersensitivity to albuterol sulfate - Patients with known allergic reactions to albuterol should avoid this medication 1
- Hypersensitivity to any components in the formulation - Including excipients or preservatives in the medication 1, 2
Precautions and Relative Contraindications
While not absolute contraindications, caution should be exercised in the following conditions:
- Narrow-angle glaucoma - The anticholinergic effects of ipratropium can potentially worsen this condition 3
- Prostatic hypertrophy - Ipratropium's anticholinergic properties may cause urinary retention in patients with prostatic enlargement 3
- Bladder neck obstruction - Similar to prostatic hypertrophy, the anticholinergic effects may worsen urinary symptoms 3
- Cardiovascular disorders - Including coronary insufficiency and hypertension, as beta-agonists like albuterol can cause tachycardia and increased blood pressure 3
Special Considerations
- Paradoxical bronchospasm - Although rare, inhaled bronchodilators can sometimes cause paradoxical bronchospasm, which may be life-threatening. If this occurs, the medication should be discontinued immediately 3
- Worsening of narrow-angle glaucoma - The ipratropium component may increase intraocular pressure if the medication comes in contact with the eyes 3
- Cardiovascular effects - The albuterol component may cause palpitations, tachycardia, and blood pressure changes, particularly in patients with underlying cardiovascular disease 3
Clinical Implications
When prescribing Combivent, clinicians should:
- Thoroughly assess patient history for hypersensitivity to either active ingredient 1, 2
- Consider alternative therapies in patients with severe cardiovascular disorders 3
- Monitor patients with glaucoma or prostatic hypertrophy for worsening of symptoms 3
- Be aware that the combination formulation contains EDTA to prevent discoloration of the solution, which does not typically induce bronchospasm but could be an allergen for some patients 3
The combination of ipratropium bromide and albuterol provides better bronchodilation than either component alone in COPD patients, but these contraindications must be carefully considered before initiating therapy 4, 5.