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Combivent (Levosalbutamol Ipratropium Bromide) Buyer and Patient Handbook in Singapore

What is Combivent?

Combivent is a combination inhaler containing levosalbutamol (a short-acting β₂-agonist) and ipratropium bromide (an anticholinergic), used to relieve acute bronchospasm in Asthma and chronic obstructive airway disease. It belongs to the bronchodilator class and is approved by the Health Sciences Authority (HSA) of Singapore. The inhaler delivers a fixed dose of 50 µg levosalbutamol and 20 µg ipratropium per puff.

Who Should Use Combivent?

• Adults and adolescents (≥12 years) experiencing reversible airway obstruction.
• Individuals who need both β₂-agonist and anticholinergic action for optimal bronchodilation.
• Patients whose symptoms are not fully controlled by a single bronchodilator inhaler.

How Does It Work?

Combivent works by relaxing the smooth muscles of the airways: levosalbutamol stimulates β₂-receptors to cause rapid dilation, while ipratropium blocks muscarinic receptors to prevent bronchoconstriction. The dual mechanism provides a broader “opening” of the airways than either agent alone. It is not habit-forming, but overuse may signal uncontrolled disease and should be reviewed by a healthcare professional.

Why Choose Combivent?

• Convenient dual therapy in one device reduces the number of inhalations needed during an attack.
• The branded formulation guarantees consistent particle size and dose delivery, while generic equivalents offer cost savings with comparable bio-equivalence.
• Off-label use (e.g., for exercise-induced bronchospasm) should only be considered after professional advice.

Dosage, Administration, Lifestyle and Dietary Recommendations

Recommended Dosage

• Adults and adolescents: 1 puff (50/20 µg) every 4-6 hours as needed, not exceeding 4 puffs per 24 hours.

How to Take

1. Shake the inhaler gently and remove the cap.
2. Exhale completely, place the mouthpiece between your lips, and inhale slowly while pressing the canister.
3. Hold your breath for 5-10 seconds, then breathe out gently.

Missed Dose

If you miss a dose and your symptoms are still present, take a puff as soon as you remember. Avoid taking two doses too close together; wait at least 4 hours before the next dose.

Overdose

Symptoms may include rapid heartbeat, tremor, or severe coughing. Seek immediate medical attention or contact the Singapore Poison Centre (180-225 5555).

Special Populations

• Elderly: Start at the lowest effective frequency; monitor for tremor or palpitations.
• Renal impairment: No dose adjustment needed, but observe for accumulation of ipratropium.
• Pregnancy & breastfeeding: Use only if the benefit outweighs potential risk; limited data available.

Lifestyle & Diet

• Avoid using the inhaler immediately after vigorous exercise; allow a few minutes for normal breathing to resume.
• Grapefruit juice does not significantly affect combivent, but excessive caffeine may increase tremor.
• Keep rescue inhalers accessible during travel and in workplaces.

Precautions and Warnings

• Do not exceed the recommended maximum daily dose.
• Use with caution in patients with cardiovascular disease, Thyrotoxicosis, or Diabetes, as levosalbutamol can raise heart rate and blood glucose.
• Monitor for paradoxical bronchospasm; discontinue and seek help if breathing worsens after inhalation.

Drug Interactions

Potential Side Effects

Common Side Effects

• Tremor
• Palpitations
• Dry mouth

Less Common Side Effects

• Headache
• Nausea
• Sore throat

Serious Side Effects

• Severe chest tightness or wheezing (paradoxical bronchospasm) - stop use and seek urgent care.
• Rapid or irregular heartbeat - consult a doctor promptly.

Who Should Avoid This Medication?

• Individuals with known hypersensitivity to levosalbutamol, ipratropium, or any inhaler excipients.
• Patients with acute narrow-angle Glaucoma or urinary retention.
• Those who have experienced a severe allergic reaction to any component of the inhaler.

Storage Instructions

• Store at 20-25 °C (68-77 °F); protect from extreme heat or freezing.
• Keep the inhaler in the original container to avoid moisture exposure.
• Keep out of reach of children; discard after the indicated expiry date.

Combivent Alternatives

Frequently Asked Questions

How quickly does Combivent relieve symptoms?

Combivent typically begins to improve breathing within 5-15 minutes after inhalation.

Can I use Combivent with my regular maintenance inhaler?

Yes, it can be used as a rescue inhaler alongside daily controller medications; space doses by at least 5 minutes.

Is it safe to use Combivent during pregnancy?

Only if clearly needed; discuss with your obstetrician to balance benefits and potential risks.

What should I do if I experience a dry mouth after using Combivent?

Sip water or use a sugar-free lozenge; if discomfort persists, inform a healthcare professional.

Can I take Combivent before exercise?

A single puff 10-15 minutes before strenuous activity can help prevent exercise-induced bronchospasm.

Does smoking affect Combivent’s effectiveness?

Smoking can reduce bronchodilator response; quitting or reducing tobacco use is advised.

How many inhalations does the canister contain?

Each cartridge provides 200 puffs, sufficient for several months of as-needed use at the recommended frequency.

Are there any drug interactions with common cold medicines?

Decongestants containing pseudoephedrine may increase heart rate; monitor symptoms and consult a pharmacist if needed.

Glossary

• β₂-agonist: A medication that stimulates β₂-adrenergic receptors to relax airway muscles.
• Anticholinergic: A drug that blocks acetylcholine receptors, preventing bronchoconstriction.
• Bronchospasm: Sudden narrowing of the airways causing difficulty breathing.
• Paradoxical bronchospasm: Worsening of airway obstruction after inhaler use, a rare but serious reaction.

Disclaimer

The information provided here is for general educational purposes and does not replace professional medical advice. Off-label use should only be considered after consulting a qualified healthcare provider. Our platform offers convenient access to approved medicines in Singapore, but the ultimate responsibility for safe use rests with the reader. Always consult a doctor or pharmacist for personalized recommendations.