DuoNeb

Generic name: albuterol and ipratropium (inhalation)
Drug class: Bronchodilator combinations

Medically reviewed by  A Ras MD.

What is DuoNeb?

DuoNeb is a prescription medicine that is used to open the airways in lung diseases where spasm may cause breathing problems.

Description

The active components in DuoNeb® (ipratropium bromide and albuterol sulfate) Inhalation Solution are albuterol sulfate and ipratropium bromide.

Albuterol sulfate, is a salt of racemic albuterol and a relatively selective β2-adrenergic bronchodilator chemically described as α1-[(tert-butylamino)methyl]-4-hydroxy-mxylene-α, α’-diol sulfate (2:1) (salt). It has a molecular weight of 576.7 and the empirical formula is (C₁₃H₂₁NO₃)2•H₂SO₄. It is a white crystalline powder, soluble in water and slightly soluble in ethanol. The World Health Organization recommended name for albuterol base is salbutamol.

Figure 3 1-1: Chemical structure of albuterol sulfate

Ipratropium bromide is an anticholinergic bronchodilator chemically described as 8azoniabicyclo [3.2.1]-octane, 3-(3-hydroxy-1-oxo-2-phenylpropoxy)-8methyl-8-(1methylethyl)-, bromide, monohydrate (endo, syn)-, (±)-; a synthetic quaternary ammonium compound, chemically related to atropine. It has a molecular weight of 430.4 and the empirical formula is C₂₀H₃₀BrNO₃•H₂O. It is a white crystalline substance, freely soluble in water and lower alcohols, and insoluble in lipophilic solvents such as ether, chloroform, and fluorocarbons.

Figure 3. 1-2: Chemical structure of ipratropium bromide.

Each 3 mL vial of DuoNeb (ipratropium bromide and albuterol sulfate) contains 3.0 mg (0.1%) of albuterol sulfate (equivalent to 2.5 mg (0.083%) of albuterol base) and 0.5 mg (0.017%) of ipratropium bromide in an isotonic, sterile, aqueous solution containing sodium chloride, hydrochloric acid to adjust to pH 4, and edetate disodium, USP (a chelating agent).

DuoNeb (ipratropium bromide and albuterol sulfate) is a clear, colorless solution. It does not require dilution prior to administration by nebulization. For DuoNeb (ipratropium bromide and albuterol sulfate) Inhalation Solution, like all other nebulized treatments, the amount delivered to the lungs will depend on patient factors, the jet nebulizer utilized, and compressor performance. Using the Pari-LC-Plus™ nebulizer (with face mask or mouthpiece) connected to a PRONEB™ compressor system, under in vitro conditions, the mean delivered dose from the mouth piece (% nominal dose) was approximately 46% of albuterol and 42% of ipratropium bromide at a mean flow rate of 3.6 L/min. The mean nebulization time was 15 minutes or less. DuoNeb (ipratropium bromide and albuterol sulfate) should be administered from jet nebulizers at adequate flow rates, via face masks or mouthpieces

Before taking DuoNeb, tell your doctor:

• If you are allergic to DuoNeb; any part of this medicine; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.
• If you take other drugs called anticholinergics, like ipratropium or oxybutynin. Ask your doctor if you are not sure if any of your drugs are anticholinergic.
• If you are breast-feeding or plan to breast-feed.

This is not a list of all drugs or health problems that interact with this medicine.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take DuoNeb with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take DuoNeb?

• Tell all of your health care providers that you take DuoNeb. This includes your doctors, nurses, pharmacists, and dentists.
• Avoid driving and doing other tasks or actions that call for you to be alert or have clear eyesight until you see how DuoNeb affects you.
• Do not take more of DuoNeb or use it more often than you have been told. Deaths have happened when too much of DuoNeb was taken. Talk with your doctor.
• Call your doctor right away if your normal dose does not work well, if your signs get worse, or if you need to use DuoNeb more often than normal.
• If you have high blood sugar (diabetes), you will need to watch your blood sugar closely.
• Do not get DuoNeb in the eyes.
• If DuoNeb gets in the eyes, rinse with water right away. Call the doctor right away if DuoNeb gets in the eyes and blurred eyesight, worsened glaucoma, or eye pain happens.
• Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using DuoNeb while you are pregnant.

How is DuoNeb best taken?

Use DuoNeb as ordered by your doctor. Read all information given to you. Follow all instructions closely.

• For breathing in only as a liquid (solution) by a special machine (nebulizer) into the lungs.
• Do not use if the solution is cloudy, leaking, or has particles.
• Do not use if solution changes color.
• Do not mix other drugs in nebulizer.

What do I do if I miss a dose?

• If you use DuoNeb on a regular basis, use a missed dose as soon as you think about it.
• If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
• Do not use 2 doses at the same time or extra doses.
• Many times DuoNeb is used on an as needed basis. Do not use more often than told by the doctor.

What are the side effects of DuoNeb that I need to call my doctor about immediately?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Signs of low potassium levels like muscle pain or weakness, muscle cramps, or a heartbeat that does not feel normal.
• Signs of high blood pressure like very bad headache or dizziness, passing out, or change in eyesight.
• Chest pain or pressure or a fast heartbeat.
• A heartbeat that does not feel normal.
• Change in eyesight, eye pain, or very bad eye irritation.
• Seeing halos or bright colors around lights.
• Red eyes.
• Trouble passing urine, pain when passing urine, passing urine in a weak stream or drips, or passing urine more often.
• Very bad dizziness or passing out.
• This medicine can cause very bad breathing problems right after you take a dose. Sometimes, this may be life-threatening. If you have trouble breathing, breathing that is worse, wheezing, or coughing after using DuoNeb, use a rescue inhaler and get medical help right away.

What are some other side effects of DuoNeb?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Feeling nervous and excitable.
• Headache.
• Shakiness.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-332-1088. You may also report side effects at https://www.fda.gov/medwatch.

If overdose is suspected:

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

How do I store and/or throw out DuoNeb?

• Store at room temperature. Do not freeze.
• Protect from light.
• Store unused containers in foil pouch until use.
• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

SRC: NLM .