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Appropriate use of combivent ipratropium bromide and albuterol sulfate inhalation aerosol includes an understanding of the way it should be administered see patient s instructions for use .

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2Remove orange protective dust capIf the cap is not on the mouthpiecemake sure there is nothing in the mouthpiece before useFor best resultsthe canister should be at room temperature before use.

Additional side effects identified from the published literature and/or post-marketing surveillance on the use of ipratropium bromide-containing productssingly or in combination with albuterolincludehypersensitivitypharyngeal edemamouth edemaurinary retentionmydriasisbronchospasmincluding paradoxical bronchospasmcases of precipitation or worsening of narrow-angle glaucomaglaucomaintraocular pressure increasedacute eye painhalo visionblurred visionaccommodation disorderocular irritationcorneal edemaconjunctival hyperaemianasal congestiondrying of secretionsmucosal ulcersstomatitisirritation from aerosolthroat irritationdry throatwheezingexacerbation of COPD symptomshoarsenesspalpitationsheartburndrowsinessCNS stimulationcoordination difficultyflushingalopeciahypotensionedemagastrointestinal distressdiarrheanauseavomitinggastrointestinal motility disorderconstipationhypokalemiamental disorderhyperhidrosismuscle spasmsmuscular weaknessmyalgiaastheniamyocardial ischemiadiastolic blood pressure decreasedand systolic blood pressure increased.

Use COMBIVENT Inhalation Aerosol exactly as prescribed by your doctorDo not change your dose or how often you use COMBIVENT Inhalation Aerosol without talking with your doctorTalk to your doctor if you have questions about your medical condition or your treatment.

3Shake and Test SprayPerform this step before using for the first timeand whenever the aerosol has not been used for more than 24 hoursotherwiseproceed directly to Step 4.

Ipratropium bromide levels remained below detectable limitsTable 1 All Adverse Eventsin percentagesfrom Two Large Double-blindParallel12-Week Studies of Patients with COPD*

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ask your health care provider if combivent respimat spray may interact with other medicines that you take.

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