Introduction About COMBIMIST L INHALER

COMBIMIST L INHALER is a combination of Ipratropium and Levosalbutamol which belongs to the group of medicines called Bronchodilator agents and Adrenergic beta-agonists, respectively. COMBIMIST L INHALER is used in adults, adolescents, and children (aged 4 years and above) to manage/prevent bronchospasm (tightening of airway muscles) with reversible obstructive airway diseases such as asthma, COPD (inflammatory lung disease), bronchitis (inflammation of airways), and/or emphysema (lung disease that cause shortness of breath).

COMBIMIST L INHALER is not recommended for use in patients allergic to ipratropium, levosalbutamol, and/or atropine.

Before using COMBIMIST L INHALER, inform your doctor if you have high blood pressure, seizures, diabetes, narrow angle glaucoma (increased eye pressure), lung problems (such as asthma), heart problems (such as coronary insufficiency, cardiac arrhythmias), kidney problems (such as renal impairment), and/or liver problems (such as hepatic impairment).

COMBIMIST L INHALER is generally not recommended for use in pregnant women unless it is clearly necessary. It is advised to be used with caution in breastfeeding women only if necessary since it is not known whether the medicine passes through breast milk.

COMBIMIST L INHALER should be used with caution in children and adolescents (aged 4 to 18 years) and is advised to be used with caution in elderly patients (aged above 65 years) after consulting the doctor.

The most common side effects using COMBIMIST L INHALER are dry mouth, sore throat, stuffy nose, throat irritation, dizziness, headache, nausea, and/or vomiting. Consult your doctor if any of these symptoms worsens.

Uses Of COMBIMIST L INHALER

• Manages/prevents bronchospasm with reversible obstructive airway diseases such as asthma, COPD, bronchitis, and/or emphysema in affected individuals

How COMBIMIST L INHALER Works

COMBIMIST L INHALER provides ease in breathing from bronchospasm (constricted airway muscles), where Ipatropium and Levosalbutamol work together to relax airway muscles which results in widening of airways providing relief from obstructive airflow and easy in breathing from bronchospasm associated with reversible obstructive airway diseases (such as asthma, COPD) in affected individuals.

How to use COMBIMIST L INHALER

Take COMBIMIST L INHALER as advised by your physician. It is for inhalation use only. Remove the cap and shake the inhaler. Insert the inhaler into spacer and breath out. Press down the inhaler and breath in slowly through the inhaler. Hold your breath for a count of 10 and slowly breath out. Close the inhaler after use. Your doctor will decide the correct dose and duration for you depending upon your age, body weight and disease condition.

Side Effects Of COMBIMIST L INHALER

How To Manage Side Effects

Dry mouth:

Try to drink plenty of cold water and sip on cold unsweetened drinks and use lip balm if your lips are dry. Brush your teeth twice a day and use mouthwash. Consult and inform your doctor if the symptom gets worse.

Dizziness:

Try to rest and get enough sleep. Try to avoid driving or operating any tools or machines while you feel dizzy. Limit consumption of alcohol, as it can aggravate dizziness. Consult and inform your doctor if the symptom worsens.

Headache:

If COMBIMIST L INHALER causes headache, then take rest and drink plenty of fluids. Try to avoid drinking alcohol. Ask your doctor to recommend a painkiller. Headaches should usually go away after the first week of taking COMBIMIST L INHALER. If it lasts more than a week or severe, inform your doctor.

Nausea and vomiting:

Take COMBIMIST L INHALER with or just after a meal. Stick to simple meals. Avoid eating oil rich or spicy foods, sugary snacks and drinks. Avoid drinking too much liquid along with your meals, drink slowly in between meals. Inform your doctor if the condition worsens.

Constipation:

Try to eat high-fiber foods such as vegetables, cereals, fresh fruit, and drink plenty of water. Involve in regular exercise (going for a daily walk or run) and if this does not help, consult and inform your doctor for receiving alternate managements for constipation.

Diarrhoea:

Drink plenty of water and stay hydrated. Try to avoid taking any medicine on your own to manage diarrhea. Consult and inform your doctor if the symptom worsens.

Indigestion:

Try to have smaller and more frequent meals and drink slowly. Reduce consumption of coffee, cola, tea, or alcohol and lose weight if you are obese.  Try to avoid smoking and don’t have rich, fatty or spicy foods. Consult your doctor and inform if the symptom does not improve.

Warning & Precautions

Pregnancy

COMBIMIST L INHALER is generally not recommended for use in pregnant women unless it is clearly necessary.  Consult your doctor before using COMBIMIST L INHALER.

Breastfeeding

COMBIMIST L INHALER should be used with caution in breastfeeding women only if clearly necessary since it is unknown whether the medicine passes through breast milk. Consult your doctor before using the medicine.

Driving and Using Machines

Do not drive/operate machines if you feel dizzy, and/or experience accommodation disorder, dilated pupils/blurred vision while using COMBIMIST L INHALER.

Kidney

COMBIMIST L INHALER should be used with caution in patients with kidney problems such as renal impairment. Consult your doctor before using COMBIMIST L INHALER.

Liver

COMBIMIST L INHALER should be used with caution in patients with liver problems such as hepatic impairment. Consult your doctor before using COMBIMIST L INHALER.

Allergy

Do not take COMBIMIST L INHALER if you are allergic to ipratropium, levosalbutamol, atropine, and/or any other ingredients of the medicine.

Lungs

COMBIMIST L INHALER should be used with caution in patients with lung problems such as asthma. Consult your doctor before using the medicine. 

Heart Disease

COMBIMIST L INHALER should be used with caution in patients with heart problems such as coronary insufficiency, cardiac arrhythmias. Consult your doctor before using COMBIMIST L INHALER.

Interactions

A. Drug-Drug interactions:

Before using COMBIMIST L INHALER, inform your doctor if you are taking any of the following medicine:

• medicines used to manage high blood pressure such as beta-adregenic/receptor blocking agents (Ex. propanolol, metoprolol, atenolol)
• anticholinergic agents (medicines used to block acetylcholine) Ex. atropine, benztropine
• diuretics (used to manage high blood pressure) Ex. chlorothiazide, chlorthalidone
• monoamine oxidase inhibitors/tricyclic antidepressants (medicines used to manage depression) Ex. selegiline, phenelzine, amitriptyline, imipramine

B. Drug–Food interactions:

COMBIMIST L INHALER is not recommended for use in patients allergic to soyabean, and/or other related food products such as peanut.

Overdosage:

If you or anyone else accidentally take too much of COMBIMIST L INHALER, then consult your doctor immediately or visit the nearby hospital. Symptoms of overdose are seizures, chest pain, high/low blood pressure, fast heartbeat, irregular heartbeats, nervousness, headache, tremor, dry mouth, palpitation, nausea, dizziness, fatigue, weakness, sleeplessness, hypokalaemia (low potassium level in blood), and/or visual accommodation disorder.

Synopsis

More Information

• Keep COMBIMIST L INHALER out of reach of children
• Do not store COMBIMIST L INHALER above 30°C

FAQs About COMBIMIST L INHALER

What is COMBIMIST L INHALER used for?

COMBIMIST L INHALER is used in adults, adolescents, and children (aged 4 years and above) to manage/prevent bronchospasm (tightening of airway muscles) with reversible obstructive airway diseases such as asthma, COPD (inflammatory lung disease), bronchitis (inflammation of airways), and/or emphysema (lung disease that cause shortness of breath).

What are the side effects of COMBIMIST L INHALER?

The most common side effects using COMBIMIST L INHALER are dry mouth, sore throat, stuffy nose, throat irritation, dizziness, headache, nausea, and/or vomiting. Consult your doctor if any of these symptoms worsens.

How COMBIMIST L INHALER works?

COMBIMIST L INHALER provides ease in breathing from bronchospasm (constricted airway muscles), where Ipatropium and Levosalbutamol work together to relax airway muscles which results in widening of airways providing relief from obstructive airflow and easy in breathing from bronchospasm associated with reversible obstructive airway diseases (such as asthma, COPD) in affected individuals.

How COMBIMIST L INHALER should be administered?

Take COMBIMIST L INHALER as advised by your physician. It is for inhalation use only. Remove the cap and shake the inhaler. Insert the inhaler into spacer and breath out. Press down the inhaler and breath in slowly through the inhaler. Hold your breath for a count of 10 and slowly breath out. Close the inhaler after use. Your doctor will decide the correct dose and duration for you depending upon your age, body weight and disease condition.

Can COMBIMIST L INHALER be used in pregnant and breastfeeding women?

No, COMBIMIST L INHALER is generally not recommended for use in pregnant women unless it is clearly necessary. It should be used with caution in breastfeeding women only if necessary since it is not known whether the medicine pass through breast milk. Consult your doctor before using COMBIMIST L INHALER.

References

1. K.D. Tripathi. Anticholinergic Drugs and Drugs Acting on Autonomic Ganglia. Essentials of medical pharmacology. Seventh edition. 2013. Page- 116.

2. Hongzhen Xu, Lin Tong, Peng Gao,  Yan Hu, Huijuan Wang, Zhimin Chen, Luo Fang. Combination of ipratropium bromide and salbutamol in children and adolescents with asthma: A meta-analysis. NIH National Library of Medicine. National Center for Biotechnology Information. PMC PubMed Central. [Revised in February 2021] [Accessed on 27th May 2022] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901745/

3. CiplaMed. DUOLIN Inhaler. [Revised in April 2019] [Accessed on 27th May 2022] https://www.ciplamed.com/content/duolin-inhaler

4. CiplaMed. DUOLIN forte Inhaler.[Accessed on 27th May 2022] https://www.ciplamed.com/product-index-listing?field_speciality_tid=All&field_other_specialty_tid=All&field_brand_value=&field_molecule_value=levo

Useful Diagnostic Tests

• Spirometry
• Chest X-ray
• CT scan

Author Details

Written By Dr. K .AZEEM HUSSAIN - B.D.S

Reviewed By Dr. Sankara Babu Gorle - MBBS, MD(Pharmacology) View profile

Last updated on 26 Nov 2022 | 07:08 PM(IST)