When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to albuterol, ipratropium, levalbuterol, or atropine. Do not use Combivent® if you are allergic to soya lecithin, soybeans, or peanuts.

How to Use This Medicine:
Powder Under Pressure, Solution, Spray

• Your doctor will tell you how much medicine to use. Do not use more than directed. This medicine comes in more than one form. Make sure you understand how to use your medicine. Ask your doctor or pharmacist if you have questions.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Aerosol inhaler:
  
  • You will use this medicine with a device called a metered-dose inhaler. The inhaler fits on the medicine canister and turns the medicine into a fine spray that you breathe in through your mouth and to your lungs. You may be told to use a spacer, which is a tube that is placed between the inhaler and your mouth. Your caregiver will show you how to use your inhaler and the spacer (if needed).
  • The first time you use a canister, shake it well for 10 seconds. Then spray the medicine 3 times away from your face. The medicine is now ready to use.
  • Shake the canister well for 10 seconds each time before you use a dose. If you have not used the medicine in 24 hours, repeat the steps for the first use.
  • Clean the inhaler mouthpiece daily with warm water.
• Spray inhaler:
  
  • You need to prime the spray inhaler the first time you use it and if you have not used it for more than 3 days in a row.
  • To prime the spray inhaler, point the inhaler away from your face and press the button until some medicine sprays out. Then spray the medicine 3 more times. The medicine is now ready to use.
  • Follow the instructions that came with the medicine if it has been more than 3 days since you used the medicine.
  • Clean the mouthpiece with a damp cloth or a tissue. Do this at least once a week.
• Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
• Keep the medicine in the foil pouch until you are ready to use it. Store at room temperature, away from heat and direct light. Do not freeze.
• Store the canister at room temperature, away from heat and direct light. Do not freeze. Do not keep this medicine inside a car where it could be exposed to extreme heat or cold. Do not poke holes in the canister or throw it into a fire, even if the canister is empty.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some medicines can affect how ipratropium/albuterol works. Tell your doctor if you are using any of the following:
  
  • Other inhaled medicines
  • Beta-blocker medicine
  • Diuretic (water pills)
  • Medicine to treat depression or an MAO inhibitor within the past 2 weeks

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, diabetes, blood vessel problems, glaucoma, heart disease, heart rhythm problems, high blood pressure, an overactive thyroid, prostate problems, trouble urinating, or a history of seizures.
• This medicine may cause the following problems:
  
  • Paradoxical bronchospasm (trouble breathing), which can be life-threatening
  • Heart rhythm changes
• Do not use this medicine for a sudden COPD attack. Make sure you always have your rescue medicine with you to treat sudden symptoms.
• If any of your COPD medicines do not seem to be working as well as usual, call your doctor right away. Take all of your COPD medicines as instructed. Do not use more medicine or change your dose without asking your doctor.
• This medicine may cause dizziness, drowsiness, or trouble seeing. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blurred vision, eye pain, seeing halos around objects
• Chest pain, fast, pounding, or uneven heartbeat
• Decrease in how much or how often you urinate, painful or difficult urination
• Dry mouth, increased thirst, muscle cramps, nausea, vomiting
• Increased trouble breathing

If you notice these less serious side effects, talk with your doctor:

• Nervousness, shaking

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088