When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to ipratropium or to other medicines like ipratropium (such as atropine, scopolamine, or hyoscyamine). This medicine is not to be used during an asthma attack.

How to Use This Medicine:
Aerosol

• Your doctor will tell you how much medicine to use. Do not use more than directed.
• 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).
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Remove the cap and look at the mouthpiece to make sure it is clean.
• Shake the inhaler well just before each use. Avoid spraying this medicine into your eyes.
• Test spray in the air before using for the first time or if the inhaler has not been used for a while.
• To inhale this medicine, breathe out fully, trying to get as much air out of the lungs as possible. Put the mouthpiece just in front of your mouth with the canister upright.
• Open your mouth and breathe in slowly and deeply (like yawning), and at the same time firmly press down on the top of the canister once.
• Hold your breath for about 5 to 10 seconds, and then breathe out slowly.
• If you are supposed to use more than one puff, wait at least 15 seconds before inhaling the second puff. Repeat these steps for the next puff starting with shaking the inhaler. You do not need to repeat the test spray.
• When you have finished all your inhalations, rinse your mouth out with water.
• Carefully follow the patient instructions about cleaning and caring for your inhaler.

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

• Make sure your doctor knows if you are using atropine, scopolamine, or any other ipratropium product (such as an ipratropium nasal spray, an albuterol plus ipratropium liquid, Combivent®, or Duoneb®).

Warnings While Using This Medicine:

• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have glaucoma, an enlarged prostate, or any problems with urination.
• This medicine will not stop an asthma attack that has already started. Your doctor may prescribe another medicine for you to use in case of an acute asthma attack.
• If you use any type of corticosteroid medicine to control your asthma, keep using it as ordered by your doctor. This includes corticosteroid medicines that are taken by mouth or inhaled (such as prednisone, Azmacort®, Deltasone®, or Flovent®).
• If any of your asthma medicines do not seem to be working as well as usual, call your doctor right away. Do not change your doses or stop using your medicines without asking your doctor.
• Do not spray the medicine into your eyes. If this does happen, rinse your eyes with cool water for a few minutes. The medicine might make the dark part of your eye bigger for a few hours. Call your doctor if you have eye pain, blurred vision, or start seeing halos or odd colors when you look at things.
• Call your doctor if your symptoms do not improve or if they get worse.

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 or eye pain.
• Fast, pounding heartbeat.
• Lightheadedness, dizziness, or fainting.
• Problems with bowel movements (stools).
• Trouble urinating or pain when urinating.
• Worsening asthma symptoms or breathing problems.

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

• Back pain.
• Dry mouth or throat, cough, sore throat, or runny or stuffy nose.
• Headache.
• Nervousness.
• Upset stomach.

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