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There are numerous case reports in the literature of precipitation of glaucoma with the use of ipratropium and albuterol via nebulized solutionThis is thought to occur through direct contact with the eyesand is seen with the combination since both beta agonists and anticholinergics can increase intraocular pressureThere is one report of glaucoma associated with the use of nebulized albuterol and ipratropium aerosol in an emergency departmentCaution is warranted when the combination is used in patients predisposed to glaucomaExtra care should be taken to avoid contact with the eyesRef]

Get emergency medical help if you have any of these signs of an allergic reactionhivesdifficult breathingswelling of your facelipstongueor throat.

Remove 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 useShake 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.

Check with your doctor immediately if any of the following side effects occur while taking albuterol/ipratropium:

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patients were randomized to atrovent 40 200 mcg n 345 ,cfc-propelled combivent inhalation aerosol 36 206 mcg n 180 , ipratropiumdelivered by the respimat 40 mcg n 252 or placebo n 341 .

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