Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 2.5 mg/3mL Solution — NDC 47335-0756-52 package photo

Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 2.5 mg/3mL Solution

by Sun Pharmaceutical Industries, Inc. · 12 POUCH in 1 CARTON (47335-756-52) / 5 VIAL in 1 POUCH / 3 mL in 1 VIAL
NDC 47335-0756-52
🏷️ FDA NDC (as labeled) 47335-756-52 billing pads the product segment with a zero
This package
Contains3 mL in 1 vial Cost per mL$0.0855 NADAC Per package$15.39 / 180 ml Pack sizes2 compare ↓
Also priced by: Medicaid pays $0.1060/unit · Part D plans $0.1058/unit — full pricing hub ↓
Also comes in: 6 pouches 47335-0756-49
Rx only Generic On market Non-controlled
🗂️ Data synced Aug 27, 2026 · sources: openFDA · FDA label (DailyMed) · FDA Orange & Purple Book · First Databank · CMS NADAC, ASP, Medicare & Medicaid · RxNorm
📋 All sources & update times →

🆔 Identity & classification

FDA NDC (as labeled) 47335-756-52
Product NDC 47335-756
11-digit billing NDC 47335075652
NCPDP billing unit ML — per mL (volume)
RxCUI 1437702
UNII J697UZ2A9J, 021SEF3731
Application # ANDA207875
SPL Set ID 38f9a201-3954-4370-8e71-7ec2df88a1ff
Established class (EPC) Anticholinergic; beta2-Adrenergic Agonist
Mechanism of action Adrenergic beta2-Agonists; Cholinergic Antagonists
DEA schedule Non-controlled
Marketing category ANDA
Marketing status On market
FDA listing status Listed (active directory)
Marketing start 2021-11-15
Route RESPIRATORY (INHALATION)
Dosage form SOLUTION
Substance IPRATROPIUM BROMIDE; ALBUTEROL SULFATE
GPI-14 44209902012015
GPI class Ipratropium-Albuterol
GCN Seq No 048018
GCN 13456
HICL code 009040
Ingredient (HICL) Ipratropium/Albuterol Sulfate
HIC1 code B
Therapeutic class — broad (HIC1) Respiratory System
HIC2 code B6
Therapeutic class — intermediate (HIC2) Drugs Affecting The Trachea And Bronchi (Cont3)
HIC3 code B62
Therapeutic class — specific (HIC3) Beta-Adrenergic And Anticholinergic Combo, Inhaled
AHFS code 12:08.08.00
AHFS class Antimuscarinics/Antispasmodics
FDB label name IPRAT-ALBUT 0.5-3(2.5) MG/3 ML
FDB brand name Ipratropium-Albuterol
Legend status F — Federal legend — prescription drug or device
TE code (Orange Book) AN · RLD · RS
Why two NDCs? The FDA registers this code as 47335-756-52 — a 5-3-2 layout, and that's what's printed on the package and shown on DailyMed. For insurance claims, every NDC is standardized to a uniform 11-digit 5-4-2 format by adding a zero to the product segment → 47335-0756-52. Same drug, same package — only the format differs.
Where does this data come from?
Identifiers from the FDA openFDA NDC Directory and Structured Product Labeling; RxCUI from RxNorm (NLM); GPI from Medi-Span; GCN / HIC / AHFS / legend from First Databank.

🏷️ RxNorm drug class

This medicine belongs to the beta2-Adrenergic Agonist class.

Pharmacologic class beta2-Adrenergic Agonist
Drug family (ATC) Selective beta-2-adrenoreceptor agonists, Selective beta-2-adrenoreceptor agonists
How it works Adrenergic beta2-Agonists
Where does this data come from?
Therapeutic classes from RxNorm RxClass (U.S. National Library of Medicine) — Established Pharmacologic Class (FDA), ATC drug family (WHO) and mechanism of action, matched by this product’s RxCUI.

🏭 Manufacturer & labeler

LabelerSun Pharmaceutical Industries, Inc.
Application holderSUN PHARMACEUTICAL INDUSTRIES LTD
FDA applicationANDA207875 (ANDA)
Labeler code47335
First marketedNov 2021
Product typeHuman Prescription Drug
Portfolio889 products on file
The labeler markets the product; the application holder owns the FDA approval. They’re often the same company but can differ (e.g. a repackager or an authorized generic). A mailing address / phone appears here when the manufacturer includes it in the product’s FDA label (not all do).
Where does this data come from?
Labeler, application holder and registered establishment from the FDA openFDA NDC Directory and Drugs@FDA; address/contact from the product’s FDA label.

🩺 Clinical

Label name IPRAT-ALBUT 0.5-3(2.5) MG/3 ML Ingredient Ipratropium/Albuterol Sulfate
Where does this data come from?
Plain-language summary from MedlinePlus (U.S. National Library of Medicine); supplement & herbal interactions and nutrient depletion data from the Natural Medicines database; our full guide is HelloPharmacist editorial content.

🧪 Inactive Ingredients / Excipients

Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.

💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.

  • UNII 7FLD91C86K
    Edetate disodium is a chemical compound that binds and removes certain metal ions. In medicines, it acts as a preservative and stabilizer by preventing metals like calcium from interfering with the product's shelf life and consistency.
  • UNII QTT17582CB
    A strong acid used to adjust and maintain the proper pH level in liquid medicines, ensuring stability and preventing breakdown of active ingredients.
  • UNII 451W47IQ8X
    Sodium chloride is common table salt. It's used in medicines as a buffer to maintain proper pH, as a filler to add bulk, or to adjust the osmotic balance in liquid formulations.
  • UNII 059QF0KO0R
    Water is a liquid solvent that dissolves and mixes ingredients together in liquid medicines, syrups, and injections. It helps distribute the active drug evenly throughout the product.

4 inactive ingredients listed in the exact product block matched to this NDC.

Where does this data come from?
Data sourced from official FDA Structured Product Labeling (SPL) via DailyMedingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.

Inactive ingredient FAQ

Are inactive ingredients the same for every manufacturer?
No. Inactive ingredients can differ by manufacturer, dosage form, strength, and package / product version.
Why might an inactive ingredient be missing?
Some SPLs do not provide a complete structured inactive-ingredient list, and older or unusual labels may only include the information in narrative text.
Can inactive ingredients matter?
Yes. They can matter for allergies, intolerances, dyes, gluten / lactose concerns, preservatives, and formulation differences — but confirm with a pharmacist or the manufacturer when it’s clinically important.

💲 Pricing

A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.

Price systemPer mLPer package
Retail pharmacies payNADAC · weekly $0.086 $15.39 / 180 ml
Medicaid paysCMS SDUD · 12 mo $0.1060 $19.08 / 180 ml
Medicare drug plans payPart D · Q2 2026 $0.1058 $19.04 / 180 ml
Medicare Part B allowsASP · J7620 $0.201 / J7620 unit
NADAC price history (per mL) — tap or hover for the price & month
Mar 2022 Sep 2022 Jan 2026 Aug 2026 $0.086 $0.060
▲ Up 41% over the last 21 months.
Where does this data come from?
NADAC (National Average Drug Acquisition Cost) is the CMS weekly pharmacy-acquisition-cost survey — what pharmacies pay. ASP (Average Sales Price) is the CMS Medicare Part B drug-payment file, published quarterly. Medicaid pays is computed by us from CMS State Drug Utilization Data (total reimbursed ÷ units, trailing 12 months) — gross of rebates and inclusive of dispensing fees, so it reflects what Medicaid paid, not an acquisition cost. Medicare drug plans pay is the median negotiated point-of-sale unit cost across plans listing this NDC in the CMS quarterly Prescription Drug Plan pricing files, before rebates. The VA pays is the federal contract price (FSS, and the statutory Big 4 ceiling where listed) from the VA National Acquisition Center pharmaceutical price file. All are free public government data; each measures a different payer, so the figures are not directly comparable.

🧾 Billing & reimbursement

FDA NDC (as labeled)47335-756-52
11-digit billing NDC47335-0756-52
Format5-3-2 as registered → padded to 5-4-2 for billing (zero added to the product segment)
HCPCS J-codeJ7620
DescriptorALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME
Billing units / pkg0.33 units
Crosswalk sourcePDAC NDC-HCPCS crosswalk (DME MAC / DMEPOS)
Where does this data come from?
The HCPCS J-code crosswalk comes from the CMS ASP NDC-HCPCS crosswalk and the DMEPDAC (DME MAC) NDC-HCPCS crosswalk — free public CMS data. Billing units are derived from the code’s descriptor and the package amount.

🔁 Therapeutic equivalents

ProductLabelerPackNADAC/unitTEStatusPrice vs. this
Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 2.5 mg/3mL 00378-9671-30 Mylan 1 pouch $0.081 AN Availability likely save 5%
Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 3 mg/3mL 00487-0201-01 Nephron 30 pouches $0.081 AN Availability likely save 5%
Ipratropium Bromide And Albuterol Sulfate 2.5 mg/3mL; .5 mg/3mL 60687-0405-83 American 30 pouches $0.081 AN Availability likely save 5%
Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 3 mg/3mL 62135-0831-84 Chartwell 6 pouches $0.081 AN Availability likely save 5%
Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 3 mg/3mL 64980-0645-03 Rising 30 pouches $0.081 AN Availability likely save 5%
Ipratropium Bromide and Albuterol Sulfate 2.5 mg/3mL; .5 mg/3mL 69097-0173-53 Cipla 6 pouches $0.081 AN Availability likely save 5%
Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 2.5 mg/3mL 69097-0840-53 Cipla 30 pouches $0.081 AN Availability likely save 5%
Ipratropium Bromide And Albuterol Sulfate 2.5 mg/3mL; .5 mg/3mL 76204-0600-01 Ritedose 30 pouches $0.081 AN Availability likely save 5%
Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 2.5 mg/3mLthis 47335-0756-52 Sun 12 pouches $0.085 AN Availability likely
Ipratropium Bromide And Albuterol Sulfate 2.5 mg/3mL; .5 mg/3mL 50090-1382-00 A-S 30 vials AN FDA listed
Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 3 mg/3mL 50090-1669-00 A-S 30 vials AN FDA listed
Ipratropium Bromide And Albuterol Sulfate 2.5 mg/3mL; .5 mg/3mL 60429-0975-30 Golden 1 pouch AN FDA listed
Ipratropium Bromide and Albuterol Sulfate 2.5 mg/3mL; .5 mg/3mL 65862-0906-03 Aurobindo 30 pouches FDA listed
Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 3 mg/3mL 68788-8103-03 Preferred 30 pouches AN FDA listed
Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 3 mg/3mL 71205-0051-15 Proficient 15 pouches AN FDA listed
Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 2.5 mg/3mL 71205-0726-15 Proficient 1 pouch AN FDA listed
About this product: this is a generic version of the medicine. FDA equivalence ratings are shown when available, and other versions are listed above, least expensive first.
Where does this data come from?
Equivalents are other NDCs of the same ingredient, form and route from the openFDA NDC Directory, ranked least-expensive-first by NADAC. Therapeutic-equivalence (AB) ratings come from the FDA Orange Book; biologics use the FDA Purple Book for biosimilar & interchangeable status.

Availability & generic status

🏛️
2021
On the market since
Nov 2021
📍
2026
Currently FDA-listed
5 years listed
🔓
·
Generic on the market
this product is a generic
This is a generic drug

This product is an FDA-approved generic. Other versions of the same drug are listed under Therapeutic equivalents, least expensive first.

Where does this data come from?
Patents and exclusivity from the FDA Orange Book (small-molecule drugs), refreshed from public FDA data. Generic launch timing is an estimate, not a guarantee.

🗺️ Medicaid utilization & spend

📍 This exact package only: Medicaid data is reported per full 11-digit NDC — labeler, product and pack size — so every number here is for 47335-0756-52, not the drug overall. Other pack sizes report separately.
💊 Pharmacy benefit only: These are Medicaid outpatient pharmacy claims, billed by NDC. They exclude the medical benefit — clinic- or hospital-administered drugs billed under HCPCS J-codes — so drugs used mostly that way (e.g. Avastin, Lucentis, Keytruda) can look low or missing here. That’s expected, not an error.
📅 Q1 2025 – Q1 2026 · 5 quarters of data
ⓘ The newest quarter is usually incomplete when first published; states restate recent quarters in later CMS releases, so the latest figures typically revise upward. State coverage-policy changes can also shift quarter-to-quarter totals.
Prescriptions last 4 qtrs
16.2K
Units reimbursed last 4 qtrs
4.8M
Gross reimbursed last 4 qtrs
$506.4K
Avg / prescription
$31.20
Avg / unit
$0.1060
Latest quarter Q1 2026
3.6KRx
Medicaid pays / mL
$0.1060
gross reimbursed
vs
NADAC / mL
$0.0855
acquisition cost
=
Spread
+$0.0205
+24% vs cost
What Medicaid paid per mL (before rebates; includes the pharmacy’s dispensing fee) compared with NADAC — the average price pharmacies pay to buy the drug. A positive spread means Medicaid reimbursed more than the purchase price, before manufacturer rebates.
Fee-for-service vs managed care
49% FFS 51% MCO
Fee-for-service · 7,949 Rx Managed care · 8,283 Rx
State Medicaid map
Alaska: no data reported AK Maine: 234,297 units · 16,795 per 100k residents ME Washington: 16,656 units · 213 per 100k residents WA Idaho: 32,943 units · 1,677 per 100k residents ID Montana: no data reported MT North Dakota: no data reported ND Minnesota: 65,697 units · 1,145 per 100k residents MN Wisconsin: 254,121 units · 4,300 per 100k residents WI Michigan: 122,460 units · 1,220 per 100k residents MI New York: 293,223 units · 1,498 per 100k residents NY Vermont: 60,822 units · 9,401 per 100k residents VT New Hampshire: no data reported NH Oregon: 5,040 units · 119 per 100k residents OR Nevada: 94,620 units · 2,962 per 100k residents NV Wyoming: 16,020 units · 2,743 per 100k residents WY South Dakota: no data reported SD Iowa: 41,343 units · 1,289 per 100k residents IA Illinois: 312,249 units · 2,488 per 100k residents IL Indiana: 5,491 units · 80.0 per 100k residents IN Ohio: 103,797 units · 881 per 100k residents OH Pennsylvania: 37,440 units · 289 per 100k residents PA New Jersey: 97,777 units · 1,052 per 100k residents NJ Massachusetts: 58,184 units · 831 per 100k residents MA California: 461,124 units · 1,183 per 100k residents CA Utah: 24,495 units · 717 per 100k residents UT Colorado: 143,250 units · 2,437 per 100k residents CO Nebraska: 48,795 units · 2,467 per 100k residents NE Missouri: 65,352 units · 1,055 per 100k residents MO Kentucky: 348,879 units · 7,708 per 100k residents KY West Virginia: 135,735 units · 7,669 per 100k residents WV Virginia: 60,615 units · 695 per 100k residents VA Maryland: 63,060 units · 1,020 per 100k residents MD Connecticut: 66,450 units · 1,837 per 100k residents CT Rhode Island: no data reported RI Arizona: 333,033 units · 4,482 per 100k residents AZ New Mexico: 131,028 units · 6,198 per 100k residents NM Kansas: 14,970 units · 509 per 100k residents KS Arkansas: no data reported AR Tennessee: 157,140 units · 2,205 per 100k residents TN North Carolina: 134,088 units · 1,238 per 100k residents NC South Carolina: 11,343 units · 211 per 100k residents SC Delaware: no data reported DE Oklahoma: 92,210 units · 2,275 per 100k residents OK Louisiana: 73,290 units · 1,602 per 100k residents LA Mississippi: 52,757 units · 1,794 per 100k residents MS Alabama: 31,440 units · 616 per 100k residents AL Georgia: 34,470 units · 313 per 100k residents GA D.C.: no data reported DC Hawaii: no data reported HI Texas: 67,503 units · 221 per 100k residents TX Florida: 373,050 units · 1,650 per 100k residents FL
Units reimbursed · per 100k residents
80.016,795
gray = no data reported
Colors are per 100,000 residents, so big states don’t automatically dominate. Tap or hover a state for its actual totals.
Tap or hover a state
…for its Medicaid breakdown
🏆 Top states by units · per 100k residents
1 Maine 16,795 /100k
2 Vermont 9,401 /100k
3 Kentucky 7,708 /100k
4 West Virginia 7,669 /100k
5 New Mexico 6,198 /100k
6 Arizona 4,482 /100k
7 Wisconsin 4,300 /100k
8 Nevada 2,962 /100k
National units — by quarter
💵 About the dollar figures: “reimbursed” is what Medicaid paid pharmacies before confidential manufacturer rebates, so the program’s real net cost is lower than these numbers. Fee-for-service and managed-care claims are combined unless split above. Source: CMS State Drug Utilization Data; per-100k rates use 2023 Census population estimates.

💊 Medicaid utilization by pack size

Medicaid (SDUD) totals over the four most recent reported quarters for every package size of this drug — handy when a specific package (e.g. a starter/titration pack) carries little or no Medicaid volume on its own.
6 pouches47335-0756-49 47,707 Rx · $1,028,671
12 pouches this page47335-0756-52 16,232 Rx · $506,411
Drug total (last 4 qtrs): 63,939 Rx · 14,551,925 units · $1,535,082 gross reimbursed
Tap a pack size to open its page. Source: CMS State Drug Utilization Data, last 4 quarters.

🔬 Reported adverse events (FAERS)

Read carefully: FAERS reports are voluntary and unverified. Counts are not incidence, do not establish causation, are subject to reporting bias, and cannot be used to compare one drug to another. Shown for signal context only. Reports for Ipratropium Bromide and Albuterol Sulfate — the ingredient across all brands.

Top reported reactions

Dyspnoea266
Pneumonia112
Fatigue108
Cough105
Nausea89
Headache85
Death79

Age at onset

Neonate1
Child2
Adolescent3
Adult116
Elderly110

Reporter sex

1,646 reports
Male · 37%
Female · 63%

Serious outcomes

Hospitalization477
Life-threatening28
Disabling25
Reports over time (by year) — tap or hover for the count & year
2019 2021 2023 2026 165 0
Most recent year is provisional (FAERS lags ~3 months).
Where does this data come from?
Adverse-event reports from the FDA Adverse Event Reporting System (FAERS) via openFDA. FAERS reports are voluntary and unverified — counts are not incidence and don’t establish causation.

📦 Packaging — all sizes for this product

Package NDCDescription Per unit Per pack Marketing startStatus
47335-0756-49 6 POUCH in 1 CARTON (47335-756-49) / 5 VIAL in 1 POUCH / 3 mL in 1 VIAL $0.0812 / mL $7.31 2021-11-15 Active
47335-0756-52 You're viewing this 12 POUCH in 1 CARTON (47335-756-52) / 5 VIAL in 1 POUCH / 3 mL in 1 VIAL $0.0855 / mL $15.38 2021-11-15 Active

Per mL, this pack runs about 5% above the cheapest pack (NDC 47335-0756-49, $0.0812 vs $0.0855 NADAC).

This pack accounts for about 25% of this product's recent Medicaid fills; most go to a different pack size. See all packs ↓

Pack size FAQ

What quantity is in NDC 47335-0756-52?
NDC 47335-0756-52 is listed by the FDA — 12 pouch in 1 carton / 5 vial in 1 pouch / 3 ml in 1 vial.
What NDC number is used to bill for this package of Ipratropium Bromide and Albuterol Sulfate .5 mg/3mL; 2.5 mg/3mL Solution?
Bill NDC 47335-0756-52 — the 11-digit billing format is 47335075652. Pharmacy and medical claims use the 11-digit form; the FDA label may print a shorter form of the same code.

Prices are the latest CMS NADAC pharmacy acquisition cost per NDC; per-pack figures are per-unit × pack quantity, shown only when the pack is denominated in the same measure NADAC prices.

📄 Full prescribing information FDA SPL

The complete FDA label for this product — the official prescribing information, verbatim, section by section. Jump with a chip, search within the label, or expand everything.
🎯 Indications and Usage 27 words

INDICATIONS AND USAGE Ipratropium bromide and albuterol sulfate inhalation solution is indicated for the treatment of bronchospasm associated with COPD in patients requiring more than one bronchodilator.

⏱️ Dosage and Administration ~1 min read

DOSAGE AND ADMINISTRATION The recommended dose of ipratropium bromide and albuterol sulfate inhalation solution is one 3 mL vial administered 4 times per day via nebulization with up to 2 additional 3 mL doses allowed per day, if needed. Safety and efficacy of additional doses or increased frequency of administration of ipratropium bromide and albuterol sulfate inhalation solution beyond these guidelines has not been studied and the safety and efficacy of extra doses of albuterol sulfate or ipratropium bromide in addition to the recommended doses of ipratropium bromide and albuterol sulfate inhalation solution have not been studied.

The use of ipratropium bromide and albuterol sulfate inhalation solution can be continued as medically indicated to control recurring bouts of bronchospasm. If a previously effective regimen fails to provide the usual relief, medical advice should be sought immediately, as this is often a sign of worsening COPD, which would require reassessment of therapy. A Pari-LC-Plus™ nebulizer (with face mask or mouthpiece) connected to a PRONEB™ compressor was used to deliver ipratropium bromide and albuterol sulfate inhalation solution to each patient in one U.S. clinical study.

The safety and efficacy of ipratropium bromide and albuterol sulfate inhalation solution delivered by other nebulizers and compressors have not been established. Ipratropium bromide and albuterol sulfate inhalation solution should be administered via jet nebulizer connected to an air compressor with an adequate air flow, equipped with a mouthpiece or suitable face mask.

Contraindications 28 words

CONTRAINDICATIONS Ipratropium bromide and albuterol sulfate inhalation solution is contraindicated in patients with a history of hypersensitivity to any of its components, or to atropine and its derivatives.

⚠️ Warnings ~1 min read

WARNINGS Paradoxical Bronchospasm : In the clinical study of ipratropium bromide and albuterol sulfate, paradoxical bronchospasm was not observed. However, paradoxical bronchospasm has been observed with both inhaled ipratropium bromide and albuterol products and can be life-threatening. If this occurs, ipratropium bromide and albuterol sulfate should be discontinued immediately and alternative therapy instituted.

Do Not Exceed Recommended Dose : Fatalities have been reported in association with excessive use of inhaled products containing sympathomimetic amines and with the home use of nebulizers. Cardiovascular Effect : Ipratropium bromide and albuterol sulfate, like other beta adrenergic agonists, can produce a clinically significant cardiovascular effect in some patients as measured by pulse rate, blood pressure, and/or symptoms. Although such effects are uncommon for ipratropium bromide and albuterol sulfate at recommended doses, if they occur, the drug may need to be discontinued.

In addition, beta agonists have been reported to produce ECG changes, such as flattening of the T-wave, prolongation of the QTc interval, and ST segment depression. The clinical significance of these findings is unknown. Therefore, ipratropium bromide and albuterol sulfate, like other sympathomimetic amines, should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension.

Immediate Hypersensitivity Reactions : Immediate hypersensitivity reactions to albuterol and/or ipratropium bromide may occur after the administration of ipratropium bromide and albuterol sulfate as demonstrated by rare cases of urticaria, angioedema, rash, pruritus, oropharyngeal edema, bronchospasm, and anaphylaxis.

🤒 Adverse Reactions ~1 min read

ADVERSE REACTIONS Adverse reaction information concerning ipratropium bromide and albuterol sulfate was derived from the 12-week controlled clinical trial. ADVERSE EVENTS OCCURRING IN ≥ 1% OF ≥ 1 TREATMENT GROUP(S) AND WHERE THE COMBINATION TREATMENT SHOWED THE HIGHEST PERCENTAGE Body System COSTART Term Albuterol n (%) Ipratropium n (%) Ipratropium Bromide and Albuterol Sulfate n (%) NUMBER OF PATIENTS 761 754 765 N (%) Patients with AE 327 (43) 329 (43.6) 367 (48) BODY AS A WHOLE Pain 8 (1.1) 4 (0.5) 10 (1.3) Pain chest 11 (1.4) 14 (1.9) 20 (2.6) DIGESTIVE Diarrhea 5 (0.7) 9 (1.2) 14 (1.8) Dyspepsia 7 (0.9) 8 (1.1) 10 (1.3) Nausea 7 (0.9) 6 (0.8) 11 (1.4) MUSCULO-SKELETAL Cramps leg 8 (1.1) 6 (0.8) 11 (1.4) RESPIRATORY Bronchitis 11 (1.4) 13 (1.7) 13 (1.7) Lung Disease 36 (4.7) 34 (4.5) 49 (6.4) Pharyngitis 27 (3.5) 27 (3.6) 34 (4.4) Pneumonia 7 (0.9) 8 (1.1) 10 (1.3) UROGENITAL Infection urinary tract 3 (0.4) 9 (1.2) 12 (1.6) Additional adverse reactions reported in more than 1% of patients treated with ipratropium bromide and albuterol sulfate included constipation and voice alterations.

In the clinical trial, there was a 0.3% incidence of possible allergic-type reactions, including skin rash, pruritus, and urticaria. Additional information derived from the published literature on the use of albuterol sulfate and ipratropium bromide singly or in combination includes precipitation or worsening of narrow-angle glaucoma, acute eye pain, blurred vision, mydriasis, paradoxical bronchospasm, wheezing, exacerbation of COPD symptoms, drowsiness, aching, flushing, upper respiratory tract infection, palpitations, taste perversion, elevated heart rate, sinusitis, back pain, sore throat, and metabolic acidosis.

Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

🔄 Drug Interactions ~1 min read

Drug Interactions Anticholinergic agents : Although ipratropium bromide is minimally absorbed into the systemic circulation, there is some potential for an additive interaction with concomitantly used anticholinergic medications. Caution is, therefore, advised in the coadministration of ipratropium bromide and albuterol sulfate with other drugs having anticholinergic properties. ß-adrenergic agents : Caution is advised in the coadministration of ipratropium bromide and albuterol sulfate and other sympathomimetic agents due to the increased risk of adverse cardiovascular effects. ß-receptor blocking agents : These agents and albuterol sulfate inhibit the effect of each other. β-receptor blocking agents should be used with caution in patients with hyperreactive airways, and if used, relatively selective β1 selective agents are recommended.

Diuretics : The electrocardiogram (ECG) changes and/or hypokalemia that may result from the administration of non-potassium sparing diuretics (such as loop or thiazide diuretics) can be acutely worsened by β-agonists, especially when the recommended dose of the β-agonist is exceeded. Although the clinical significance of these effects is not known, caution is advised in the coadministration of β-agonist-containing drugs, such as ipratropium bromide and albuterol sulfate, with non-potassium sparing diuretics. Monoamine oxidase inhibitors or tricyclic antidepressants : Ipratropium bromide and albuterol sulfate should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents because the action of albuterol sulfate on the cardiovascular system may be potentiated.

🤰 Pregnancy ~2 min read

Pregnancy TERATOGENIC EFFECTS: Pregnancy Category C Albuterol sulfate : Pregnancy Category C. Albuterol sulfate has been shown to be teratogenic in mice. A study in CD-1 mice given albuterol sulfate subcutaneously showed cleft palate formation in 5 of 111 (4.5%) fetuses at 0.25 mg/kg (less than the maximum recommended daily inhalation dose for adults on a mg/m 2 basis) and in 10 of 108 (9.3%) fetuses at 2.5 mg/kg (approximately equal to the maximum recommended daily inhalation dose for adults on a mg/m 2 basis).

The drug did not induce cleft palate formation when administered subcutaneously at a dose of 0.025 mg/kg (less than the maximum recommended daily inhalation dose for adults on a mg/m 2 basis). Cleft palate formation also occurred in 22 of 72 (30.5%) fetuses from females treated subcutaneously with 2.5 mg/kg isoproterenol (positive control). A reproduction study in Stride rabbits revealed cranioschisis in 7 of 19 (37%) fetuses when albuterol was administered orally at a dose of 50 mg/kg (approximately 55 times the maximum recommended daily inhalation dose for adults on a mg/m 2 basis).

A study in which pregnant rats were dosed with radiolabeled albuterol sulfate demonstrated that drug-related material is transferred from the maternal circulation to the fetus. During worldwide marketing experience, various congenital anomalies, including cleft palate and limb defects, have been reported in the offspring of patients being treated with albuterol. Some of the mothers were taking multiple medications during their pregnancies.

Because no consistent pattern of defects can be discerned, a relationship between albuterol use and congenital anomalies has not been established. Ipratropium bromide : Pregnancy Category B. Reproduction studies in CD-1 mice, Sprague-Dawley rats and New Zealand rabbits demonstrated no evidence of teratogenicity at oral doses up to 10, 100, and 125 mg/kg, respectively (approximately 15, 270, and 680 times the maximum recommended daily inhalation dose for adults on a mg/m 2 basis).

Reproduction studies in rats and rabbits demonstrated no evidence of teratogenicity at inhalation doses up to 1.5 and 1.8 mg/kg, respectively (approximately 4 and 10 times the maximum recommended daily inhalation dose for adults on a mg/m 2 basis). There are no adequate and well-controlled studies of the use of ipratropium bromide and albuterol sulfate, albuterol sulfate, or ipratropium bromide in pregnant women. Ipratropium bromide and albuterol sulfate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

🧒 Pediatric Use 23 words

Pediatric Use The safety and effectiveness of ipratropium bromide and albuterol sulfate in patients below 18 years of age have not been established.

🧓 Geriatric Use 73 words

Geriatric Use Of the total number of subjects in clinical studies of ipratropium bromide and albuterol sulfate, 62 percent were 65 and over, while 19 percent were 75 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.

🆘 Overdosage ~1 min read

OVERDOSAGE The effects of overdosage with ipratropium bromide and albuterol sulfate are expected to be related primarily to albuterol sulfate, since ipratropium bromide is not well-absorbed systemically after oral or aerosol administration. The expected symptoms with overdosage are those of excessive beta-adrenergic stimulation and/or occurrence or exaggeration of symptoms such as seizures, angina, hypertension or hypotension, tachycardia with rates up to 200 beats per minute, arrhythmia, nervousness, headache, tremor, dry mouth, palpitation, nausea, dizziness, fatigue, malaise, insomnia, and exaggeration of pharmacological effects listed in ADVERSE REACTIONS.

Hypokalemia may also occur. As with all sympathomimetic aerosol medications, cardiac arrest and even death may be associated with abuse of ipratropium bromide and albuterol sulfate. Treatment consists of discontinuation of ipratropium bromide and albuterol sulfate together with appropriate symptomatic therapy.

The judicious use of a cardioselective beta-receptor blocker may be considered, bearing in mind that such medication can produce bronchospasm. There is insufficient evidence to determine if dialysis is beneficial for overdosage of ipratropium bromide and albuterol sulfate. The oral median lethal dose of albuterol sulfate in mice is greater than 2,000 mg/kg (approximately 540 times the maximum recommended daily inhalation dose of ipratropium bromide and albuterol sulfate on a mg/m 2 basis).

The subcutaneous median lethal dose of albuterol sulfate in mature rats and small young rats is approximately 450 and 2,000 mg/kg respectively (approximately 240 and 1,100 times the maximum recommended daily inhalation dose of ipratropium bromide and albuterol sulfate on a mg/m 2 basis, respectively). The inhalation median lethal dose has not been determined in animals. The oral median lethal dose of ipratropium bromide in mice, rats and dogs is greater than 1,000 mg/kg, approximately 1,700 mg/kg and approximately 400 mg/kg, respectively (approximately 1400, 4600, and 3600 times the maximum recommended daily inhalation dose in adults on a mg/m 2 basis, respectively).

🧬 Clinical Pharmacology ~2 min read

CLINICAL PHARMACOLOGY Ipratropium bromide and albuterol sulfate inhalation solution is a combination of the β2-adrenergic bronchodilator, albuterol sulfate, and the anticholinergic bronchodilator, ipratropium bromide. Albuterol Sulfate Mechanism of Action : The prime action of β-adrenergic drugs is to stimulate adenyl cyclase, the enzyme that catalyzes the formation of cyclic-3',5'-adenosine monophosphate (cAMP) from adenosine triphosphate (ATP). The cAMP thus formed mediates the cellular responses.

In vitro studies and in vivo pharmacologic studies have demonstrated that albuterol has a preferential effect on β2-adrenergic receptors compared with isoproterenol. While it is recognized that β2-adrenergic receptors are the predominant receptors in bronchial smooth muscle, recent data indicated that 10% to 50% of the β-­receptors in the human heart may be β2-receptors. The precise function of these receptors, however, is not yet established.

Albuterol has been shown in most controlled clinical trials to have more effect on the respiratory tract, in the form of bronchial smooth muscle relaxation, than isoproterenol at comparable doses while producing fewer cardiovascular effects. Controlled clinical studies and other clinical experience have shown that inhaled albuterol, like other β-adrenergic agonist drugs, can produce a significant cardiovascular effect in some patients. Pharmacokinetics: Albuterol sulfate is longer acting than isoproterenol in most patients by any route of administration, because it is not a substrate for the cellular uptake processes for catecholamine nor for the metabolism of catechol-O-methyl transferase.

Instead the drug is conjugatively metabolized to albuterol 4'-O-sulfate. Animal Pharmacology/Toxicology: Intravenous studies in rats with albuterol sulfate have demonstrated that albuterol crosses the blood-brain barrier and reaches brain concentrations amounting to approximately 5% of plasma concentrations. In structures outside of the blood-brain barrier (pineal and pituitary glands), albuterol concentrations were found to be 100 times those found in whole brain.

Studies in laboratory animals (minipigs, rodents, and dogs) have demonstrated the occurrence of cardiac arrythmias and sudden death (with histological evidence of myocardial necrosis) when beta-agonists and methyl-xanthines are administered concurrently. The clinical significance of these findings is unknown. Ipratropium Bromide Mechanism of Action:.

Ipratropium bromide is an anticholinergic (parasympatholytic) agent, which blocks the muscarinic receptors of acetylcholine, and, based on animal studies, appears to inhibit vagally mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released from the vagus nerve. Anticholinergics prevent the increases in intracellular concentration of cyclic guanosine monophosphate (cGMP), resulting from the interaction of acetylcholine with the muscarinic receptors of bronchial smooth muscle. Pharmacokinetics: The bronchodilation following inhalation of ipratropium is primarily a local, site-specific effect, not a systemic one.

Much of an inhaled dose is swallowed as shown by fecal excretion studies. Following nebulization of a 1 mg dose to healthy volunteers, a mean of 4% of the dose was excreted unchanged in the urine. Ipratropium bromide is minimally (0% to 9% in vitro) bound to plasma albumin and α1­-acid glycoproteins.

It is partially metabolized to inactive ester hydrolysis products. Following intravenous administration, approximately one-half is excreted unchanged in the urine. The half-life of elimination is about 1.6 hours after intravenous administration.

Ipratropium bromide that reaches the systemic circulation is reportedly removed by the kidneys rapidly at a rate that exceeds the glomerular filtration rate. The pharmacokinetics of ipratropium bromide and albuterol sulfate inhalation solution or ipratropium bromide have not been studied in the elderly and in patients wi…

📦 How Supplied / Storage and Handling 121 words

HOW SUPPLIED Ipratropium bromide and albuterol sulfate inhalation solution, USP is supplied as a 3 mL sterile solution for nebulization in sterile low-density polyethylene unit-dose vials. Store in pouch until time of use. Supplied in cartons as listed below.

NDC 47335-756-49 carton of 30 vials (5 vials per foil pouch) NDC 47335-756-52 carton of 60 vials (5 vials per foil pouch) Store at 20° to 25°C (68° to 77°F); excursions permitted between 15° and 30°C (59° and 86°F) [see USP Controlled Room Temperature]. Protect from light. Unit dose vials should remain stored in the protective foil pouch at all times.

Once removed from the foil pouch, the individual vials should be used within one week. Discard if solution is not colorless.

📋 Description ~2 min read

DESCRIPTION The active components in ipratropium bromide and albuterol sulfate inhalation solution are albuterol sulfate and ipratropium bromide. Albuterol sulfate, is a salt of racemic albuterol and a relatively selective β2-adrenergic bronchodilator chemically described as α 1 -[(tert-butylamino)methyl]-4-hydroxy-m­-xylene-α, α'-diol sulfate (2:1) (salt). It has a molecular weight of 576.7 and the molecular formula is (C 13 H 21 NO 3 ) 2 •H 2 SO 4 .

It is a white or practically white powder, soluble in water and slightly soluble in ethanol. The World Health Organization recommended name for albuterol base is salbutamol. Figure 3 1-1.

Chemical structure of albuterol sulfate. Ipratropium bromide is an anticholinergic bronchodilator chemically described as 8-­azoniabicyclo [3.2.1]-octane, 3-(3-hydroxy-1-oxo-2-phenylpropoxy)-8methyl-8-(1­methylethyl)-, bromide, monohydrate (endo, syn)-, (±)-; a synthetic quaternary ammonium compound, chemically related to atropine. It has a molecular weight of 430.4 and the molecular formula is C 20 H 30 BrNO 3 •H 2 O.

It is a white to off-white crystalline substance, freely soluble in water and lower alcohols, and insoluble in lipophilic solvents such as ether, chloroform, and fluorocarbons. Figure 3. 1-2.

Chemical structure of ipratropium bromide. Each 3 mL vial of ipratropium bromide and albuterol sulfate inhalation solution contains 3 mg (0.1%) of albuterol sulfate USP (equivalent to 2.5 mg (0.083%) of albuterol base) and 0.5 mg (0.017%) of ipratropium bromide USP in an isotonic, sterile, aqueous solution containing sodium chloride, hydrochloric acid to adjust to pH 4, edetate disodium, USP (a chelating agent) and water for injection. Ipratropium bromide and albuterol sulfate inhalation solution is a clear, colorless solution.

It does not require dilution prior to administration by nebulization. For ipratropium bromide and albuterol sulfate inhalation solution, like all other nebulized treatments, the amount delivered to the lungs will depend on patient factors, the jet nebulizer utilized, and compressor performance. Using the Pari-LC-Plus™ nebulizer (with face mask or mouthpiece) connected to a PRONEB™ compressor system, under in vitro conditions, the mean delivered dose from the mouth piece (% nominal dose) was approximately 46% of albuterol and 42% of ipratropium bromide at a mean flow rate of

3.6L/min. The mean nebulization time was 15 minutes or less. Ipratropium bromide and albuterol sulfate inhalation solution should be administered from jet nebulizers at adequate flow rates, via face masks or mouthpieces (see DOSAGE AND ADMINISTRATION). structure1 structure2

💬 Information for Patients 144 words

Information for Patients The action of ipratropium bromide and albuterol sulfate should last up to 5 hours. Ipratropium bromide and albuterol sulfate should not be used more frequently than recommended. Patients should be instructed not to increase the dose or frequency of ipratropium bromide and albuterol sulfate without consulting their healthcare provider.

If symptoms worsen, patients should be instructed to seek medical consultation. Patients must avoid exposing their eyes to this product as temporary pupillary dilation, blurred vision, eye pain, or precipitation or worsening of narrow-angle glaucoma may occur, and therefore proper nebulizer technique should be assured, particularly if a mask is used. If a patient becomes pregnant or begins nursing while on ipratropium bromide and albuterol sulfate, they should contact their healthcare provider about use of ipratropium bromide and albuterol sulfate.

See the illustrated Patient's Instruction for Use in the product package insert.

Source: FDA Structured Product Labeling, mirrored from DailyMed / openFDA. Prefer the government’s original formatting? View this label on DailyMed ↗
For educational and professional reference only — not medical advice. Pricing reflects published NADAC and CMS ASP (free public data) and may differ from your acquisition cost; always verify before billing or dispensing.