This product is used to treat and prevent symptoms (wheezing and shortness of breath) caused by ongoing lung disease (chronic obstructive pulmonary disease-COPD which includes bronchitis and emphysema). This product contains 2 medications: ipratropium and albuterol (also known as salbutamol). Both drugs work by relaxing the muscles around the airways so that they open up and you can breathe more easily. Controlling symptoms of breathing problems can decrease time lost from work or school.

Read the Patient Information Leaflet if available from your pharmacist before you start using this product and each time you get a refill. This medication is used with a special machine called a nebulizer that changes the solution to a fine mist that you inhale. Learn how to prepare the solution and use the nebulizer properly. If a child is using this medication, a parent or other responsible adult should supervise the child. If you have any questions, ask your doctor, pharmacist, or respiratory therapist.

This product should be clear and colorless. Before using, check this product for particles or discoloration. If either is present, do not use the liquid.

Inhale this medication into your lungs using the nebulizer as directed by your doctor, usually 4 times a day. Avoid getting this medication into your eyes. It may cause eye pain/irritation, temporary blurred vision, and other vision changes. It is recommended that you use a mouthpiece rather than a face mask with the nebulizer or that you close your eyes during use. Each treatment usually takes about 5 to 15 minutes. Use this medication only through a nebulizer. Do not swallow or inject the solution. To prevent infections, clean the nebulizer and mouthpiece/face mask according to the manufacturer's directions.

The US brand does not require any mixing before use. The Canadian brand can be used unmixed or if directed, may be mixed with sterile saline just before use. Once a vial is opened, throw away any unused solution.

The dosage is based on your medical condition and response to treatment. Do not increase your dose or use this drug more often than prescribed without your doctor's approval. Using too much of this medication will increase your risk of serious (possibly fatal) side effects.

Rinse your mouth after treatment to prevent dry mouth and throat irritation.

Use this medication regularly to get the most benefit from it. This medication works best if used at evenly spaced intervals. To help you remember, use it at the same times each day.

Learn which of your inhalers/medications you should use every day and which you should use if your breathing suddenly worsens (quick-relief drugs). Ask your doctor ahead of time what you should do if you have new or worsening cough or shortness of breath, wheezing, increased sputum, waking up at night with trouble breathing, if you use your quick-relief inhaler more often, or if your quick-relief inhaler does not seem to be working well. Learn when you can treat sudden breathing problems by yourself and when you must get medical help right away.

Tell your doctor if your symptoms do not get better or if they get worse.

See also How to Use section.

Headache, dizziness, nausea, dry mouth, shaking (tremors), nervousness, or constipation may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Rarely, this medication may cause severe sudden worsening of breathing problems right after use. If you have sudden worsening of breathing, get medical help right away.

Tell your doctor right away if you have any serious side effects, including:

• difficult/painful urination
• muscle cramps

Get medical help right away if you have any very serious side effects, including:

• chest pain
• fast/pounding/irregular heartbeat
• rapid breathing
• confusion
• eye pain/swelling/redness
• vision changes (such as seeing rainbows around lights at night, blurred vision)

A very serious allergic reaction to this product is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

• rash
• itching/swelling (especially of the face/tongue/throat)
• severe dizziness
• trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Before using this product, tell your doctor or pharmacist if you are allergic to ipratropium or albuterol (salbutamol); or to tiotropium; or to atropine or other belladonna-type drugs; or to levalbuterol; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

• high blood pressure
• heart disease (such as chest pain, heart attack, irregular heartbeat)
• personal or family history of glaucoma (angle-closure type)
• difficulty urinating (for example, due to enlarged prostate)
• seizure
• overactive thyroid (hyperthyroidism)
• diabetes

This drug may make you dizzy or blur your vision or cause vision changes. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially problems urinating or constipation.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this medication passes into breast milk. Consult your doctor before breastfeeding.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Albuterol is very similar to levalbuterol. Do not use medications containing levalbuterol while using albuterol.

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call 1-800-222-1222. Canada residents can call 1-844-764-7669. Symptoms of overdose may include: chest pain, fast/irregular heartbeat, seizures.

Do not share this medication with others.

Lab and/or medical tests (such as lung function, blood pressure) may be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).