Duavent Special Precautions

If a previously effective dose fails to provide the usual relief, symptoms become worse, or the usual duration of action is reduced, consult a physician for medical advice as this would require reassessment of therapy.
Excessive use of sympathomimetic oral inhalations has been associated with fatalities in asthmatic patients. The exact cause of death is unknown but cardiac arrest following severe, acute asthmatic crisis and hypoxia is suspected.
Paradoxical bronchospasm, a potentially life-threatening event, has been observed with both inhaled Ipratropium and Salbutamol. If it occurs, discontinue use of the product immediately.
Therapy with Salbutamol and other beta₂-agonists may produce decrease in plasma potassium concentration possibly through intracellular shunting resulting in cardiovascular undesirable effects.
Immediate hypersensitivity reactions including urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema may occur rarely after administration of the product.
Data from an observational study and another pooled analysis have shown an increased risk of mortality and/or cardiovascular events (e.g., myocardial infarction, stroke, transient ischemic attacks) in patients receiving inhaled anticholinergic agents, including ipratropium.
Concomitant administration of Ipratropium-Salbutamol has been reported to increase intraocular pressure and precipitate angle-closure glaucoma as a result of inadvertent contact to the eyes.
Patients with cystic fibrosis may be more prone to gastrointestinal motility disturbances. Consult a physician in case of acute, rapidly worsening of dyspnea.
Use with caution in patients with the following conditions: Narrow-angle glaucoma; Cardiovascular disorders including coronary insufficiency, cardiac arrhythmias or hypertension; Convulsive disorders; Hyperthyroidism; Diabetes mellitus; In patients who are unusually responsive to sympathomimetic amines; Prostatic hypertrophy or bladder-neck obstruction; Hepatic or renal disease.
Use with caution in patients with severe airway obstruction where concomitant therapy with steroid, xanthine derivatives, or diuretics may result in hypokalemia; plasma potassium concentrations should be monitored.
Pulmoneb: Patients should not expose the eyes to the nebulized solution of Ipratropium-Salbutamol since this may result in temporary pupillary dilation, precipitation or worsening of narrow-angle glaucoma, eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival and corneal congestion. Proper nebulizer techniques should be assured, particularly if a mask is used. Consult a physician if any combination of these symptoms develops.