DuoNeb contains the active ingredients albuterol sulfate, a β-adrenergic bronchodilator, and ipratropium bromide, an anticholinergic bronchodilator. It is formulated as a clear, colorless inhalation solution administered via nebulization, with each unit-dose vial containing 0.5 mg of ipratropium bromide and 3 mg of albuterol sulfate. Key inactive ingredients include sodium chloride and hydrochloric acid for pH adjustment. DuoNeb is intended to deliver these medications to the lungs through nebulization.

How should I use this medication?

This medication is for inhalation using a nebulizer. Nebulizers make a liquid into an aerosol that you breathe in through your mouth or your mouth and nose and into your lungs. Take it as directed on the prescription label. Do not use it more often than directed.

This medication comes with INSTRUCTIONS FOR USE. Ask your pharmacist for directions on how to use this medication. Read the information carefully. Talk to your pharmacist or care team if you have questions.

Talk to your care team about the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

Where should I keep my medication?

Keep out of the reach of children and pets.

Store in a refrigerator or at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Protect from light. Keep unopened vials in the foil pouch. Throw away any unused medication after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
• Increase in blood pressure
• Muscle pain or cramps
• Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
• Trouble passing urine
• Wheezing or trouble breathing that is worse after use

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

• Constipation
• Cough
• Dry mouth
• Headache
• Sore throat
• Tremors or shaking
• Trouble sleeping

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What should I tell my care team before I take this medication?

They need to know if you have any of the following conditions:

• Heart disease
• High blood pressure
• Irregular heartbeat or rhythm
• An unusual or allergic reaction to ipratropium, albuterol, atropine, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

What may interact with this medication?

This medication may interact with the following:

• Atropine
• Beta-blockers like metoprolol and propranolol
• Certain medications for allergy, cough, and cold
• Certain medications for bladder problems like oxybutynin, tolterodine
• Certain medications for depression, anxiety, or psychotic disturbances
• Certain medications for stomach problems like dicyclomine, hyoscyamine
• Certain medications for travel sickness like scopolamine
• Certain medications for Parkinson's disease like benztropine, trihexyphenidyl
• Diuretics
• MAOIs like Carbex, Eldepryl, Marplan, Nardil, and Parnate
• Some medications for irregular heartbeat
• Stimulant medications for attention disorders, weight loss, or staying awake

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Visit your care team for regular checks on your progress. Tell your care team if your symptoms do not start to get better or if they get worse.

If your symptoms get worse or if you are using this medication more than normal, call your care team right away.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy and drinking plenty of water may help. Contact your care team if the problem does not go away or is severe.

This medication may affect your coordination, reaction time, or judgement. Do not drive or operate machinery until you know how this medication affects you. Sit up or stand slowly to reduce the risk of dizzy or fainting spells.