Combivent UDVs (Salbutamol, ipratropium)

How does it work?

Combivent UDVs contain two active ingredients, ipratropium bromide and salbutamol sulphate, both of which are bronchodilators. Combivent UDVs are used to treat people suffering from chronic obstructive pulmonary disease, who require regular treatment with ipratropium and salbutamol.

Salbutamol belongs to a group of medicines called short-acting beta 2 agonists. It works by acting on receptors in the lungs called beta 2 receptors. Stimulation of these receptors causes the muscles in the airways to relax, allowing the airways to open.

Ipratropium bromide is a type of medicine known as an antimuscarinic bronchodilator. It works by blocking different types of receptors, called muscarinic receptors, which are found on the muscle surrounding the airways in the lungs. Stimulation of these receptors by a natural chemical called acetylcholine normally causes the muscle in the airways to contract, and this makes the airways narrow. Depending on how much the receptors are stimulated, this can cause difficulties breathing, as is seen in asthma and bronchitis. As ipratropium blocks the receptors, it stops the action of acetylcholine and allows the airways to open, making it easier to breathe.

This combination of medicines has an additive effect in opening the airways. This makes it easier to breathe in conditions where the airways tighten, such as chronic bronchitis, where it is difficult for air to get in and out of the lungs.

This medicine is inhaled into the lungs using nebuliser device, which allows the medicine to act directly in the lungs where it is needed most. Inhaling the medicine also reduces the potential for side effects occurring in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if it is taken by mouth.

What is it used for?

  • Chronic obstructive pulmonary disease (COPD).


  • Follow the instructions for use that are provided with your medicine. Do not exceed the dose of that your doctor has prescribed you to use.
  • This medicine may cause an unexpected increase in wheezing (paradoxical bronchospasm) immediately after use.. If this happens, stop using the medicine and consult your doctor. The medicine should be stopped and an alternative treatment found.
  • Consult your doctor immediately if you experience sudden and rapidly worsening difficulty in breathing, or if this medicine becomes less effective than normal.
  • Avoid eye contact with this medicine, especially if you have, or are susceptible to, glaucoma. Seek medical advice if the medicine gets into the eyes.
  • Consult your doctor immediately if you experience any of the following while using this medicine: red and painful eyes, possibly with headache, loss of vision or blurred vision, seeing haloes around lights. These symptoms may be due to an increase in pressure inside the eyeball and require investigation by your doctor.
  • Blood potassium levels should be monitored in people with severe airway obstruction, as low oxygen levels in the blood (hypoxia) and various airway medicines, including this one, can lower blood potassium.

Use with caution in

  • Closed angle glaucoma.
  • Cystic fibrosis.
  • Enlarged prostate gland (prostatic hypertrophy).
  • Over active thyroid gland (hyperthyroidism).
  • People with diabetes.
  • Severe disease involving the heart and blood vessels (cardiovascular disease).
  • People who have recently had a heart attack.
  • Severe disease resulting from structural deformity of the heart or veins.
  • Tumour of the adrenal gland (phaeochromocytoma).

Not to be used in

  • Allergy to ipratropium bromide or related medicines, eg atropine.
  • Fast, abnormal heart rhythms (tachyarrhythmias).
  • Heart disease characterised by thickening of the internal heart muscle and a blockage inside the heart (hypertrophic obstructive cardiomyopathy).
  • This medicine is not recommended for children and adolescents under 12 years of age, as there is no information regarding its safety and efficacy in this age group.
  • Pregnancy.
  • Breastfeeding.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • This medicine should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than the possible risk to the foetus, particularly in the first trimester. Seek medical advice from your doctor.
  • This medicine should be used with caution by breastfeeding mothers, and only if the expected benefit to the mother is greater than any possible risk to the baby. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Common (affect between 1 in 10 and 1 in 100 people)

  • Dry mouth.

Uncommon (affect between 1 in 100 and 1 in 1000 people)

  • Headache.
  • Difficulty in passing urine (urinary retention).
  • Dizziness.
  • Shaking, usually of the hands (tremor).
  • Nervousness.
  • Awareness of your heartbeat (palpitations).
  • Increased heart rate (tachycardia).
  • Cough.
  • Voice problems.
  • Nausea.
  • Weakness or loss of strength (asthenia).

Very rare (affect less than 1 in 10,000 people)

  • Abnormal heart rhythm (arrhythmia).
  • Chest pain (due to heart problems such as angina).

Frequency unknown

  • Hypersensitivity reactions such as swelling of the lips, throat and tongue (angioedema), itchy blistering rash or anaphylactic shock.
  • Low blood potassium level (hypokalaemia).
  • Visual disturbances, such as blurred vision, eye pain.
  • Changes in blood pressure.
  • Unexpected narrowing of the airways (paradoxical bronchospasm).
  • Throat irritation.
  • Vomiting.
  • Muscle spasms and weakness.
  • Rash or itching.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

This medicine should not be taken with beta-blockers, such as atenolol, propranolol or timolol. This is because beta-blockers have an opposite action to this medicine and cause the airways to narrow. This can result in breathing difficulties for people with asthma or COPD. This problem has sometimes been seen with eye drops containing beta-blockers, eg used for glaucoma.

Salbutamol can potentially cause a serious decrease in the levels of potassium in the blood (hypokalaemia), which may result in adverse effects. This effect can be increased by the following medicines, which can also lower potassium in the blood:

  • xanthine derivates, such as theophylline or aminophylline
  • corticosteroids, such as beclometasone and prednisolone
  • other beta 2 agonists, such as salmeterol
  • diuretics, such as bendroflumethiazide and furosemide.

This is why people with severe asthma or COPD, who may be taking several of these medicines, should have their blood potassium levels monitored regularly.

Other medicines containing the same active ingredients

There are currently no other medicines available in the UK that contain both ipratropium bromide and salbutamol sulphate as the active ingredients.