The Combimist L Inhaler is a pressurized metered-dose inhaler (pMDI) designed for the maintenance treatment of reversible obstructive airways diseases, including asthma and chronic obstructive pulmonary disease (COPD). It combines two active ingredients in a single, convenient device: Levosalbutamol, a fast-acting bronchodilator that provides rapid relief from bronchospasm, and Ipratropium Bromide, an anticholinergic agent that works to reduce airway secretions and provide longer-lasting bronchial smooth muscle relaxation. This synergistic formulation offers a comprehensive approach to managing bronchoconstriction, improving lung function, and enhancing overall quality of life for patients requiring dual therapy. Its design ensures consistent dosing and portability, making it an integral part of a managed respiratory care plan.

Features

• Dual Drug Formulation: Contains a fixed-dose combination of Levosalbutamol (50 mcg) and Ipratropium Bromide (20 mcg) per actuation.
• Metered-Dose Delivery: Provides precise, consistent dosing with each inhalation, ensuring reliable medication administration.
• Rapid Onset of Action: Levosalbutamol begins working within minutes to relieve acute bronchospasm.
• Sustained Bronchodilation: Ipratropium Bromide offers prolonged bronchial smooth muscle relaxation, reducing the frequency of dosing.
• Portable and Compact: Ergonomically designed canister with a mouthpiece for easy carry and use anywhere.
• Dose Counter: Integrated dose indicator to track remaining medication and remind patients to refill prescriptions timely.
• Compatible with Spacers: Can be used with valved holding chambers to improve drug delivery, especially for patients with poor inhalation technique.
• CFC-Free Propellant: Uses hydrofluoroalkane (HFA) as an environmentally friendly propellant.

Benefits

• Provides rapid and sustained relief from bronchoconstriction, reducing the frequency and severity of asthma and COPD symptoms.
• Enhances exercise tolerance and daily activity levels by improving lung function and reducing breathlessness.
• Minimizes the need for rescue inhalers through effective maintenance therapy, leading to better disease control.
• Simplifies treatment regimens by combining two medications into a single inhaler, improving adherence.
• Reduces airway inflammation and mucus production, decreasing the risk of exacerbations.
• Supports long-term respiratory health with a well-tolerated profile when used as prescribed.

Common use

The Combimist L Inhaler is indicated for the regular treatment of bronchospasm associated with reversible obstructive airway diseases. It is commonly prescribed for:

• Asthma: For patients who require combined bronchodilator therapy to control symptoms and prevent exacerbations.
• Chronic Obstructive Pulmonary Disease (COPD): Including chronic bronchitis and emphysema, where persistent airflow limitation requires maintenance therapy.
• It is used as a preventive measure before exposure to known triggers (e.g., exercise, allergens) and as part of a daily management plan to maintain open airways.

Dosage and direction

• Adults and adolescents (12 years and older): The usual dose is two inhalations (puffs) taken four times a day. The maximum recommended dose is 12 inhalations in 24 hours.
• Administration: Shake the inhaler well before each use. Exhale fully, place the mouthpiece between the lips, and inhale deeply and slowly while pressing the canister to release the medication. Hold breath for 10 seconds, then exhale slowly. Wait at least 30 seconds before taking a second inhalation if required.
• Priming: If the inhaler is new or has not been used for more than 3 days, prime it by releasing 3 test sprays into the air away from the face.
• Always follow the specific dosage instructions provided by the healthcare provider. Do not exceed the prescribed dose.

Precautions

• Not intended for the relief of acute bronchospasm; patients should have a separate rapid-acting bronchodilator for rescue use.
• Use with caution in patients with cardiovascular disorders (e.g., hypertension, arrhythmias), glaucoma, prostatic hyperplasia, or urinary retention.
• May cause paradoxical bronchospasm; if this occurs, discontinue use immediately and seek alternative therapy.
• Monitor for signs of hypokalemia, especially in patients taking xanthine derivatives, steroids, or diuretics.
• Avoid contact with eyes; rinse thoroughly if accidental exposure occurs.
• Not recommended for children under 12 years of age unless specifically advised by a physician.
• Pregnancy and lactation: Use only if clearly needed and under medical supervision.

Contraindications

• Hypersensitivity to Levosalbutamol, Ipratropium Bromide, or any other component of the formulation.
• History of hypersensitivity to atropine or its derivatives.
• Patients with known narrow-angle glaucoma.
• Not indicated for the initial treatment of acute episodes of bronchospasm.

Possible side effect

Common side effects may include:

• Headache
• Dry mouth
• Cough
• Throat irritation
• Nausea
• Tremor
• Palpitations
• Tachycardia
• Dizziness

Less common but serious side effects requiring medical attention:

• Worsening bronchospasm
• Significant increase in blood pressure
• Angina pectoris
• Urinary retention
• Acute narrow-angle glaucoma
• Allergic reactions such as rash, urticaria, or swelling

Drug interaction

• Beta-blockers (e.g., propranolol) may antagonize the effects of bronchodilators and should be avoided.
• Concomitant use with other sympathomimetic agents may increase the risk of cardiovascular side effects.
• Xanthine derivatives, steroids, or diuretics may potentiate hypokalemia.
• Anticholinergic drugs may enhance the effects of Ipratropium Bromide, increasing the risk of side effects.
• Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants may potentiate the cardiovascular effects of Levosalbutamol.

Missed dose

If a dose is missed, take it as soon as remembered. However, if it is almost time for the next dose, skip the missed dose and resume the regular schedule. Do not double the dose to make up for a missed one.

Overdose

Symptoms of overdose may include:

• Exaggeration of known side effects such as tachycardia, tremor, hypertension, hypokalemia, angina, and nausea.
• Anticholinergic effects: dry mouth, blurred vision, urinary retention. In case of suspected overdose, seek immediate medical attention. Treatment is supportive and may include activated charcoal, cardiovascular monitoring, and correction of electrolyte imbalances.

Storage

• Store at room temperature (15–30°C), away from direct sunlight and heat.
• Do not puncture or incinerate the canister, even when empty.
• Keep out of reach of children.
• The canister should not be frozen.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for personalized recommendations and to address any health concerns. Do not disregard professional medical advice or delay seeking it based on information provided here.

Reviews

“As a pulmonologist with over 20 years of experience, I find the Combimist L Inhaler to be an effective option for patients requiring dual bronchodilation. Its combination therapy simplifies management and improves adherence.” — Dr. A. Sharma, MD

“After switching to Combimist L, my asthma symptoms are much better controlled. I use it regularly and have noticed a significant reduction in rescue inhaler use.” — Priya T., long-term user

“The dose counter is a helpful feature that ensures I never run out unexpectedly. It’s easy to use and portable, making it convenient for my active lifestyle.” — Rohan K., COPD patient