Combimist L Inhaler is a prescription metered-dose inhaler designed for the management of asthma and chronic obstructive pulmonary disease (COPD). It combines two active ingredients, Levosalbutamol and Ipratropium Bromide, to provide both rapid bronchodilation and sustained airway control. This synergistic formulation targets different pathways of bronchoconstriction, making it a versatile option for patients requiring comprehensive respiratory support. Its carefully calibrated mechanism addresses both immediate symptom relief and preventive maintenance in a single device.

Features

• Contains Levosalbutamol (levo-isomer of Salbutamol) 50 mcg and Ipratropium Bromide 20 mcg per puff
• Delivers medication via a hydrofluoroalkane (HFA) propellant
• Designed with a dose counter to track remaining inhalations
• Provides approximately 200 actuations per canister
• Compatible with standard spacer devices for improved lung deposition
• Features an ergonomic mouthpiece for ease of use
• Requires priming before first use and after periods of non-use

Benefits

• Delivers fast-acting relief from acute bronchospasm, often within minutes of administration
• Offers prolonged bronchodilation due to the complementary mechanisms of its two active agents
• Reduces the frequency and severity of asthma and COPD exacerbations
• Minimizes the need for rescue inhalers through effective maintenance therapy
• Enhances overall lung function and exercise tolerance in chronic respiratory conditions
• Simplifies treatment regimens by combining two medications in one inhaler

Common use

Combimist L Inhaler is commonly prescribed for the management of reversible obstructive airway diseases. It is indicated for patients with asthma who require both quick-relief and maintenance therapy, as well as those with COPD, including chronic bronchitis and emphysema. It is particularly beneficial for individuals who do not achieve sufficient control with a single bronchodilator. The inhaler may be used as a preventer before anticipated triggers (such as exercise) or as a reliever during acute episodes of breathlessness.

Dosage and direction

The dosage must be individualized based on the patient’s condition and response. For adults and adolescents 12 years and older, the usual dose is two inhalations (puffs) four times a day. The maximum recommended dose is 12 inhalations in 24 hours. Shake the inhaler well before each use. Exhale fully, place the mouthpiece between the lips, and inhale deeply and slowly while pressing the canister. Hold breath for 10 seconds if possible, then exhale slowly. Wait at least one minute before the second puff, if prescribed. Rinse the mouth with water after each use to reduce the risk of oral thrush.

Precautions

• Not recommended for initial treatment of acute asthma attacks; a short-acting beta-agonist may be preferred
• Use with caution in patients with cardiovascular disorders, including hypertension, arrhythmias, or ischemic heart disease
• Monitor patients with diabetes, as beta-agonists may increase blood glucose levels
• May cause paradoxical bronchospasm; discontinue immediately if it occurs
• Avoid contact with eyes to prevent irritation or blurred vision
• Not a substitute for corticosteroids in inflammatory airway disease
• Use during pregnancy or lactation only if clearly needed and under medical supervision

Contraindications

• Hypersensitivity to Levosalbutamol, Ipratropium Bromide, or any component of the formulation
• History of tachyarrhythmias or severe cardiac disease
• Patients with narrow-angle glaucoma
• Urinary retention, particularly in men with prostatic hyperplasia
• Not intended for children under 12 years of age

Possible side effects

Common side effects may include:

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

Less common but serious side effects:

• Tachycardia or other cardiac arrhythmias
• Worsening bronchospasm
• Increased intraocular pressure
• Hypokalemia
• Allergic reactions such as rash or angioedema

Drug interaction

• Beta-blockers may reduce the efficacy of Combimist L and exacerbate bronchospasm
• Concomitant use with other sympathomimetic agents may increase the risk of cardiovascular side effects
• Diuretics or corticosteroids may enhance the hypokalemic effect of Levosalbutamol
• Anticholinergic drugs may potentiate the effects of Ipratropium Bromide
• Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants may prolong and intensify cardiovascular effects

Missed dose

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

Overdose

Overdose may manifest as exaggerated pharmacological effects: severe tachycardia, tremors, hypotension, angina, hypokalemia, and nervousness. Acute overdose with Ipratropium may lead to anticholinergic symptoms such as dry mouth, blurred vision, and urinary retention. Treatment is supportive and symptomatic; consider cardioselective beta-blockers for severe cardiovascular effects, but only under strict monitoring due to risk of bronchospasm.

Storage

Store at room temperature (15–30°C). Avoid freezing or exposure to direct sunlight. Do not puncture or incinerate the canister, even when empty. Keep out of reach of children. The inhaler should be discarded after the labeled number of actuations has been used, or after 3 months from first priming, whichever comes first.

Disclaimer

This information is intended for medical professionals and patients under prescription. It is not exhaustive and does not replace professional medical advice, diagnosis, or treatment. Always consult a healthcare provider for personalized recommendations and to address any questions about medical conditions or use of Combimist L Inhaler.

Reviews

(Compiled from clinical feedback and patient reports)

• “Effective for both prevention and acute relief in moderate asthma.”
• “Patients with COPD show improved exercise capacity and reduced dyspnea.”
• “The combination therapy reduces inhaler burden and improves adherence.”
• “Well-tolerated, though some users report mild tremor initially.”
• “Dose counter is a practical feature for tracking usage.”