SPECIAL POPULATIONS: Patients with hepatic or renal impairment: COMBIVENT has not been studied in patients with hepatic or renal insufficiency. It should be used with caution in those patient populations.
Paediatric population: Because of insufficient information in children COMBIVENT is not indicated for paediatric patients.
Patients should be advised to consult a physician or the nearest hospital immediately in the case of acute or rapidly worsening dyspnoea if additional inhalations of COMBIVENT do not produce an adequate improvement.
If higher than recommended doses of COMBIVENT are required to control symptoms, the patient's therapy plan should be reviewed.
In asthma, concomitant anti-inflammatory therapy should be considered
The following doses of COMBIVENT are recommended for adults (including elderly patients): COMBIVENT nebuliser solution in unit dose vials (UDVs): COMBIVENT nebuliser solution in unit dose vials may be administered from a suitable nebuliser or an intermittent positive pressure ventilator.
Treatment should be initiated and administered under medical supervision, e.g. in the hospital setting. Home based treatment can be recommended in exceptional cases (severe symptoms or experienced patients requiring higher doses) when a low dose rapid acting beta-agonist bronchodilator has been insufficient in providing relief after consultation with an experienced physician.
The treatment with the nebuliser solution in UDVs should always be started with the lowest recommended dose (1 UDV). In very severe cases two unit dose vials may be required for symptom relief. Administration should be stopped when sufficient symptom relief is achieved.
Treatment of acute attacks: 1 unit dose vial is sufficient for prompt symptom relief in many cases.
In severe cases if an attack has not been relieved by one unit dose vial, the administration of a second unit dose vial may be required. Patients should be advised to consult the physician or the nearest hospital immediately in these cases.
Maintenance treatment: 1 unit dose vial three or four times daily.
Instructions for use: The unit dose vials are intended only for inhalation with suitable nebulising devices and must not be taken orally or administered parenterally.
The content of the unit dose vials does not need to be diluted for nebulization.
Prepare the nebulizer for filling, according to the instructions provided by the manufacturer or physician.
Open the pouch foil and tear one unit dose vial from the strip.
Open the unit dose vial by firmly twisting the top.
Squeeze the content of the unit dose vial into the nebuliser reservoir.
Assemble the nebuliser and use as directed.
After use throw away any solution left in the reservoir and clean the nebuliser, following the manufacturer's instructions.
Since the unit dose vials contain no preservative, it is important that the contents are used soon after opening and that a fresh vial is used for each administration to avoid microbial contamination. Partly used, opened or damaged unit dose vials should be discarded.
It is strongly recommended not to mix COMBIVENT nebuliser solution with other drugs in the same nebuliser.