This combination inhalation aerosol is indicated for patients with chronic obstructive pulmonary disease (COPD) who are already on regular bronchodilator therapy but continue to show signs of bronchospasm and require an additional bronchodilator.

This inhalation aerosol is a combination of Salbutamol (as sulphate) and Ipratropium Bromide. It is an environmentally friendly hydrofluoroalkane (HFA) based inhaler, as it does not contain chlorofluorocarbon (CFC), which contributes to ozone layer depletion.

Salbutamol is a short-acting beta2-adrenergic bronchodilator, while Ipratropium Bromide is an anticholinergic bronchodilator. When used together, Ipratropium Bromide blocks the increase in intracellular cyclic guanosine monophosphate caused by acetylcholine interaction with muscarinic receptors on bronchial smooth muscle. This combination provides dual bronchodilation through two mechanisms—anticholinergic (parasympatholytic) and sympathomimetic—thereby improving airflow in COPD patients. The combined use produces a greater bronchodilatory effect than either drug alone at standard doses.

Adult dose (Including the elderly): 2 puffs of Salpium 4 times a day (Patients may take additional puffs as required but a total number of puffs should not exceed 12 in 24 hours). Or as directed by the physician.

Using an Inhaler seems simple, but most patients do not know how to use it in the right way. If the Inhaler is used in the wrong way, less medicine can reach the lungs. Correct and regular use of the Inhaler will prevent or lessen the severity of asthma attacks.

Following simple steps can help to use Inhaler effectively (According to "National Asthma Guidelines for Medical Practitioners" published by Asthma Association):

• Take off the cap.
• Shake the inhaler (at least six times) vigorously before each use.
• If the inhaler is new or if it has not been used for a week or more, shake it well and release one puff into the air to make sure that it works.
• Breathe out as full as comfortably possible & hold the inhaler upright.
• Place the actuator into mouth between the teeth and close lips around the mouthpiece.
• While breathing deeply and slowly through the mouth, press down firmly and fully on the canister to release medicine.
• Remove the inhaler from mouth. Continue holding breath for at least 10 seconds or as long as it is comfortable.
• If doctor has prescribed more than one inhalation per treatment, wait 1 minute between puffs (inhalations).
• Shake the inhaler well and repeat steps 4 to 7.
• After use, replace the cap on the mouthpiece. After each treatment, rinse mouth with water.
• Check your technique in front of a mirror from time to time, if you see a white mist during the inhalation, you may not have closed your lips properly around mouthpiece, or you may not be breathing in as you press the can. This indicates failure of technique. If this happens, repeat the procedure from step 4 carefully.

Instructions for Cleaning Inhaler: Clean your Inhaler at least once a week. Remove canister and rinse the plastic actuator and cap in warm water but do not put the metal canister into water. Dry the actuator and cap thoroughly and gently replace the metal canister into the actuator with a twisting motion. Put the cap on the mouthpiece.

This inhalation aerosol has been used together with other commonly used COPD medications, including sympathomimetic bronchodilators, methylxanthines, and steroids. However, no formal drug interaction studies have been conducted with this combination or with other COPD therapies. Ipratropium Bromide should be used cautiously with other anticholinergic and sympathomimetic agents, as this may increase the risk of cardiovascular adverse effects. Beta-2 agonist–containing medicines, such as this inhaler, should be used with extreme caution in patients receiving non–potassium-sparing diuretics, monoamine oxidase inhibitors (MAOIs), or tricyclic antidepressants.

This inhalation aerosol is contraindicated in patients with known hypersensitivity to soya-lecithin or related foods such as soybean and peanut. It is also contraindicated in patients hypersensitive to any component of the product or to atropine and its derivatives.

Due to Salbutamol, mild tremor and headache have been reported, which usually resolve with continued treatment. Rarely, muscle cramps and hypersensitivity reactions such as angioedema, urticaria, bronchospasm, and hypotension may occur.

Due to Ipratropium Bromide, rare side effects include headache, influenza-like symptoms, chest pain, nausea, dyspnea, cough, pharyngitis, and sinusitis.

Ipratropium Bromide is Pregnancy Category B, with studies showing no teratogenic effects. Salbutamol is Pregnancy Category C and has shown teratogenic effects in animals.

There are no adequate and well-controlled studies for this combination in pregnant women. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is unknown whether the components are excreted in human milk; therefore, caution is advised during breastfeeding.

Use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder-neck obstruction due to Ipratropium Bromide.

Salbutamol should be used cautiously in patients with convulsive disorders, hyperthyroidism, diabetes mellitus, and those who are unusually sensitive to sympathomimetic agents.

Overdose effects are mainly related to Salbutamol. Symptoms may include anginal pain, hypertension, hypokalemia, and tachycardia.

Combined bronchodilators

Do not puncture, break, or incinerate the pressurized canister even when empty. Avoid direct sunlight and heat. Store in a cool, dry place. Keep out of reach of children and away from eyes.