Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler)

1. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) © The Swiss Pharmacy

2. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) is used for the treatment or prevention of bronchospasm in adults, adolescents, and children (4 years of age and older) with reversible obstructive airway diseases like asthma and COPD, including chronic bronchitis and emphysema. Duolin Inhaler is a combination of an anticholinergic and beta-adrenergic used for patients with chronic obstructive pulmonary disease (COPD) on a regular aerosol bronchodilator who continue to have evidence of bronchospasm and who require a second bronchodilator. © The Swiss Pharmacy

3. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Duolin Inhaler is manufactured by Cipla Limited, India. Each puff contains Levalbuterol / Levosalbutamol Sulfate 50 mcg and Ipratropium Bromide 20 mcg. © The Swiss Pharmacy

4. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Chemical Structure - Ipratropium Bromide © The Swiss Pharmacy

5. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Chemical Structure - Levalbuterol Tartrate © The Swiss Pharmacy

6. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) The active ingredients contained in Duolin Inhaler are Ipratropium Bromide and Levalbuterol Tartrate (Levosalbutamol Tartrate). Each puff contains 50 mcg of Levalbuterol Tartrate (Levosalbutamol Tartrate) and 20 mcg of Ipratropium Bromide. © The Swiss Pharmacy

7. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Uses of Duolin Inhaler: Ipratropium Bromide and Levalbuterol Tartrate inhalation solution is a combination of two medicines called bronchodilators. Ipratropium and Levalbuterol combination is used to help control the symptoms of lung diseases, such as asthma, chronic bronchitis, and emphysema. It is also used to treat air flow blockage and prevent the worsening of chronic obstructive pulmonary disease (COPD) in patients who need another medicine. Duolin Inhaler contains Levalbuterol Tartrate, which is a beta-adrenergic agonist, and Ipratropium Bromide, which is an anticholinergic. These two medicines work together to help open the airways in your lungs. Ipratropium Bromide and Levalbuterol Tartrate inhalation solution is used to help treat airway narrowing (bronchospasm) that happens with chronic obstructive pulmonary disease (COPD) in adult patients who need to use more than one bronchodilator medicine. URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

8. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Recommended Adult Dosage The dosage of Duolin Inhaler Levalbuterol Inhaler) is is 2 inhalations, four times a day. Patients may take additional inhalations as required; however, the total number of inhalations should not exceed 12 in 24 hours. It is recommended to “test-spray” three times before using for the first time and in cases where the aerosol has not been used for more than 24 hours. Avoid spraying into eyes. Duolin Inhaler (Generic Ipratropium and URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

9. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Contraindications ➔Duolin Inhaler is contraindicated in patients with a known hypersensitivity to Ipratropium Bromide, Levosalbutamol Tartarate, Racemic Albuterol or any component of the tablet. Reactions have included urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema ➔Administration of Ipratropium Bromide is contraindicated in patients who are hypersensitive to atropine or its derivatives. ➔Duolin Inhaler is contraindicated in patients with a history of hypersensitivity to soya lecithin or related food products such as soybean and peanut. URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

10. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Storage Instructions Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) has to be stored at controlled room temperature i.e. from 20°C to 25°C (68°F to 77°F) with excursions permitted between 15° to 30°C (59° to 86°F). Keep this as well as all other medicines away from children and pets. URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

11. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Warnings Paradoxical Bronchospasm: Discontinue Duolin Inhaler immediately and treat with alternative therapy if paradoxical bronchospasm occurs. Deterioration of Asthma: Asthma may deteriorate acutely over a period of hours or chronically over several days or longer. If the patient needs more doses of Levosalbutamol (Levalbuterol) than usual, this may be a marker of destabilization of asthma and requires re-evaluation of the patient and treatment regimen. Use of Anti-Inflammatory Agents: The use of a beta-adrenergic agonist alone may not be adequate to control asthma in many patients. Early consideration should be given to adding anti- inflammatory agents, e.g., corticosteroids, to the therapeutic regimen. Patients with cardiovascular system disorders: Use with caution because of beta-adrenergic stimulation. URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

12. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Warnings Ocular effects: Advise patients to avoid spraying into eyes and to contact a physician if blurred vision, halos, or other visual disturbances occur. Monitor patients with narrow-angle glaucoma. Do Not Exceed Recommended Dose: Fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs in patients with asthma. The exact cause of death is unknown, but cardiac arrest following an unexpected development of a severe acute asthmatic crisis and subsequent hypoxia is suspected. Immediate Hypersensitivity Reactions: Immediate hypersensitivity reactions may occur after administration of ipratropium bromide or racemic salbutamol (Albuterol), as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema. In case such a reaction occurs, Duolin Inhaler must be stopped at once and alternative treatment should be considered. URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

13. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Warnings Urinary retention: Use with caution in patients with prostatic hyperplasia or bladder-neck obstruction Coexisting conditions: Levalbuterol (Levosalbutamol), like all sympathomimetic amines, should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, hypertension, and cardiac arrhythmias; in patients with convulsive disorders, hyperthyroidism, or diabetes mellitus; and in patients who are unusually responsive to sympathomimetic amines. Ipratropium Bromide: Ipratropium bromide is a bronchodilator for the maintenance treatment of bronchospasm associated with COPD and is not indicated for the initial treatment of acute episodes of bronchospasm, where rescue therapy is required for rapid response. URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

14. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Possible Side Effects Use of Levalbuterol (Levosalbutamol) may be associated with the following serious side effects: Paradoxical bronchospasm, Cardiovascular effects, Immediate hypersensitivity reactions and Hypokalemia. Following side effects were observed in 2% or more of the patients receiving Levalbuterol inhalation or racemic Albuterol and more frequently than in patients receiving placebo during placebo-controlled trial in patients with asthma 12 years of age and older: Allergic reaction, Flu syndrome, Accidental injury, Pain, Back pain, Tachycardia, Migraine, Dyspepsia, Leg cramps, Dizziness, Hypertonia, Nervousness, Tremor, Anxiety, Cough increased, Infection viral, Rhinitis, Sinusitis and Turbinate edema URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

15. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Possible Side Effects Ipratropium Bromide inhalation side effects reported by three percent or more patients in the 12-week controlled clinical trials from 12-week active-controlled clinical trials are Headache, Pain, Influenza-like symptoms, Back Pain, Chest Pain, Hypertension/Hypertension Aggravated, Dizziness, Insomnia, Tremor, Nervousness, Mouth Dryness, Nausea, Constipation, Arthritis, Coughing, Dyspnea, Bronchitis, Bronchospasm, Sputum Increased, Respiratory Disorder, Upper Respiratory Tract Infection, Pharyngitis, Rhinitis and Sinusitus. URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

16. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Overdosage Levalbuterol Tartarate: The expected symptoms with overdosage are those of excessive beta-adrenergic receptor stimulation and/or occurrence or exaggeration of any of the symptoms listed under adverse reactions, e.g., seizures, angina, hypertension or hypotension, tachycardia with rates up to 200 beats/minute, arrhythmias, nervousness, headache, tremor, dry mouth, palpitation, nausea, dizziness, fatigue, malaise, and sleeplessness. Hypokalemia may also occur. As with all sympathomimetic medications, cardiac arrest and, even, death may be associated with the abuse of Levalbuterol (Levosalbutamol). Ipratropium Bromide: Dose of Ipratropium Bromide up to 1.2 mg (60 puffs) have been administered by inhalation without the appearance of serious systemic anticholinergic effects. Minor systemic manifestations of anticholinergic action, including dry mouth, visual accommodation disorder and increase of heart rate may occur. URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

17. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Treatment of Duolin Inhaler Overdosage Levalbuterol Tartarate: Treatment consists of discontinuation of Levalbuterol Tartarate (Levosalbutamol) together with appropriate symptomatic therapy. The judicious use of a cardioselective beta- receptor blocker may be considered, bearing in mind that such medication can produce bronchospasm. There is insufficient evidence to determine if dialysis is beneficial in treating overdosage of Levalbuterol. Ipratropium Bromide: Should signs of serious anticholinergic toxicity appear, cholinesterase inhibitors may be considered. URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

18. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Duolin Inhaler During Pregnancy Ipratropium Bromide and Levalbuterol Tartarate Inhaler (Duolin Inhaler) has been classified by the US FDA as Pregnancy Category C. There are no adequate and well-controlled studies of Ipratropium Bromide and Levalbuterol Tartarate combination inhaler (Duolin Inhaler) in pregnant women. Published literature, including cohort studies, case control studies and case series, over several decades have not identified a drug associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes with Ipratropium Bromide. URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

19. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Duolin Inhaler During Pregnancy Available data from published epidemiological studies and postmarketing case reports of pregnancy outcomes following inhaled Albuterol use do not consistently demonstrate a risk of major birth defects or, miscarriage. Because animal reproduction studies are not always predictive of human response, Duolin Inhaler should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy

20. Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) Duolin Inhaler Duolin Inhaler (Generic Ipratropium Bromide and Levalbuterol Tartrate Inhaler) is manufactured by Cipla Limited, India. URL: URL: https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html https://www.theswisspharmacy.com/product_info.php?info=p9535_Levosalbutamol-and-Ipratropium-Inhaler.html © The Swiss Pharmacy