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Activation of beta 2adrenergic receptors on airway smooth muscle leads to the activation of adenylyl cyclase and to an increase in the intracellular concentration of cyclic-35adenosine monophosphatecyclic AMPThis increase of cyclic AMP leads to the activation of protein kinase Awhich inhibits the phosphorylation of myosin and lowers intracellular ionic calcium concentrationsresulting in relaxationAlbuterol relaxes the smooth muscles of all airwaysfrom the trachea to the terminal bronchiolesAlbuterol acts as a functional antagonist to relax the airway irrespective of the spasmogen involvedthus protecting against all bronchoconstrictor challengesIncreased cyclic AMP concentrations are also associated with the inhibition of release of mediators from mast cells in the airway.

This product contains trichloromonofluoromethaneCFC-11dichlorodifluoromethaneCFC-12and dichlorotetrafluoroethaneCFC-114substances which harm the environment by destroying ozone in the upper atmosphere.

Effects Seen with Anticholinergic DrugsCOMBIVENT Inhalation Aerosol contains ipratropium bromide andthereforeshould be used with caution in patients with narrow-angle glaucomaprostatic hyperplasiaor bladder-neck obstructionEffects Seen with Sympathomimetic DrugsPreparations containing sympathomimetic amines such as albuterol sulfate should be used with caution in patients with convulsive disordershyperthyroidismor diabetes mellitus and in patients who are unusually responsive to sympathomimetic aminesBeta-adrenergic agents may also produce significant hypokalemia in some patientspossibly through intracellular shuntingwhich has the potential to produce adverse cardiovascular effectsThe decrease in serum potassium is usually transientnot requiring supplementationUse in Hepatic or Renal DiseaseCOMBIVENT Inhalation Aerosol has not been studied in patients with hepatic or renal insufficiencyIt should be used with caution in those patient populations.

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