albuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.salsalateMonitor Closely (1)salsalate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.saquinavirContraindicated (1)saquinavir, albuterol. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Contraindicated. Saquinavir boosted with ritonavir increases risk of hypokalemia, QT prolongation, and cardiac arrhythmias.Monitor Closely (1)albuterol and saquinavir both increase QTc interval. Use Caution/Monitor.scopolamineMonitor Closely (1)ipratropium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.scullcapMonitor Closely (1)scullcap increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.secobarbitalMonitor Closely (1)secobarbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.selpercatinibMonitor Closely (1)albuterol and selpercatinib both increase QTc interval. Use Caution/Monitor.serdexmethylphenidate/dexmethylphenidateMonitor Closely (1)albuterol and serdexmethylphenidate/dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.sertralineMonitor Closely (1)albuterol and sertraline both increase QTc interval. Use Caution/Monitor.sevofluraneMonitor Closely (1)albuterol and sevoflurane both increase QTc interval. Use Caution/Monitor.shepherd's purseMonitor Closely (1)shepherd's purse increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.siponimodMonitor Closely (1)albuterol and siponimod both increase QTc interval. Use Caution/Monitor.sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycolMonitor Closely (1)albuterol and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.solifenacinMonitor Closely (2)ipratropium and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages. albuterol and solifenacin both increase QTc interval. Use Caution/Monitor.solriamfetolMonitor Closely (1)albuterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.sorafenibMonitor Closely (1)albuterol and sorafenib both increase QTc interval. Use Caution/Monitor.sotalolMonitor Closely (3)sotalol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor. albuterol and sotalol both increase QTc interval. Use Caution/Monitor. sotalol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.spironolactoneMonitor Closely (1)spironolactone increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.succinylcholineMonitor Closely (2)succinylcholine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. succinylcholine increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.sufentanilMonitor Closely (1)sufentanil increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.sulfasalazineMonitor Closely (1)sulfasalazine increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.sulindacMonitor Closely (1)sulindac increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.sunitinibMonitor Closely (1)albuterol and sunitinib both increase QTc interval. Use Caution/Monitor.tacrolimusMonitor Closely (1)albuterol and tacrolimus both increase QTc interval. Use Caution/Monitor.tapentadolMonitor Closely (1)tapentadol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.telavancinMonitor Closely (1)albuterol and telavancin both increase QTc interval. Use Caution/Monitor.temazepamMonitor Closely (1)temazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.terbutalineMonitor Closely (3)albuterol and terbutaline both decrease serum potassium. Use Caution/Monitor. albuterol and terbutaline both decrease sedation. Use Caution/Monitor. albuterol and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.tetrabenazineMonitor Closely (1)albuterol and tetrabenazine both increase QTc interval. Use Caution/Monitor.thioridazineContraindicated (1)albuterol and thioridazine both increase QTc interval. Contraindicated.Monitor Closely (4)thioridazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. thioridazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. ipratropium decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.thiothixeneMonitor Closely (4)thiothixene increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. ipratropium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor. thiothixene increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. ipratropium decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.timololMonitor Closely (2)timolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor. timolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tiotropiumMonitor Closely (1)ipratropium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.tolfenamic acidMonitor Closely (1)tolfenamic acid increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tolmetinMonitor Closely (1)tolmetin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tolterodineMonitor Closely (1)ipratropium and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.tolvaptanMonitor Closely (1)tolvaptan increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.topiramateMonitor Closely (1)topiramate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.toremifeneMonitor Closely (1)albuterol and toremifene both increase QTc interval. Use Caution/Monitor.torsemideMonitor Closely (1)albuterol and torsemide both decrease serum potassium. Use Caution/Monitor.Minor (1)albuterol, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.tramadolMonitor Closely (1)tramadol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.tranylcypromineSerious - Use Alternative (1)tranylcypromine increases effects of albuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.trazodoneMonitor Closely (3)trazodone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. albuterol and trazodone both increase QTc interval. Use Caution/Monitor. ipratropium and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.Serious - Use Alternative (1)trazodone, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.triamtereneMonitor Closely (1)triamterene increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.triazolamMonitor Closely (1)triazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.triclabendazoleMonitor Closely (1)albuterol and triclabendazole both increase QTc interval. Use Caution/Monitor.triclofosMonitor Closely (1)triclofos increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.trifluoperazineMonitor Closely (4)ipratropium decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor. trifluoperazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. trifluoperazine increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.trihexyphenidylMonitor Closely (1)ipratropium and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.trimipramineMonitor Closely (3)albuterol and trimipramine both increase QTc interval. Use Caution/Monitor. trimipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. ipratropium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.Serious - Use Alternative (1)trimipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.triprolidineMonitor Closely (1)triprolidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.triptorelinMonitor Closely (1)albuterol and triptorelin both increase QTc interval. Use Caution/Monitor.trospium chlorideMonitor Closely (1)ipratropium and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.umeclidinium bromideMonitor Closely (1)umeclidinium bromide and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agents umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (1)ipratropium, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Concomitant use with other anticholinergic-containing drugs may lead to additive anticholinergic adverse effects.valbenazineMonitor Closely (1)valbenazine and albuterol both increase QTc interval. Use Caution/Monitor.vandetanibMonitor Closely (1)albuterol and vandetanib both increase QTc interval. Use Caution/Monitor.vardenafilMonitor Closely (1)albuterol and vardenafil both increase QTc interval. Use Caution/Monitor.vecuroniumMonitor Closely (1)ipratropium and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.vemurafenibMonitor Closely (1)albuterol and vemurafenib both increase QTc interval. Use Caution/Monitor.voclosporinMonitor Closely (1)albuterol and voclosporin both increase QTc interval. Use Caution/Monitor.voriconazoleMonitor Closely (1)albuterol and voriconazole both increase QTc interval. Use Caution/Monitor.vorinostatMonitor Closely (1)albuterol and vorinostat both increase QTc interval. Use Caution/Monitor.xylometazolineMonitor Closely (2)albuterol and xylometazoline both decrease sedation. Use Caution/Monitor. albuterol and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.yohimbineMonitor Closely (2)albuterol and yohimbine both decrease sedation. Use Caution/Monitor. albuterol and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.ziconotideMonitor Closely (1)ziconotide increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziprasidoneMonitor Closely (5)ziprasidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. ziprasidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. albuterol and ziprasidone both increase QTc interval. Use Caution/Monitor. ipratropium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.zotepineMonitor Closely (2)ipratropium decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. ipratropium decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. >10% Bronchitis (2-12%) 1-10% Upper respiratory tract infection (1-10%) Lung disease (6%) Headache (3-6%) Dyspnea (2-5%) Nasopharyngitis (4%) Cough (3-4%) Pharyngitis (2-4%) Pain (1-3%) Chest pain (2.6%) Sinusitis (2.3%) Nausea (1-2%) Diarrhea (1.8%) Urinary tract infection (1.6%) Influenza (1.4%) Leg cramps (1.4%) Nausea (1.4%) Pneumonia (1.4%) Rhinitis (1.1%) <1% Allergic-type reactions, such as skin reactions (eg, rash, pruritus, urticaria [including giant urticaria]), angioedema (eg, of tongue, lips, face), laryngospasm, and anaphylaxis Angina Arrhythmia Arthralgia Dizziness Dry mouth Dyspepsia Dysphonia Edema Fatigue Hypertension Insomnia Nervousness Palpitation Paresthesia Tachycardia Tremor Vomiting Postmarketing Reports Cardiovascular: Palpitations, hypotension, myocardial infarction, decreased diastolic blood pressure (BP), increased systolic BP General: Anaphylactoid reactions, drowsiness, flushing, alopecia, edema, hypokalemia, mental disorder, hyperhidrosis, metabolic acidosis (with albuterol products), asthenia Gastrointestinal (GI): Mucosal ulcers, stomatitis, heartburn, distress (diarrhea, nausea, vomiting), GI motility disorder, constipation Muscular: Muscle spasms, muscular weakness, myalgia Neurologic and psychiatric: Central nervous system (CNS) stimulation, coordination difficulty Other: Throat irritation, dry throat, hoarseness Renal: Urinary retention Respiratory: Bronchospasm (including paradoxical bronchospasm), nasal congestion, drying of secretions, wheezing, exacerbation of COPD symptoms Sensory: Mydriasis, precipitation or worsening of narrow-angle glaucoma, glaucoma, increased intraocular pressure (IOP), acute eye pain, halo vision, blurred vision, accommodation disorder, ocular irritation, corneal edema, conjunctival hyperemia Contraindications Hypersensitivity to albuterol, ipratropium, atropine and derivatives, soy, or peanut Cautions Paradoxical bronchospasm; discontinue immediately, and administer alternative therapy History of cardiovascular disorders; beta-adrenergic stimulation can result in clinically significant cardiovascular effects, myocardial ischemia, or electrocardiographic (ECG) changes Avoid spraying into eyes, and contact physician if visual disturbances (eg, blurred vision or halos) occur; monitor patients with narrow-angle glaucoma May produce clinically important hypokalemia leading to adverse cardiovascular effects in some patients May cause immediate hypersensitivity reaction (urticaria, angioedema, rash, bronchospasm, anaphylaxis, or oropharyngeal edema); discontinue immediately, and administer alternative therapy Use cution in patients with convulsive disorders, hyperthyroidism, diabetes mellitus, prostatic hyperplasia, or bladder-neck obstruction May cause dizziness and blurred vision; patients should use caution when performing tasks requiring mental alertness Do not exceed recommended dosage; fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs in patients with asthma Keep out of reach of children Avoid freezing Pregnancy There are no randomized clinical studies of the drug combination, or its individual components, ipratropium bromide and albuterol sulfate, in pregnant women; ipratropium is negligibly absorbed systemically following oral inhalation; therefore, maternal use is not expected to result in fetal exposure to drug Published literature, including cohort studies, case-control studies and case series, over several decades have not identified drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes with ipratropium bromide 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; there are clinical considerations with use of therapy in pregnant women; animal reproduction studies have not been conducted with drug Because of potential for beta-agonist interference with uterine contractility, use of