Combimist-L Inhaler

Combimist-L Inhaler is a combination medicine used to relieve symptoms such as shortness of breath, chest tightness, breathing difficulties, wheezing, coughing, etc. The preparation contains 2 active ingredients: ipratropium (20 mcg) + levosalbutamol (50 mcg).


For inhalation use: treatment and prevention of chronic obstructive airway diseases: chronic bronchitis with the bronchial obstructive syndrome (with or without emphysema), mild to moderate bronchial asthma, especially with concomitant diseases of the cardiovascular system; bronchospasm during surgical operations. Airway preparation before administration of antibiotics, mucolytic agents, corticosteroids, sodium cromoglycate in aerosols.

For intranasal use: chronic rhinitis with hypersecretion.

How does it work?

Combimist-L is a bronchodilating agent that blocks m-cholinergic receptors of the smooth muscles of the tracheobronchial tree (mainly at the level of large and medium bronchi) and inhibits reflex bronchoconstriction, reduces the secretion of the glands of the mucous membrane of the nasal cavity and bronchial glands. The drug has structural similarities with the acetylcholine molecule, it is a competitive antagonist. It effectively prevents narrowing of the bronchi resulting from inhalation of cigarette smoke, cold air, the effects of various bronchospasm agents, and also eliminates bronchospasm associated with the influence of n.vagus. When inhaled, it practically does not have a resorptive effect. The bronchodilating effect develops after 5-15 minutes, reaches a maximum after 1-2 hours and lasts up to 6 hours (sometimes up to 8 hours).

Dosage and instructions for use

Combimist L Inhaler is available in the form of a nasal spray but can also be used through the mouth, inhaled.

Use this medicine exactly as prescribed.  Do not use this medicine in larger or smaller quantities or for longer than recommended by your doctor.  Do not stop using this medication without consulting your doctor.

The dosage regimen is individual, depending on indications, age, applied dosage form. It’s recommended to make inhalations up to 3 times a day with a maximum dosage of 42 mcg per nostril (approximately two sprays).

If you missed the dose, take it as soon as possible. It is recommended to skip the missed dose if it is almost the time for your next scheduled dose. Do not use an additional dose to make up for the missed dose.

Side effects

In some cases Combimist L inhaler can cause the following side effects:

  • dry mouth;
  • headache;
  • nausea;
  • dizziness;
  • increased viscosity of sputum;
  • tachycardia;
  • wheezing;
  • shortness of breath;
  • constipation;
  • back pain;
  • low blood pressure;
  • cough;
  • viral infections;
  • blocked or runny nose;
  • sore throat and hoarseness;
  • shaking and trembling of arms and feet;
  • indigestion;
  • muscle pain and cramps;
  • nervousness;
  • chest pain and discomfort;
  • increased heartbeat;
  • difficulty in swallowing;
  • unusual tiredness and weakness;
  • visual disturbances;
  • palpitations;
  • paresis of accommodation;
  • weakened gastrointestinal motility;
  • bladder pain;
  • urinary retention;
  • paradoxical bronchospasm;
  • allergic reactions – skin rash (including urticaria and erythema multiforme), swelling of the tongue, lips and face, laryngospasm, and other manifestations of anaphylaxis.

Consult your doctor if you have any undesirable side effects.

Overdose symptoms include increased anticholinergic reactions. Treatment should be symptomatic.


Do not use Combimist-L inhaler if you have any of the conditions mentioned below:

  • hypersensitivity to ipratropium or levosalbutamol;
  • tachyarrhythmia;
  • increased intraocular pressure;
  • prostatic hyperplasia;
  • mechanical gastrointestinal stenosis;
  • megacolon;
  • I trimester of pregnancy.
  • hypertrophic obstructive cardiomyopathy.

Use with caution: kidney disease, liver disease, heart disease, diabetes, hypokalemia, seizure disorders.

Pregnancy and lactation

The inhaler is contraindicated for use in the first trimester of pregnancy. Use in the II and III trimesters of pregnancy is possible in the presence of strict indications. Contraindications for use during lactation have not been established.

Use in children

This medicine is not recommended for use in patients less than 12 years of age.

Drug interactions

Do not combine Combimist-L inhaler with the following medications:

  • Amitriptyline;
  • Atenolol;
  • Aripiprazole;
  • Atropine;
  • Clozapine;
  • Chlorpheniramine;
  • Formoterol;
  • Furosemide;
  • Hydrochlorothiazide;
  • Ketoconazole;
  • Pseudoephedrine;
  • Propranolol;
  • Tiotropium;
  • Xylometazoline.

Special instructions

Combimist-L should be used with caution in patients with angle-closure glaucoma, urinary tract obstruction due to prostatic hyperplasia.

Since ipratropium can affect visual acuity, caution should be exercised during treatment while driving vehicles and other potentially hazardous activities.

Interaction with alcohol is unknown. It is recommended to consult your doctor before use.