Do not combine these COPD medications

Most people with chronic obstructive pulmonary disease (COPD) use an inhaler every day to manage shortness of breath and other symptoms of this progressive lung disease.

There are many different kinds of inhalers. Some are used once or twice a day to control COPD and prevent exacerbations (exacerbations). When the condition worsens, other medicines are used as needed. Therefore, most COPD patients use several different inhalers in their treatment plan.

This article describes some of the problems associated with the use of different inhaled medications. It also lists inhalers that shouldn’t be used together and several that might be fine.

Chronic Obstructive Pulmonary Disease Inhaled Drug Class

There are different classes of inhaled medications used to treat COPD. Among them:

  • Antimuscarinic drugs reverse airway narrowing by acting on neurotransmitters called neurotransmitters acetylcholine.
  • Long-acting beta agonists (LABAs) relax the airways by acting on receptors in the lungs called beta-2 adrenergic receptors.
  • Short-acting beta agonists (SABAs) act like LABAs but are used as rescue inhalers rather than daily use
  • Inhaled steroids improve breathing by reducing inflammation.

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There are four main classes of inhaled drugs used to treat COPD: antimuscarinic drugs, long-acting beta agonists (LABAs), short-acting beta agonists (SABA), and inhaled steroids.

possible concerns

Although more than one inhaler may be prescribed to treat COPD, that doesn’t mean they can all be used together. In fact, using some at the same time may carry health risks.

Possible concerns include:

  • Overdose: Some inhalers contain one drug, while others contain two or three drugs. This increases the risk of overdose if the same drug is contained in two different inhalers.
  • Increased side effects: Inhalers of the same class of drugs can cause many of the same symptoms.Using two inhalers of the same class can increase the risk or severity of side effects
  • Interactions: Some inhaled drugs can interact with other inhaled drugs, causing a severe drop in serum potassium (Hypokalemia) and heart rhythm problems (Arrhythmia).

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Not all COPD inhalers can be used together. Using an inhaler from the same category may result in an overdose and increase your risk of side effects. Other inhaled medications may interact and cause abnormally low potassium levels and heart rhythm problems.

safe or unsafe combination

Some inhalers can be used together and some cannot. If you or a loved one is being treated for COPD, here are a few things to keep in mind:

antimuscarinic inhaler

Controller medications are medications used to control COPD symptoms and prevent exacerbations. Antimuscarinic drugs are controller medications that are used once or twice a day.

drug class consider reason
Atrovent HFA (ipratropium bromide) antimuscarinic Should not be used with other medicines containing antimuscarinic medicines increased risk of side effects
Added Ellipta (umeclidinium) antimuscarinic Should not be used with other medicines containing antimuscarinic medicines increased risk of side effects
Spiriva (Tiotropium Bromide) antimuscarinic Should not be used with other medicines containing antimuscarinic medicines increased risk of side effects
Tudorza (Aclidinium Bromide) antimuscarinic Should not be used with other medicines containing antimuscarinic medicines increased risk of side effects
Anoro Ellipta (umeclidinium/vilanterol) Antimuscarinic, LABA Should not be used with other medicines containing antimuscarinic medicines increased risk of side effects
Bevespi Aerosphere (glycopyrrolate/formoterol) Antimuscarinic, LABA Should not be used with other medicines containing antimuscarinic medicines increased risk of side effects
Breo Ellipta (fluticasone/vilanterol) Antimuscarinic, LABA Should not be used with other medicines containing antimuscarinic medicines increased risk of side effects
Stiolto Respimat (Tiotropium/Odacaterol) Antimuscarinic, LABA Should not be used with other medicines containing antimuscarinic medicines increased risk of side effects
Trelegy Ellipta (fluticasone/umeclidinium/vilanterol) Antimuscarinic, LABA, inhaled steroids Should not be used with other medicines containing antimuscarinic medicines increased risk of side effects
Combivent Respimat (ipratropium/salbutamol) Antimuscarinic, SABA Should not be used with other medicines containing antimuscarinic medicines increased risk of side effects

beta-agonist

Beta-2 adrenergic agonists (also called beta-agonists) are the mainstay of treatment for COPD. There is a short-acting version for use as a rescue inhaler and a long-acting version for COPD control.

class consider reason
salbutamol (generic) Saba Can be taken with LABA not applicable
Brovana (Afortro) Laba Can be taken with SABA not applicable
Fodil (Formoterol) Laba Can be taken with SABA not applicable
Perforomist (Formoterol) Laba Can be taken with SABA not applicable
Serevent (Salmeterol) Laba Can be taken with SABA not applicable
Striverdi Respimat (Odatro) Laba Can be taken with SABA not applicable

inhaled steroids

Inhaled corticosteroids (also called inhaled steroids) are often used in combination with other inhaled medications to control COPD. They are mainly used in people with a history of exacerbations.

class consider reason
Advair (fluticasone/salmeterol) Inhaled steroids and LABA Can be taken with SABA not applicable
Symbicort (budesonide/formoterol) Inhaled steroids and LABA Can be taken with SABA not applicable
Flovent (fluticasone) inhaled steroids Can be used with Advair or Symbicort for severe COPD Increased risk of hypokalemia and heart rhythm problems
QVAR (beclomethasone) inhaled steroids Can be used with Advair or Symbicort for severe COPD Increased risk of hypokalemia and heart rhythm problems

generalize

People with COPD are often treated with more than one inhaler. Some are used as control medications and some are used as “rescue inhalers” during a COPD attack. Although these medicines are effective, not all medicines can be used together.

While it is common to use more than one inhaler for COPD, problems can arise if you use two medications from the same class. Doing so can double your drug, leading to an overdose and increasing your risk of side effects. Other drugs are known to interact, causing severe drops in blood potassium and heart rhythm problems.

VigorTip words

To make sure your inhalers can be taken together, check the medicine category. If you find yourself taking more than one drug in the same class, ask your doctor to check your prescription.

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13 sources

VigorTip Health uses only high-quality resources, including peer-reviewed research, to support the facts in our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable and trustworthy.

  1. National Library of Medicine, DailyMed. Atrovent HFA-Ipratropium Bromide Aerosol, Metered [drug label].

  2. National Library of Medicine, DailyMed. Increse Elliptaumeclidinium Aerosol, Powder [drug label].

  3. National Library of Medicine, DailyMed. Spiriva Respimatiotropium bromide inhalation spray, metered [drug label].

  4. National Library of Medicine, DailyMed. Tudorza Pressair – Aclidinium Bromide Powder, Metered [drug label].

  5. National Library of Medicine, DailyMed. Anoro Elliptaumeclidinium bromide and vilanterol trifenatate powder [drug label].

  6. National Library of Medicine, DailyMed. Bevespi Aerosphere – Glycopyrronium Bromide and Formoterol Fumarate Aerosol, Metered [drug label].

  7. National Library of Medicine, DailyMed. Breo Ellipta – Fluticasone Furoate and Vilanterol Trifenamate Powder [drug label].

  8. National Library of Medicine, DailyMed. Stiolto Respimatiotropium bromide and Odacaterol spray, metered [drug label].

  9. National Library of Medicine, DailyMed. Combivent Respimat-ipratropium bromide and salbutamol spray, metered [drug label].

  10. National Library of Medicine, DailyMed. Advair Diskus – Fluticasone Propionate and Salmeterol Powder [drug label].

  11. National Library of Medicine, DailyMed. Symbicort-budesonide and formoterol fumarate dihydrate aerosol [drug label].

  12. National Library of Medicine, DailyMed. Flovent Diskus – Fluticasone Propionate Powder, Metered [drug label].

  13. National Library of Medicine, DailyMed. QVAR Redihaler – Beclomethasone Dipropionate HFA Aerosol, Metered [drug label].

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