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I truely understand the concept of how the receptors in the lung are saturated with Spiriva , and therefore atrovent is ineffective. I had a Pulmonoligist specifically order Spiriva and Atrovent together. Either He does not understand the concept of Both meds being similar in structure, or there is another benefit ? Is anyone familiar or has ran across this scenerio ? If so please tell me the benefit, if one drug blocks the receptors and is already on board for 24 hrs, and atrovent a 6hr med is trying to block the already blocked receptors , how is this effective?

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Comment by Zahara Zawawi on April 28, 2009 at 1:11pm
As far as I know Spariva shouldn't be used in combination with Atrovent. I remember reading it on the package insert in the Spiriva box.

This is what I found on the SPIRIVA website: "SPIRIVA has not been studied with either ATROVENT Inhalation Aerosol or COMBIVENT Inhalation Aerosol, and, therefore, it is not recommended to use SPIRIVA with these medications." from http://www.spiriva.com/consumer/about-spiriva/is-spiriva-As

Have you asked the Dr. what his rational is?
Comment by Vergel on April 19, 2009 at 2:56am
Thanks Tammy, that is because you have such a good question. Keep em coming. Alfonso has a lot in his reasoning tank, he's one of my mentors.
Comment by Tammy on April 18, 2009 at 6:55am
I appreciate all of the comments left by Alfonso & Vergel about the difference between spiriva and atrovent, its nice to have a real conversation with intelligent people, finally
Comment by Vergel on April 15, 2009 at 12:45pm
That article could be the the last nail to the coffin (coughin ha-ha), but it's just that we have to pay to see it (it originated in pharmacicstsletter.com). Another thing I've noticed is that it mentions brand-specific meds from the same company, doesn't that smell fishy in a way? (I'm such a Marxist)
excerpt from progressive-medical.com:

"A recent study has shown that using Spiriva® and Atrovent® at the same time may help improve breathing in some patients; however, the improvement is small.1 Although adding Atrovent® to Spiriva® typically does not make a significant difference, it may be appropriate in some individuals with chronic obstructive pulmonary disease (COPD) to use Atrovent® during the first 1-2 weeks when initially starting Spiriva®. Spiriva® should be used daily for over a week before it is fully beneficial. Then, two weeks after beginning Spiriva® and Atrovent®, the Atrovent® should be stopped."

It shows here precarious statements, it still needs strong backup from independent research teams. It's still a good find though.
Comment by Vergel on April 14, 2009 at 10:47am
You ought to be a lawyer Al, you can make this doctor look better than what he seem to be LOL. That's the closest thing to make his order logical. If we look closer to the pharmacodynamics of both meds (atro&spiriva) they are both nonselective to muscarinic 1, 2 & 3(M1,M2,M3), and both dissociates faster in the M2 site which is a good thing, staying in M2 would be offsetting it's intended effect as it would enhance bronchoconstriction thus contradicting itself. The only difference between the two is that Atro is a little faster, that makes Alfonso's surmise good. If we go back to Atrovent 101 (if there is such a thing), more of these muscarinic receptors populate the larger airways which means if atro kicks in, the deposition of Spiriva would be a lot better as there will be less resistance from the larger airways. Atro wears off... Spiriva kicks in. The MD never minds about side-effects as both drugs are poorly absorbed systemically w/c means all the side-effects are just local in the airways . He's imaginative after all LOL.
Comment by Vergel on April 13, 2009 at 3:21am
beta 2 agonists (Albuterol/Ventolin) would have a separate effect with anticholinergics(Ipratropium, Tiotropium) but compliments each other. Albuterol reverses bronchoconstriction actively while Atrovent is more of a maintainer. Going back to the basics it's simply albuterol enhances the "fight reaction" which is bronchodilation and Atrovent inhibits the "flight reaction"(bronchoconstriction, increased secretions) or in other words it blocks the cholinergic effect, so they're like batman and robin the dynamic duo(neb).
Now going back to the Spiriva and Atrovent that is overkill. The doctor should know that there are studies that are saying that Atro and Spiriva increases the risk of heart attacks and strokes, and a lot of lawyers are capitalizing on these... remember the Zoloft?


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