{
 "query": "albuterol / ipratropium",
 "ingredient": "albuterol / ipratropium",
 "slug": "albuterol-ipratropium",
 "rxcui": "214199",
 "brands": [
  "Combivent"
 ],
 "names": [
  "albuterol / ipratropium"
 ],
 "components": [
  {
   "ingredient": "albuterol",
   "slug": "albuterol",
   "grade": "B",
   "total": 81,
   "scores": {
    "safety": "A",
    "evidence": "D",
    "regulatory": "C",
    "conflict": "A",
    "options": "A"
   },
   "boxed": false,
   "controlled": false,
   "first_approval_fmt": "05/01/1981",
   "first_approval": "19810501"
  },
  {
   "ingredient": "ipratropium",
   "slug": "ipratropium",
   "grade": "B",
   "total": 86,
   "scores": {
    "safety": "A",
    "evidence": "D",
    "regulatory": "A",
    "conflict": "A",
    "options": "C"
   },
   "boxed": false,
   "controlled": false,
   "first_approval_fmt": "12/29/1986",
   "first_approval": "19861229"
  }
 ],
 "classes": [],
 "alternatives": [],
 "label": {},
 "faers": null,
 "faers_base": {
  "total": 20692304,
  "serious_share": 0.5742697381596559,
  "death_share": 0.09102355155810585
 },
 "recalls": [],
 "recall_total": 0,
 "drugsfda": {
  "first_approval": "19810501",
  "first_approval_fmt": "",
  "anda": 28,
  "nda": 0,
  "rems": false,
  "labeling_recent": 0
 },
 "trials": null,
 "pubmed": null,
 "payments": {
  "year": "2024",
  "usd": 0.0,
  "records": 0,
  "by_name": [],
  "names_checked": [
   "albuterol / ipratropium",
   "Combivent"
  ],
  "source": "bulk-index"
 },
 "partd": {
  "year": "2024",
  "claims": 1243653,
  "beneficiaries": 381509,
  "spend": 406229700.3,
  "by_brand": [
   {
    "brand": "Ipratropium-Albuterol",
    "claims": 641618,
    "per_claim": 28.559904928,
    "is_generic": false
   },
   {
    "brand": "Combivent Respimat",
    "claims": 602035,
    "per_claim": 644.32325566,
    "is_generic": false
   }
  ],
  "per_claim": 326.64231928037805
 },
 "mdl": [],
 "dsc": [],
 "settlements": [],
 "prescrire": null,
 "eml": null,
 "exposure": null,
 "scores": {
  "safety": {
   "score": 88,
   "letter": "A",
   "why": [
    "Graded by its riskiest ingredient, albuterol (88)",
    "3,469 FDA reports naming it as the suspect drug per million Medicare fills, 1.3x the median drug on this site (-2)",
    "Death share in reports is near or below the FAERS average (0.7x)",
    "1 Class I recall(s): reasonable probability of serious harm (-10)"
   ],
   "weight": 0.35
  },
  "evidence": {
   "score": 57,
   "letter": "D",
   "why": [
    "Graded by its riskiest ingredient, ipratropium (57)",
    "324 randomized trials and 16 systematic reviews/meta-analyses indexed in PubMed",
    "On the WHO Model List of Essential Medicines (shown for context; no score effect)",
    "7 independent Cochrane review(s) exist",
    "Only 28% of completed registered trials posted results (-15)"
   ],
   "weight": 0.25
  },
  "regulatory": {
   "score": 68,
   "letter": "C",
   "why": [
    "Graded by its riskiest ingredient, albuterol (68)",
    "Recalls since 2016: 1 Class I, 7 Class II, 1 Class III across 71 generic makers (-28)",
    "4 label changes approved since 2021 (-4)"
   ],
   "weight": 0.15
  },
  "conflict": {
   "score": 100,
   "letter": "A",
   "why": [
    "Graded by its riskiest ingredient, albuterol (100)",
    "Pharma paid doctors $0 tied to this drug last year: negligible",
    "Not named in any pending federal MDL"
   ],
   "weight": 0.15
  },
  "options": {
   "score": 70,
   "letter": "C",
   "why": [
    "Graded by its riskiest ingredient, ipratropium (70)",
    "Generic versions approved (28 applications)",
    "No same-class alternatives found: little leverage to switch (-30)"
   ],
   "weight": 0.1
  }
 },
 "total": 77,
 "grade": "B",
 "questions": [
  "This is a fixed combination of albuterol and ipratropium. Why both together, instead of only the one I need?",
  "The most-reported problems in FDA's adverse event data are dyspnoea, asthma, cough. How would we recognize and handle those?",
  "Why this one over bambuterol, bitolterol, clenbuterol? What would make you pick one of those instead?",
  "What result are we expecting, by when, and what is the plan if it does not happen?",
  "If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)",
  "The most-reported problems in FDA's adverse event data are dyspnoea, asthma, cough, pneumonia. How would we recognize and handle those?"
 ]
}