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top top Easyhaler Salbutamol Sulphate 100 micrograms per actuation inhalation powder. top Metered dose delivery 100 mcg of Salbutamol per actuation as Salbutamol Sulphate Ph. Eur. Excipient: Lactose monohydrate toptop White or almost white odourless powder intended for respiratory use by oral inhalation. top Symptomatic treatment of asthma attacks and exacerbations of asthma in adults and children aged 4 years and over. Prevention of exercise-induced bronchospasm or before exposure to a known unavoidable allergen challenge. Symptomatic treatment of broncho-asthma and other conditions associated with reversible airways obstruction. Salbutamol provides a short-acting bronchodilation with fast onset of action in reversible airways obstruction due to asthma. Easyhaler Salbutamol Sulphate should be used to relieve symptoms when they occur and to prevent them in those circumstances recognised by the patient to precipitate an attack (e.g. before exercise or unavoidable allergen exposure). Salbutamol is valuable as a rescue medication in mild, moderate or severe asthma, provided that reliance on it does not delay the introduction and use of regular inhaled corticosteroid therapy. Easyhaler Salbutamol Sulphate is indicated in adults, adolescents and children aged 4 to 11 years. top For oral inhalation only. This preparation is particularly useful for patients unable to use metered dose inhalers properly and for patients in whom the use of an inhalation aerosol causes irritation of airways. Inhaled salbutamol should be used only on as-needed basis at the lowest dose and frequency required. Adults and Elderly For the relief of acute bronchospasm and for managing intermittent episodes of asthma, one inhalation (100 micrograms) may be administered as a single starting dose; this may be increased to two inhalations (200 micrograms) if necessary. To prevent exercise-induced bronchospasm or allergen bronchospasm two inhalations (200 micrograms) should be taken before challenge , this dose (200 micrograms) may be repeated if necessary. Paediatric Population: Relief of acute bronchospasm Children aged 4 to 11 years 100 micrograms as required. The dose may be increased to two inhalations if required. Children aged 12 years and over: Dose as per adult population. Prevention of allergen or exercise-induced bronchospasm Children aged 4 to 11 years 100 micrograms before challenge or exertion. The dose may be increased to two inhalations if required. Children aged 12 years and over: Dose as per adult population. Chronic therapy Children aged 4 to 11 years up to 200 micrograms four times a day. On-demand use of Easyhaler Salbutamol Sulphate should not exceed four times daily. Reliance on such frequent supplementary use, or a sudden increase in dose, indicates poorly controlled or deteriorating asthma (see section 4.4). Children aged 12 years and over: Dose as per adult population. On demand use of Easyhaler Salbutamol Sulphate should not exceed eight inhalations (800 micrograms) in any 24 hour period. For optimum results in most patients Easyhaler Salbutamol Sulphate inhaler should be used regularly during asthmatic attacks. The bronchodilator effect of each administration of inhaled salbutamol lasts for four hours, except in patients whose asthma is becoming worse. Such patients should be warned not to increase their usage of salbutamol, but should seek medical advice in case treatment with an inhaled and/or systemic glucocorticosteroid is indicated. Instructions for use: The protective cover of the inhaler should be opened and the dust cap removed immediately prior to use. The inhaler should be shaken vigorously up and down 3-5 times. Whilst holding the inhaler in an upright position, between the finger and thumb, press once until a click is heard. Let inhaler click back again whilst continuing to hold in an upright position. Inhalation should take place from either a sitting or standing position. The patient should breathe out normally and place the mouthpiece between their teeth whilst using their lips to form a seal around the mouthpiece. Patients are instructed to perform a rapid and forced inhalation through the Easyhaler device. After holding their breath for at least 5 seconds the patient can resume normal breathing. Patients should not to exhale into the device. The mouthpiece of the inhaler should be cleaned once a week using a dry cloth or tissue. Patients should be instructed in the proper use of their inhaler (see patient information leaflet) and children should always have adult supervision when using the device. Illustrated instructions for use accompany each package. top Easyhaler Salbutamol Sulphate is contra-indicated in patients with a history of hypersensitivity to any components of the product. Intravenous or oral salbutamol is used for the management of premature labour uncomplicated by conditions such as placenta praevia, ante-partum haemorrhage or toxaemia of pregnancy, however inhaled salbutamol is not appropriate for management of premature labour. Salbutamol preparations should not be used for threatened abortion. top Bronchodilators should not be the only or main treatment in patients with severe or unstable asthma. Severe asthma requires regular medical assessment including lung function testing as the patients are at risk of severe attacks and even death. Physicians should consider using oral corticosteroid therapy or the maximum use of inhaled corticosteroids. Increasing use of bronchodilators, particularly short-acting inhaled ß2-agonists to relieve symptoms indicates deteriorating asthma control (especially if the peak expiratory flow rate value falls and/or becomes irregular). In the event of a previous effective dose of inhaled salbutamol failing to give relief for at least three hours or if they need more inhalations than usual, the patient should be advised to seek medical advice as soon as possible. In this situation patients should be reassessed and consideration given to an increase in their anti-inflammatory therapy, (e.g. higher doses of inhaled corticosteroids or a course of oral corticosteroids). A regular anti-inflammatory controller medication taken on a daily basis is required as soon as the patient needs inhaled ß2-agonists more than twice a week. Severe episodes of asthma must be treated in the normal way. As there may be adverse effects associated with excessive dosing, the dosage and frequency of administration should only be increased on medical advice. Salbutamol should be administered with caution in patients with thyrotoxicosis, cardiac insufficiency, hypokalaemia, myocardial ischaemia, tachyarrhythmia and hypertrophic obstructive cardiomyopathy. Potentially serious hypokalaemia may result from ß2 agonist therapy, mainly from parenteral and nebulised therapy. Particular caution is advised in acute severe asthma, as this effect may be potentiated by concomitant treatment with xanthine derivatives, steroids, diuretics and by hypoxia. It is recommended that serum potassium levels are monitored in such situations (see section 4.5). Rarely inhalation therapy may cause bronchospasm after dosing. In this event, treatment with Salbutamol must be immediately discontinued and, if need be, replaced with another therapy. Cardiovascular effects may be seen with sympathomimetic drugs, including salbutamol. There is some evidence from post-marketing data and published literature of rare occurrences of myocardial ischaemia associated with salbutamol. Patients with underlying severe heart disease (e.g. ischaemic heart disease, arrhythmia or severe heart failure) who are receiving salbutamol should be warned to seek medical advice if they experience chest pain or other symptoms of worsening heart disease. Attention should be paid to assessment of symptoms such as dyspnoea and chest pain, as they may be of either respiratory or cardiac origin. One dose contains less than 10 mg lactose, which probably does not cause symptoms in lactose intolerant patients. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. top If additional adrenergic drugs are administered to patients using Salbutamol Easyhaler they should be used with caution to avoid deleterious cardiovascular effects. Concomitant administration of salbutamol and non-selective ß-blocking drugs such as Propranolol is not recommended. Patients treated with monoamine oxidase inhibitors or tricyclic antidepressants should be followed clinically in the beginning of salbutamol treatment, because the action of salbutamol on the vascular system may be potentiated. The simultaneous administration of xanthines, corticosteroids or potassium excreting diuretics may increase hypokalaemia. top Administration of drugs during pregnancy should only be considered if the expected benefit to the mother is greater than any possible risk to the foetus. Salbutamol has been in widespread use for many years in human beings without apparent ill consequences; this includes its well established use in the management of premature labour. However, as with the majority of drugs, there is little published evidence of its safety in the early stages of human pregnancy, but in animal studies there is evidence of some harmful effects on the foetus at very high doses. As salbutamol is excreted in breast milk, its use in nursing mothers requires careful consideration. It is not known whether salbutamol has a harmful effect on the neonate, and so its use should be restricted to situations where it is felt that the expected benefit to the mother outweighs any potential risk to the neonate. top The effect of Salbutamol Easyhaler on the ability to drive and use machines has not been directly studied. From the well-known pharmacological actions of salbutamol and decades of clinical experience such effects are, however, regarded as unlikely. top The undesirable effects caused by normally used inhaled doses of salbutamol are mild, typical for sympathomimetic agents, and they usually disappear with continued treatment. Frequencies are defined as: very common (> 1/10,000 and <1/1000), very rare (<1/10,000) and not known (cannot be estimated from available data). toptop Excess repeat use of inhalations may produce adverse effects such as tachycardia, CNS stimulation, tremor, hypokalaemia and hyperglycaemia. Treatment consists of discontinuation of salbutamol together with appropriate symptomatic therapy. The preferred antidote for overdosage with salbutamol is a cardioselective beta-blocking agent, but beta-blocking drugs should be used with caution in patients with a history of bronchospasm. Hypokalaemia may occur following overdose with salbutamol. Serum potassium levels should be monitored. If hypokalaemia occurs potassium replacement via the oral route should be given. In patients with severe hypokalaemia intravenous replacement may be necessary. top Pharmacotherapeutic group: Selective beta2-adrenoreceptor agonists. ATC code: R03AC02. Salbutamol is a selective ß2 -adrenergic receptor agonist. The pharmacological effects of salbutamol are at least in part attributable to stimulation through beta-adrenergic receptors of intracellular adenyl cyclase, the enzyme that catalyses the conversion of adenosine triphosphate (ATP) to cyclic-3',5',-adenosine monophosphate (cyclic AMP). Increased cyclic AMP levels are associated with relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from cells, especially from mast cells. Salbutamol also stimulates mucous secretion and mucociliary transport in the respiratory tract. Bronchial effects of inhaled salbutamol can be detected after a few minutes and duration of action is normally 4-6 hours. Like other ß2 -adrenoceptor agonists salbutamol also has cardiovascular effects in some patients as measured by changes in pulse rate, blood pressure, symptoms and ECG changes. These effects can especially be detected after oral and intravenous administration of salbutamol. Furthermore oral and intravenous salbutamol causes reduction in uterine tonicity which has been associated with pain relief in pregnancy. In addition, salbutamol has some metabolic effects. Especially intravenous and nebulised salbutamol decreases serum potassium concentrations although the effect is generally mild and transient. Salbutamol has also lipolytic effects and it has been shown to cause increases in blood glucose and insulin probably by stimulating glycogenolysis and having a stimulatory effect on ß2 -receptors in pancreas cells. top Orally administered salbutamol is well absorbed with peak plasma concentrations occurring 1 to 4 hours after administration. The major proportion of inhaled Salbutamol is swallowed. The fraction that is distributed to the lung (approx. 10-25%) is rapidly seen in the circulation as free unmetabolised drug. The remainder is retained in the delivery system or is deposited in the oropharynx from where it is swallowed. The swallowed portion of an inhaled dose is absorbed from the gastrointestinal tract and undergoes considerable first-pass metabolism. The plasma concentrations of inhaled Salbutamol are, however, lower than those produced by usual oral doses. Salbutamol and its metabolites are rapidly excreted in the urine and faeces with about 80% of the dose being recovered in urine within 24 hours. The elimination half-life of Salbutamol is 2.7 - 5.5 hours after oral and inhaled administration. toptoptoptop The short term toxicity has been tested in different animal species - the mouse, the rat and the dog - at doses extending to several thousand fold higher than the intended human therapeutic dose - maximally in the region of 15 µg/kg daily. The lethal doses via the intravenous route in the rodents range from 50mg/kg, via the peroral route to around 2000 mg/kg and even higher. Thus the agent exhibits low acute systemic toxicity. Local toxicity on the airway has not been exclusively studied, but the historical evidence based on long clinical use suggests good airway tolerance. The subacute toxic effects on the cardiac muscle are seen at doses ranging from 0.2 to 3mg/kg. This is a manifestation of the pharmacodynamics of salbutamol at grossly elevated doses. The doses administered in subchronic toxicity studies have been in the milligram ranges per kilogram - 0.15 to 50 - via the oral route or by inhalation. The species have been the rat (p.o. administration), and the dog (p.o. and inhalation). The toxic signs and symptoms exhibited were, as noted in the paragraph above, related to the mode of action on the adrenergic receptor. The chronic toxicity, again, is manifested as exaggerated pharmacodynamic effects in animals. Animal data on reproductive toxicity is quite limited. Sympathomimetics, including salbutamol, are widely used in clinical medicine in patients of fertile age. In spite of this fact, no adverse reproductive effects attributable to salbutamol are reported in the literature. Embryotoxicity in animal studies seems to be related only to the mouse. In this species the union of the flat bones of the lower part of the skull seem to be involved. The specific mechanism of this has not been fully elucidated. Foetal toxicity at high single or elevated chronic doses are related to energy metabolism from glycogen. Catecholamines liberate energy in the form of glucose from glycogen stored in liver and muscle. This action is mediated by glycogen synthase and phosphorylase of these tissues. Elevated foetal insulin and glucose levels suggest a higher sensitivity of the foetal pancreas to this stimulation of ß-adrenergic receptors. The classic airways of mutagenic potential by which this agent has been tested have exhibited no increase in the incidence of mutations. The potential of increase in the number of neoplasms shows a species and even a strain specificity, as did the effect on the delay in union flat jaw bones. Ovarian leiomyomas, benign tumours of smooth muscle, occur with a significantly higher frequency in the rat, particularly of the Spraque-Dawley strain. The other rodent species do not appear to be affected, suggesting a difference in the susceptibility of the uterine muscle of Spraque-Dawley to ß-adrenergic stimulation. top Unopened: 3 years. After first opening of foil pouch: 6 months. top Store in a dry place at a temperature not exceeding 25°C. Use if the protective cover of the Easyhaler inhaler is recommended once the laminate foil has been opened. top The multidose powder inhaler (Easyhaler) consists of seven plastic parts and a stainless steel spring. The plastic materials of the inhaler are polyester, LDPE, polycarbonate, acetal, styrene butadiene, polypropylene. The inhaler is wrapped in laminate foil and packed in a cardboard box. The starting package contains an inhaler and a protective cover. The maintenance pack contains the dry powder inhaler only. Pack size: 200 actuations. top There are no special requirements. toptoptop Orion Corporation, Orionintie 1, FIN-02200 Espoo, Finland.
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Ventolin aerosol za inhaliranje – upute o lijeku Proizvođač: Pliva Samo na recept? DA Primjena: Selektivni agonisti beta2-adrenergičkih receptora Skoči na » opis » primjena » doziranje » mjere opreza » napomene Opis Sastav Jedna doza aerosola (jedan potisak) sadržava 100 mikrog salbutamola*. * aktivna supstancija GlaxoWellcome Pomoćne tvari: oleinska kiselina, triklorofluorometan, diklorodifluorometan. Farmaceutski oblik i veličina pakovanja Inhalat pod pritiskom, suspenzija; 200 doza Farmakoterapijska skupina i djelovanje Salbutamol je selektivni beta2-agonist koji dovodi do relaksacije glatkih mišića bronha s posljedičnom bronhodilatacijom, smanjenjem otpora u dišnim putovima i povišenjem ekspiratornog volumena. Način i mjesto izdavanja Na recept Rok valjanosti Označen je na pakovanju. Lijek se ne smije rabiti nakon isteka roka valjanosti. Čuvati pri temperaturi do 30 C, zaštićeno od smrzavanja ili izravnih sunčevih zraka. Tlačni spremnik se ne smije nasilno otvarati ni spaljivati čak i kad je zasigurno prazan. LIJEK VALJA ČUVATI IZVAN DOSEGA DJECE! Primjena Terapijske indikacije Uporaba Ventolin aerosola je indicirana u liječenju astme, bronhospazma i/ili reverzibilne bronhoopstrukcije. Ventolin aerosol je indiciran i u prevenciji bronhospazma uzrokovanog naporom. Doziranje Ventolin aerosol koristi se samo putem inhalacije. Za prekidanje akutnog bronhospazma: Odrasli: 1 do 2 udaha. Djeca >= 4 godine (ukoliko su upućeni kako ispravno primjenjivati lijek): 1 udah, po potrebi dva. Sprječavanje bronhospazma izazvanog tjelesnim naporom Odrasli: 2 udaha prije napora. Djeca >=4 godine (ukoliko su upućeni kako ispravno primjenjivati lijek): 1 do 2 udaha prije napora. Kronično liječenje: Odrasli: 1 do 2 udaha do 4 puta na dan. Djeca >=4 godine (ukoliko su upućeni kako ispravno primjenjivati inhalator): 1 do 2 udaha 4 puta na dan. Ventolin aerosol se ne smije upotrijebiti više od 4 puta na dan. Kako se uz visoke doze veže veća mogućnost pojava nuspojava, doza se može povisiti isključivo na savjet liječnika. Predoziranje U slučaju blagog do srednje teškog predoziranja mogu se javiti fini tremor skeletnih mišića (obično ruku), tahikardija i periferna vazodilatacija i obično su reverzibilni nakon prekida terapije. U slučaju težeg predoziranja, antidot je kardioselektivni beta-blokator no oni se moraju primjenjivati s oprezom u bolesnika s bronhospazmom. Kao posljedica predoziranja salbutamola može se javiti hipokalemija, te se mora kontrolirati serumska razina kalija. Ukoliko se javi bilo kakav znak predoziranja, primjena otopine Ventolina za inhaliranje mora se smjesta prekinuti. Ventolin aerosol koristi se na slijedeći način: - Okrenite spremnik kako je prikazano na slici tako da dno bočice bude gore, a nastavak za usta dolje. - Skinite poklopac s nastavka za usta i promućkajte sadržaj u bočici. - Izdahnite što je moguće potpunije. - Spremnik držite kao što je prikazano na slici. Nastavak za usta obuhvatite čvrsto usnicama. - Duboko udahnite kroz nastavak za usta, a u isto vrijeme pritisnite kažiprstom metalni spremnik prema dolje; pri tome iz spremnika izlazi određena količina lijeka, tj. jedna inhalacija. - Olabavite pritisak na spremnik. Uklonite nastavak iz usta i zadržite dah što je moguće duže. - Pričekajte barem jednu minutu, prije nego što eventualno drugi put inhalirate. - Nastavak za usta zatvorite čepom. Napomene Ventolin aerosol se primjenjuje prema uputi liječnika. Ne smije se prekoračiti doza koju je propisao liječnik – prekomjerna uporaba može biti opasna za bolesnika. Ventolin aerosolom smiju rukovati samo odrasle i potpuno odgovorne osobe pa ga npr. djeca smiju primjenjivati samo u pristutnosti i pod kontrolom odraslih. Stariji bolesnici i rastresene osobe smiju upotrebljavati Ventolin aerosol samo pod kontrolom. Čišćenje Sa spremnika treba skinuti plastični nastavak za inhaliranje, uroniti ga u toplu vodu, osušiti i kad je potupuno suh, treba ga ponovno nataknuti na spremnik. Upozorenje Sadržaj u spremniku je pod tlakom pa se ni pun ni prazan ne smije nasilno otvarati, izlagati visokim temperaturama niti spaljivati. Mjere opreza Kontraindikacije Preosjetljivost na salbutamol ili na bilo koji sastojak lijeka. Posebna upozorenja Tijekom uporabe agonista može nastati potencijalno opasna hipokalemija, posebice primjenom parenteralnih i nebulizirajućih oblika. Poseban se oprez savjetuje u liječenju akutne, teške astme jer ovaj efekt može biti potenciran hipoksijom ili istovremenom primjenom derivata ksantina, steroida ili diuretika. Kao što je slučaj i s ostalim beta2-agonistima, salbutamol može uzrokovati reverzibilne metaboličke poremećaje kao što je povišenje razine šećera u krvi. Salbutamol treba s oprezom primjenjivati u bolesnika s tireotoksikozom, kardiovaskularnim poremećajima (posebice koronarnom insuficijencijom, kardijalnim aritmijama i hipertenzijom) te u bolesnika s konvulzivnim poremećajima. Trudnoća i dojenje Ventolin se tijekom trudnoće može koristiti samo ako moguća korist za trudnicu nadmašuje moguću opasnost za plod. Ne zna se da li se salbutamol izlučuje u majčino mlijeko te se njegova primjena u trudnoći može preporučiti samo ako očekivana korist za majku nadmašuje opasnost za dijete. Nuspojave Uobičajene nuspojave obuhvaćaju palpitacije, bol u prsima, ubrzano lupanje srca, tremor i nervozu. One su obično vezane uz dozu i nestaju prekidom terapije. Reakcije preosjetljivosti, uključujući angioedem, urtikariju, bronhospazam, hipotenziju i kolaps, opisane su vrlo rijetko. Rijetko se mogu pojaviti tahikardija i kardijalna aritmija. Glavobolje i hiperaktivnost u djece opisuju se rijetko. O svakoj nuspojavi valja obavijestiti svog liječnika ili ljekarnika. Interakcije Ventolin aerosol mora se s oprezom primjenjivati u bolesnika za koje se zna da primaju veće doze ostalih simpatomimetika. Salbutamol se ne bi smio primjenjivati istodobno s neselektivnim beta-blokatorima kao što je propranolol. Preporuča se oprez kod istodobne primjene s diureticima koji ne štede kalij, inhibitorima monoamin oksidaze, tricikličnim antidepresivima i digoksinom. Napomene PLIVA d.d. Ulica grada Vukovara 49, 10 000 Zagreb, Hrvatska