Medicines & You

= Chemical Compound
= Indications
= Dosage
= Contraindication
= Special Precautions
= Adverse Reactions
= Drug-Drug Interaction

Respiratory System

a) Antiasthmatic Preparations

Ipratropium Br.
Bronchodilator for maintenance treatment of bronchospasm associated w/ COPD including chronic bronchitis & emphysema. Used together w/ inhaled ß-agonists in the treatment of acute bronchospasm associated w/ COPD including chronic bronchitis & asthma.
Hypersensitivity to stropine & its derivatives.
Narrow-angle glaucoma, prostatic hypertrophy, cystic fibrosis.
Headache, nausea, dry mouth; rare & reversible anticholinergic side effects; ocular side effects if substance enters eyes; cough.
Bronchodilatory effect intensified by ß-adrenergics & xanthine prep. Anticholinergic effects of other drugs may be enhanced.

Bambuterol HCI.
Bronchial asthma. Chronic bronchitis, emphysema & other lung diseases, where bronchospasm is a complicating factor.
Impaired liver & renal function. Hyperthyroidism. Diabetes. Pregnancy.
Tremor, headache, tonic muscle cramps, palpitations.
Suxamethonium, ß-blockers

Beclomethasone dipropionate.
Asthmatic patients requiring >800-1000 µg daily of beclomethasone dipropionate & who are no longer controlled by max doses of bronchodilators & Becotide inhaler.
1st trimester of pregnancy.
TB; adrenal suppression. Pregnancy. Transferring from systemic steroids.
Hoarseness; throat irritation; candidiasis of the mouth & throat; potential paradoxical bronchospasm.

Fenoterol HBr.
Bronchodilator for the symptomatic treatment of acute asthma episodes, prophylaxis of exercise-induced asthma, symptomatic treatment of bronchial asthma & other conditions w/ reversible airway narrowing eg chronic obstructive bronchitis. Concomitant anti-inflammatory therapy should be considered.
Hypertrophic obstructive cardiomyopathy, tachyarrhythmia.
Insufficiently controlled diabetes mellitus, recent MI &/or severe organic heart or vascular disorders, hyperthyroidism, acute rapidly worsening dyspnoea, 1st trimester of pregnancy & lactation, pheochromocytoma. Prolonged regular use need re-evaluation for the addition of anti-inflammatory drugs.
Fine tremor of skeletal muscles & nervousness, less frequent are tachycardia, dizziness, palpitations or headache. Very rare cases of local irritation or allergic reactions; cough, paradoxical bronchoconstrictions (very rare). Potentially serious hypokalemia may result from ß2-agonist therapy.
ß-adrenergics, anticholinergics & xanthine derivatives may enhance the effects of Berotec. A potentially serious reduction in effect may occur during concurrent administration of ß-blockers, caution when used w/MAOI or tricyclic antideoressants. Inhalation of halogenated hydrocarbon anesth may increase susceptibility to CV effects of ß-agonists.

Terbutaline sulfate.
Bronchial asthma, chronic bronchitis, emphysema & other lung diseases where bronchoconstriction is a complicating factor.
Thyrotoxicosis.
Hypertension, CV diseases; unstable diabetes. Hypersensitivity to sympathomimetic amines. Hypertrophic cardiomyopathia, hypokalemia.
tremor, tonic cramp & palpitations (reversible w/in 1st 1-2 wk of treatment).
ß-blockers may inhibit bronchodilating effect.

Na cromoglycate.
Preventive treatment of bronchial asthma which may be due to allergy, exercise, cold air or chemical & occupational irritants.
Abrupt w/drawal.
Mild throat irritation, coughing & transient bronchospasm. Very rarely, severe bronchospasm necessitating w/drawal of treatment may occur.

Aminophylline.
Bronchial asthma, asthmatic bronchitis, dyspnoea associated w/ obstructive pulmonary disease, cor pulmonale, CHF, prophylaxis of attracks of cardiac asthma & angina pectoris, coronary sclerosis, renal & hepatic oedema.
CHF; hepatic edema; epilepsy; hyperthyroidism; acute nephritis; childn & pregnancy.
Occasionally, headache, insomnia, tremor; tachycardia; GI disturbances; eczema or itching.
Excessive stimulation of CNS w/ xanthines or CNS stimulants. Increased plasma conc w/ erythromycin, triacetyloleandomycin, enoxacin, triamcinolone, cimetidine & reduced by phenobarb or phenytoin.

Budesonide.
Bronchial asthma.
Lung TB, fungal & viral infection in airways. Pregnancy.
Mild throat irritation & hoarseness. Candida infection in the oropharynx.

Salmeterol xinafoate.
Long-term regular treatment of reversible airways obstruction in asthma (including patients w/ nocturnal asthma & exercise-induced asthma), emphysema & chronic bronchitis.
Not for relief in acute severe asthma. Thyrotoxicosis.
Tremor, paradoxical bronchospasm, headache, palpitations, muscle cramps, tachycardia, hypersensitivity reactions.
Non-selective & cardioselective ß-blockers.

Montelukast Na.
For the prophylaxis & chronic treatment of asthma in adults & childn >6 yr old.
Should not be used for treatment of acute asthma attacks. Should not be abruptly substituted for inhaled or oral corticosteroids. Pregnancy & lactation. Childn <6yr. Patients w/ known aspirin sensitivity should continue avoidance of aspirin or NSAIDs while taking Singulair.
Abdominal pain, headache.

Theophylline.
Bronchial asthma, chronic bronchitis & other conditions w/ bronchospasm.
Severe CHF, liver disease, viral infection; elderly; pregnancy & lactation; neonates.
Tremor, headache, GI upsets, anorexia, sleep disturbances. At high plasma conc, arrhythmias & CNS-mediated convulsions markedly increase.
Plasma theophylline conc increased by cimetidine, quinolone derivatives, viloxazine, macrolide antibiotics, allopurinol, propranolol, disulfiram, isoniazid, OC, flu vaccine, mexiletine, nifedipine, norfloxacin, ranitidine, thiabendazole & verapamil. Plasma theophylline concdecreased by carbamazepine, felodipine, phenobarbital, phenytoin & rifampicin. May decrease plasma conc of lithium. Threshold for inducing convulsions may be reduced when used w/ ketamine. Increased stimulation of hepatic glucose production when used w/ glucagons. Hypokalemia potentiated w/ ß-agonists, steroids or diuretics.

Salbutamol sulfate.
Tab/Syr/Inhaler/Rotacap. Relief & prevention of bronchospasm in bronchial asthma, chronic bronchitis, emphysema, acute dyspnoea. Tab maintenance in premature labour. Inj Severe bronchospasm & status asthmaticus. Respirator soln/Nebules Status asthmaticus & other forms of severe bronchospasm when intermitten +ve pressure ventilation is required. Accuhaler Long-term use in the relief & prevention of asthma symptoms. Rescue medication in mild to severe asthma.
Threatened abortion during 1st or 2nd trimesters of pregnancy. Toxaemia of pregnancy, antepartum haemorrhage, placenta praevia.
Thyrotoxicosis. Inhaled salbutamol prep are not appropriate for managing premature labour. Pregnancy, lactation.
Fine tremor of skeletal muscle, feelings of tension, peripheral vasodilation, a compensatory small increase in heart rate, headaches, transient muscle cramps, hypersensitivity reactions, potentially serious hypokalaemia, hyperactivity in childn. Paradoxical bronchospasm (inhalers).
Non-selective ß-blockers. Hypokalemia potentiated by xanthine derivatives, steroids, diuretics & by hypoxia.

b) Cough & Cold Remedies

Per 5 mL Triprolidine HCI 1.25 mg, pseudoephedrine HCI 30mg, guaiphenesin 100mg.
Relieves discomfort & aids expectoration in wet, chest coughs.
MAOIs; severe hypertension.
Diabetes, hypertension, heart disease, hyperthyroidism, elevated intraocular pressure, prostatic enlargement. May impair ability to drive or operate machinery. Childn <2 yr.
Drowsiness, sleep disturbances; skin rashes, dryness of nose, mouth & throat. Occasionally, urinary retention.
Antihypertensives, tricyclic antidepressants, other sympathomimetics eg decongestants, appetite suppressants, amphetamine-like psychostimulants. MAOIs.

Per 5 mL. Glyceryl guaiacolate 50mg, Na citrate 180mg, diphenhydramine HCI 12.5mg, phenylpropwnolamine HCI 12.5mg, alcohol 5%.
Unproductive, irritative, spasmodic & allergic coughs.
hyperthyroidism; hypertension, coronary disease. Avoid use w/in 2wk of MAOI.
Cardiac disease; diabetes; glaucoma; pregnancy; may impair ability to drive or operate machinery.
Drowsiness, dizziness; dry mouth; epileptiform seizures (high doses).
May potentiate other CNS depressants. Actions prolonged by MAOI.

Per 5 mL. diphenhydramine HCI 14mg, ammon CI 135 mg, alcohol 1%.
Control of cough & alleviation of nasal stuffiness, sneezing, lacrimation & bronchial congestion.
MAOIs.
Childn < 1 yr; may impair ability to drive or operate machinery.
Drowsiness.
Additive effects if used w/ hypnotics, sedatives or tranquilizers.

Bromhexine HCI.
Secretolytic therapy in acute & chronic bronchopulmonary diseases associated w/ abnormal mucous secretion & impaired mucus transport.
GI ulceration. Pregnancy & lactation.
Occasionally, GI side effects. Very rarely, allergic skin rashes.
may lead to higher antibiotic conc in lung tissue.

Loratadine 5 mg, pseudoephedrine sulfate 120mg.
Relief of symptoms associated w/ allergic rhinitis & common cold including nasal congestion, sneezing, rhinorrhea, pruritus & lacrimation.
Patients receiving MAOI therapy or w/in 10 days of discontinuing such treatment. Narrow-aangle glaucoma, urinary retention, severe hypertension, severe coronary artery disease, hyperthyroidism.
Glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction, prostatic hypertrophy or bladder neck obstruction, CV disease, increased intraocular pressure or diabetes mellitus. Elderly.
Insomnia, dry mouth.
Methyldopa, mecamylamine, reserpine, veratrum alkaloids, ß-blockers, digitalis, antacids, kaolin.

Pholcodine.
Relief of unproductive cough associated w/ common cold, sinusitis, flu & infections of the upper resp tract. Suitable for diabetics.
Patients who have decreased resp reserve, asthma, impaired liver function.
Occasional nausea & vomiting. Drowsiness, restlessness, excitement, ataxia & resp depression (w/ large doses).

Mesna.
Nebulisation Bronchial clogging, cystic fibrosis, status asthmaticus, chronic bronchitis, asthma-like bronchitis, bronchial emphtsema & bronchiectasis, obstructive pulmonary atelectasis. Instillation To prevent formation of a mucous plug, facilitate bronchial aspiration in intensive care & anesth. To facilitate drainage in maxillary sinusitis.
Asthma w/o mucous clogging; intolerance to aerosols; inability to cough or expectorate effectively.
Status asthmaticus.
Irritative cough; bronchospasm in sensitive patients. Retrosternal burning sensation.

Cyclidrol.
Acute & chronic resp tract disorders w/ increased or stagnant bronchial secretion (stickly phlegm), acute & chronic bronchitis, bronchiolitis, bronchial pneumonia, particularly if associated w/ asthma, emphysema, bronchiectasis, pulmonary disorders due to cystic fibrosis. Rhinopharyngitis, pre-& post-surgical cleaning treatment of the resp tract, adjuvant in the treatment of TB.

Carbocisteine.
Acute & chronic bronchitis, bronchiectasis, bronchorrhea, chronic otitis & sinusitis, rhinopharyngitis & ear disease of tubal origin.
Active peptic ulcers.
Gastralgia, GI disturbances.

Per 5 mL Carbocisteine 100mg, promethazine HCI 2.5mg.
Antitussive & expectorant for control of cough due to colds or allergy.
Infant <1 yr.
May impair ability to drive or operate machinery.
Drowsiness.

Per 5 mL Salbutamol 1.2mg, guaiphenesin 50mg.
Productive & wheezing cough associated w/ pneumonia, flu & acute resp infection.
Threatened abortion during 1st or 2nd trimester of pregnancy.
Thyrotoxicosis. Pregnancy, lactation.
Fine tremor of skeletal muscle, feelings of tension, peripheral vasodilation, a compensatory small increase in heart rate, headaches, transient muscle cramps, hypersensitivity reactions, potentially serious hypokalaemia, hyperactivity in childn.
Non-selective ß-blockers.

c) Decongestants & other Nasal Preparation

Oxymetazoline HCI.
Relief of nasal congestion. Prevention of middle ear infection. Facilitates intranasal exam before surgery.
idiosyncrasies to sympathomimetics; hyperthyroidism; hypertension, coronary disease.
Chronic nasal congestion upon w/drawal (prolonged use). Concurrent administration w/ MAOI. Cardiac disease; diabetes mellitus.
Occasionally, burning sensation in nose/throat, local irritation, nausea, headache, dryness of nasal mucosa. Rebound nasal congestion (prolonged use). Apnoea & instant collapse in infants.
Pressor effects enhanced by MAOI. Reversal of action of antihypertensives.