Farmdeystvie Combivent Inhaler:
Combined bronchodilatory drug. Ipratropium bromide blocks m-cholinergic receptors of smooth muscle of the tracheobronchial tree (mostly large and medium bronchi), inhibits reflex bronchoconstriction, reduce the secretion of glands of the mucous membrane of respiratory tract. Having structural similarity to acetylcholine, a molecule is its competitive antagonist. It effectively prevents bronchoconstriction resulting from exposure to cigarette smoke, cold air from various bronhospazmiruyuschih agents, and also eliminates bronchospasm associated with the influence n.vagus. Almost no resorptive action (little effect on heart rate and blood pressure – for the development of tachycardia to the inhalation of approximately 500 doses), only 10% reaches the small bronchi and alveoli, and the rest settles in the throat or mouth and swallowed. Salbutamol in therapeutic doses has a pronounced stimulatory effect on beta 2-adrenergic receptors in the bronchi, blood vessels and myometrium. Virtually no effect on beta1-adrenergic receptors of the heart. Inhibits the release of mast cell histamine, leukotrienes and PgD2 and other biologically active substances for a long time. Reduces early and late bronchial reactivity. Has a pronounced effect of bronchodilators, warning or kupiruya bronchoconstriction reduces airway resistance, increases the vital capacity. Positive effect on the mucociliary clearance (in case of chronic bronchitis increases it by 36%), stimulates mucus secretion, activates the function of ciliated epithelium. Has several metabolic effects: reduces the content of K + in the plasma affects glycogenolysis and insulin release, has a hyperglycemic (especially in patients with asthma) and the lipolytic effect, increases the risk of acidosis. In recommended therapeutic doses has no negative effect on the cardiovascular system, does not cause increase blood pressure. To a lesser degree, compared with drugs of this group has a positive chrono-and inotropic effect. Causes expansion of the coronary arteries.
Pharmacokinetics Combivent Inhaler:
Combivent Inhaler ipratropium bromide inhalation is practically not absorbed and has no systemic action (in the digestive tract of swallowed drug is practically not absorbed). Relationship to plasma proteins (predominantly to albumin and glycoprotein) – 9%. As a quaternary derivative of nitrogen, a little soluble in fats and bad comes through biological membranes, does not penetrate the BBB. Partially hydrolyzed to the inactive ester derivatives. Salbutamol is well absorbed as the inhalation and if swallowed. After a single inhalation of salbutamol at a dose of 103 mg Cmax achieved in 3 hours and is 419-802-pkg/ml. During inhalation of 10-20% of the dose reaches the small bronchi, and the rest is deposited in the upper respiratory tract. Relationship to plasma proteins – 10%. Undergoes presystemic metabolism in the liver and intestinal wall. Excreted by the kidneys, mainly as unchanged (30% of the dose within 24 hours) and as an inactive metabolite fenolsulfatnogo within 72 hours, and the bile. After iv infusion of 30 minutes 1.5 mg T1 / 2 – 3.9 hours, ground clearance – 439 ml/min/1.73-kv. m passing through the BBB (concentration in CSF – 5% of plasma concentration) and the placental barrier.
Indications Combivent Inhaler:
bronhospasticheskih syndrome (including COPD and asthma, against ARI during surgery).
Contraindications Combivent Inhaler:
Hypersensitivity (including to atropine), tachyarrhythmia, GOKMP, pregnancy (I term), children’s age (12 years). With caution. Angle-closure glaucoma, urinary tract obstruction (including against prostatic hypertrophy), expressed in organic diseases of the cardiovascular system, pheochromocytoma, hyperthyroidism, insufficiently controlled diabetes mellitus, myocardial infarction (recently transferred), pregnancy (II-III trimester), lactation .
Dosage Combivent Inhaler:
inhalation. Metered dose aerosol – 2 doses 4 times a day, if necessary, may increase the multiplicity of dosing up to 12 per day.
Side effects Combivent Inhaler:
part of the respiratory system: bronchial irritation, perhaps – nasal congestion, stridor, paradoxical bronchospasm.
From the digestive system: nausea, at least – dry mouth or salivation, taste perversion, diarrhea, vomiting.
The nervous system: headache, at least – dizziness, excessive fatigue, nervousness, paresthesia, tremor, insomnia, potentially possible – violations of motor coordination, weakness.
From the CAS: increased blood pressure, at least – tachycardia, false angina, possibly lowering blood pressure.
With the urinary system: dysuria.
From the sensory organs: when hit in the eye may increase the intraocular pressure – a sharp pain in the eye, impaired visual acuity, scleral injection, hyperemia of the conjunctiva.
Allergic reaction: angioedema tongue, lips, face, skin rash (including urticaria, up to a giant), laryngospasm, bronchospasm, pruritus.
Other: dysphonia, arthralgia, alopecia.
Overdose Combivent Inhaler:
Symptoms (mainly related to the systemic action of salbutamol): headache, nausea, vomiting, irritability, tachycardia, angina pectoris, hypoxemia, acidosis, hypokalemia, hyperglycemia, muscle tremors, hallucinations, ventricular flutter, cardiac arrest and death. Treatment: symptomatic (including the introduction of cardioselective beta-blockers).
Interaction Combivent Inhaler:
Strengthens the bronchodilator effect of beta-agonists and xanthine derivatives (theophylline). Increases the effects of CNS stimulants, cardiotropic thyroid hormones. Increases the likelihood of glycoside intoxication. Reduces the effectiveness of antihypertensive drugs, nitrates. Theophylline and other xanthines increase the probability of tachyarrhythmias, drugs for inhalation anesthesia and levodopa – severe ventricular arrhythmias. MAO inhibitors and tricyclic antidepressants increase the effect of salbutamol, may lead to a sharp decrease in blood pressure. Anticholinergic drugs increase the risk of increased intraocular pressure. Diuretics, and corticosteroids increase gipokaliemichesky effect of salbutamol.
Special instructions Combivent Inhaler:
To prevent an overdose is not recommended to exceed the maximum allowable daily dose. In case of paradoxical bronchospasm, a drug should be stopped immediately. Must be borne in mind that the development of bronchospasm may be associated with the transition to a new vial of the drug. It should be remembered that during the treatment may have tachycardia, increased blood pressure, ECG changes (smoothing of the T wave, prolongation QT, reducing the segment ST), therefore caution should be used for CHF, tachyarrhythmias, hypertension. Must avoid contact with eyes. If necessary, use during lactation should stop breastfeeding.
