Symptomatic treatment of acute asthmatic attacks and other conditions with reversible airway narrowing, such as chronic obstructive bronchitis. concomitant anti-inflammatory therapy should be considered for patients with BA seizures and a steroid-sensitive hoble; prevention of exercise-induced BA.
Treatment of BA attacks and other conditions with reversible bronchial obstruction
In most cases, inhalation of 1 dose is sufficient to stop an asthma attack; if after 5 minutes the effect is insufficient, the inhalation can be repeated, but no more than 8 inhalations per day.
If the attack is not eliminated by two doses and there is a need for further inhalation, the patient should immediately seek medical attention.
Prevention of exercise-induced asthma: 1-2 doses per inhalation before exercise, but not more than 8 doses per day.
For the treatment of children, dosed aerosol Berotek N should be used only as directed by a doctor and under the supervision of adults.
For successful therapy, it is necessary to use the metered aerosol correctly. Before using the cartridge for the first time, press the valve twice. Before each inhalation, the following rules must be observed:
1. Remove the protective cap.
2. Make a full exhalation.
3. Holding the metered aerosol with the dispenser downwards, put your lips around the mouthpiece. The arrow and base of the container should be facing up.
4. Inhale as deeply as possible while pressing firmly on the base of the container, this will release the metered dose. Hold your breath for a few seconds, then remove the mouthpiece and exhale.
If you need another inhalation, repeat the above steps (p. 2-4).
After use, return the protective cap to its place.
If the metered aerosol has not been used for 3 days, you must press the valve once.
The container is opaque. Therefore, you cannot see when it is empty. An aerosol can should provide 200 doses. When all of these doses have been used, it may seem like there is still some liquid left in the can. However, it needs to be replaced because the exact amount of the preparation cannot be obtained in this case.
The amount of medicine in an aerosol can can be checked as follows: disconnect the plastic mouthpiece from the can and place the can in a container with water. The contents of an aerosol can can be assessed by observing its position in the water: if the liquid content in the can is more than 3/4 of its volume, it will sink and be at the bottom; an empty canister will float on the surface of the water; if the liquid occupies ½ of the volume, the cartridge will float vertically on the surface, bottom up; accordingly, with a liquid content of about 1/4 of the volume - at an angle to the water surface.
Clean the inhaler at least once a week. It is important to keep the mouthpiece of the inhaler clean to ensure that the preparation does not thicken or interfere with the flow of aerosol.
To clean, first remove the dust cap and separate the container from the inhaler. Rinse the inhaler with water until the thickened preparation and / or dirt is removed.
After cleaning, shake off the inhaler and leave it to air dry (do not dry with any heating system). When the mouthpiece is dry, attach the container and dust cap.
Warning: the plastic tip is specially designed for dosed aerosol Berotek N 100 mcg and serves for accurate dosing. The handpiece must not be used with other metered aerosols and Berotek N must not be used with another handpiece.
The container is under pressure and must not be forcefully opened or heated to temperatures above 50 ° C.
Hypertrophic obstructive cardiomyopathy, tachyarrhythmia. hypersensitivity to fenoterol hydrobromide or inactive ingredients of the metered aerosol.
Breastfeeding period.
Side effects
As with other β-adrenergic receptor agonists, Berotec N can cause the following side effects, including severe hypokalemia. As with any other inhalation therapy, local irritation symptoms may appear with the use of Berotec N.
Immune system disorders: hypersensitivity.
From the side of metabolism and digestion: hypokalemia.
Mental disorders: hyperexcitability, nervousness.
From the side of the central nervous system: tremor, headache, dizziness.
From the side of the cardiovascular system: myocardial ischemia, arrhythmia, tachycardia, palpitations.
From the respiratory system, chest and mediastinum (only for inhalation dosage forms): paradoxical bronchospasm, cough, throat irritation.
From the gastrointestinal tract: nausea, vomiting.
Skin and subcutaneous tissue disorders: hyperhidrosis, skin reactions: rash, itching, urticaria.
From the musculoskeletal system: muscle spasm, myalgia, muscle weakness.
Research: increase in systolic blood pressure or decrease in diastolic blood pressure.
special instructions
It is necessary to provide for the need for simultaneous anti-inflammatory therapy in patients with BA and patients with steroid-dependent hobl.
When using the new metered-dose aerosol Berotek N for the first time, some patients may notice that its taste is slightly different from the previous aerosol containing freon. Patients should be informed about this when prescribing a new metered-dose aerosol Berotek N, as well as that both aerosol dosage forms are interchangeable and identical in their properties, and the difference in taste does not affect the effectiveness and safety of the preparation.
Concomitant use with other sympathomimetic bronchodilators should only be carried out under medical supervision. Anticholinergic bronchodilators can be used for inhalation simultaneously with Berotek N.
In such situations, especially when using doses exceeding the recommended ones, Berotek N should be used only after a careful assessment of the risk / benefit ratio:
- insufficiently controlled diabetes mellitus;
- recent myocardial infarction, pronounced organic lesions of the heart or blood vessels;
- hyperthyroidism, pheochromocytoma.
In case of sudden onset and rapid progression of shortness of breath, the patient should immediately consult a doctor.
With prolonged use of the preparation:
symptomatic treatment is preferable to regular use;
it is necessary to evaluate the feasibility of additional or intensification of anti-inflammatory therapy (for example, inhaled GCS) to control the inflammatory process of the airways and to avoid complications of control over the disease.
With increasing bronchial obstruction, exceeding the recommended dose of preparations containing β2-agonists, such as Berotek N, is not only inappropriate, but also dangerous. The use of high doses of β2-agonists, such as Berotek N, for a long time can lead to a deterioration in the control of symptoms of bronchial obstruction. In this situation, in order to prevent a potentially life-threatening condition, it is necessary to revise the treatment regimen and especially the adequacy of anti-inflammatory therapy.
With β2-adrenergic receptor agonist therapy, severe hypokalemia may occur. Particular attention is required in severe asthma, since in this case hypokalemia can be potentiated by the simultaneous use of xanthine derivatives, corticosteroids, and diuretics. In addition, hypoxia as a symptom of AD can increase the negative effect of hypokalemia on the heart rate.
In patients taking digoxin, hypokalemia can lead to an increased tendency to arrhythmias. In such situations, it is recommended to monitor serum potassium levels.
With the use of sympathomimetic preparations, including Berotek N, cardiovascular effects are possible. There is some evidence of myocardial ischemia associated with the use of β-adrenergic receptor agonists, obtained from post-marketing data and isolated cases published in the literature.
Patients with major severe heart disease (for example, ischemic heart disease, arrhythmia or decompensated heart failure) taking Berotek N should be warned about the need to consult a doctor if chest pain or other symptoms of worsening heart disease appear.
Consideration should be given to assessing symptoms such as dyspnea and chest pain, as they can be of respiratory or cardiac origin.
During pregnancy and breastfeeding. No negative effect was found when using the preparation during pregnancy. However, the usual precautions should be observed when using the preparation during pregnancy.
It is necessary to take into account the inhibitory effect of fenoterol on the contractile function of the uterus. It was revealed that fenoterol passes into breast milk. The safety of using the preparation during breastfeeding has not been established.
Children. Applied to children aged 6 years as prescribed by a doctor and under the supervision of adults.
The ability to influence the reaction rate when driving or operating other mechanisms. There are no data on the effect, but the possibility of adverse reactions when using the preparation should be taken into account.
Interactions
Β-adrenergic receptor agonists, anticholinergics and xanthine derivatives (such as theophylline) can enhance the effect of fenoterol. the simultaneous administration of other β-mimetics, the systematic use of anticholinergics and xanthine derivatives (for example, theophylline) may increase the side effect.
With the simultaneous use of β-adrenergic receptor blockers, a serious decrease in bronchodilation is potentially possible.
Β-adrenergic receptor agonists should be used with caution in patients taking MAO inhibitors or tricyclic antidepressants, since the effect of β-adrenergic preparations may increase.
Inhalation of halogenated hydrocarbon anesthetics (halothane, trichlorethylene, enflurane) can increase the severity of the action of β-adrenergic preparations on the cardiovascular system.
Overdose
Symptoms probable symptoms of an overdose are excessive β-adrenergic stimulation, including tachycardia, palpitations, tremors, arterial hypotension, increased heart rate fluctuations, angina pectoris, arrhythmia, and flushing.
Treatment: sedatives, tranquilizers; in severe cases, intensive care. As specific antidotes, β-adrenergic receptor blockers are used, preferably β1-selective. Consideration should be given to the possibility of increased bronchospasm; therefore, patients with asthma need to carefully select the dose.
Storage conditions
At a temperature not higher than 25 ° C. protect from direct sunlight, heat and low temperatures. the contents of the can is under pressure. Do not open the can.