Ipratropium Bromide

Mechanism :
Ipratropium bromide is an anticholinergic (Para sympatholytic) agent, which blocks the
muscarinic receptors of acetylcholine and inhibits vagally mediated reflexes by antagonizing the
action of acetylcholine, the transmitter agent released from the vagus nerve. Anticholinergics
prevent the increases in intracellular concentration of cyclic guanosine monophosphate (cGMP)
from the interaction of acetylcholine with the muscarinic receptors of bronchial smooth muscle
Indication :

 Chronic reversible airway obstruction

 Severe acute asthma

Contraindications :
It is contraindicated in patients with a history of hypersensitivity to soya lecithin or related food
products such as soybean and peanut. Aerosol should also not be taken by patients hypersensitive
to any other components of the drug product or to atropine or it’s derivatives

Dosing :
Available as 20 mcg/puff or as 0.025% nebulization solution.

Inhalation:
<5 years:
2 inhalations every 20 min for 1 hour if required.
5-12 years:
4-8 puffs every 20 min as needed for up to 3 hours.
≥12 years:
8 puffs every 20 min as needed for up to 3 hours.

Nebulization:
<5 years:
250 mcg nebulization every 20 min for 1 hour if necessary.
5-12 years:
250-500 mcg nebulization every 20 min for 3 doses, then as needed.
≥12 years:
500 mcg nebulization every 20 min for 3 doses, then as needed.

Side effects:
Eye pain or discomfort, irritation, blurred vision, or start seeing halos or odd colors when you
look at things, bladder pain, bloody or cloudy urine, difficult, burning, or painful urination, may
cause increased BP

Salbutamol/Albuterol
Brand Names :Airomir, Airsupra, Combivent, Proair, Proventil, Ventolin
Mechanism :
Salbutamol is a beta2-adrenergic agonist. The pharmacologic effects of beta2-adrenoceptor
agonist drugs are at least in part attributable to stimulation of intracellular adenyl cyclase, the
enzyme that catalyzes the conversion of
Triphosphate (ATP) to cyclic-3,5 -adenosine monophosphate (cyclic AMP). Increased cyclic
AMP levels cause relaxation of bronchial smooth muscle and inhibition of release of mediators
of immediate hypersensitivity from cells, especially from mast cells.

Indication :
Relief of severe bronchospasm
Hyperkalemia (Use as nebuliser)

Storage
– Below 25 °C

Contraindications :
Patients with a history of hypersensitivity to any of its components.

Dosing :
Oral: Use in children >2 years.
0.3-0.4 mg/kg/day PO in 3 divided doses; Maximum: 4 mg/dose.

Aerosol inhaler:
Up to 100-200 mcg single dose on demand
1 or 2 inhalations every 4-6 hours. Max: 800 mcg daily

Nebulizer :
<4 years: 1.25-2.5 mg 6 hourly
4 to 11 years: 2.5 mg to 5 mg up to four times a day
12 & above : 5 mg (2.5 ml) per nebulization every 20 minutes for the first hour

Injectable:
Use in children >12 years of age.
Subcutaneous route: 500 mcg (8 mcg/kg) and repeated every four hours as required.
Intramuscular route: 500 mcg (8 mcg/kg) and repeated every four hours as required.
IV: 250 mcg (4 mcg/kg) injected slowly. If necessary the dose may be repeated.

Adverse Effect :
Dose related: hypokalemia, tremor, nervousness, mild tachycardia (most frequently seen with
systemic therapy), hyperglycaemia.
*Never use nebuliser solution by the parenteral route

Interaction :
Corticosteroids: Increase the risk of hypokalemia, if high dose corticosteroids are given with
high doses of salbutamol.
Diuretics: Increase the risk of hypokalemia if acetazolamide, loop diuretics, and thiazides are
given with high doses of salbutamol.
Theophylline: Increases the risk of hypokalemia if given with high doses of salbutamol.
Beta-blockers: May partially or totally inhibit the effects of salbutamol.