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Duo-Medihaler

Posted by admin on November 9th, 2009

Duo-Medihaler

Inhalation Aerosol

PHARMACIST: Tear off ‘Patient Instructions for Use” and dispense with product.

Description

Duo-Medihaler (isoproterenol hydrochloride and phenylephrine bitartrate) is a combination of two sympathomimetics administered by oral inhalation for the treatment of bronchoconstriction. Each metered dose of the aerosol delivers through the oral adapter 0.16 mg isoproterenol hydrochloride and 0.24 mg phenylephrine bitartrate of appropriate particle size (the majority less than 5 μ). This drug product also cortains cetylpyridinium chloride, dichloro­difluoromethane, dichlorotetrafluoroethane, sorbitan trioleate, and trichloromonofluoromethane. Chemically, isoproterenol hydrochlo­ride is 4-[1-hydroxy-2-[(1-methytethyl)amino]ethyl]-1,2-benzene­diol hydrochloride and phenylephrine bitartrate is (-)-m-hydroxy­-a-[(methylamino) methyl]benzyl alcohol bitartrate.

Structural formulae:

Clinical Pharmacology

Isoproterenol acts directly on beta-adrenergic receptors and phenylephrine acts directly on alpha-adrenergic receptors. The beta-adrenergic effects stem from the release of cyclic AMP following activation of the enzyme adenyl cyclase. Alpha-adren­ergic effects probably result from inhibition of adenyl cyclase. Isoproterenol produces bronchodilatation, systemic vasodilation, mild hypotension, and tachycardia. Phenylephrine produces mild bronchodilatation, systemic vasoconstriction, mild hypertension, and bradycardia. These two drugs appear to act synergistically to allow the expression of each product’s ability to relax bronchial smooth muscle. The vasoconstrictor effect of phenylephrine reduces bronchiolar blood flow thereby producing a decongestant effect, promotes retention of the drug in the bronchial mucosa, and blocks the tachycardia of isoproterenol. After oral inhalation of the combination, the pulmonary effects occur within a few minutes and persist up to three hours.

Studies demonstrate that the ventilatory effects of isoproterenol­phenylephrine are superior to those obtained with the administration of isoproterenol alone. Because isoproterenol is a potent vasodilator that lowers blood pressure and acts upon the heart to increase cardiac output and pulse rate, its combination with phenylephrine results in a product with fewer cardiovascular effects. Studies have shown the absence of tachycardia and hypotension.

Isoproterenol alone often lowers arterial blood oxygen (PO

Pharmacokinetics: The average half-life for isoproterenol admin­istered by aerosol was five minutes. A plasma concentration of 0.03 ng/ml was found within minutes following an inhalation dose of 500 mcg isoproterenol.

Isoproterenol excretion following oral or inhalation administration is primarily renal. When given by inhalation, the major metabolite is the sulfate conjugate of the drug. When the drug is administered directly into the bronchial tree, it is inactivated by the enzyme catechol-o-methyl transferase, and the predominant metabolite is 3-o-methylisoproterenol sulfate. The explanation for this difference is supported by the observation that most (90%) of an aerosol dose is deposited in the mouth, swallowed, and converted to its sulfate conjugate in the gut wall, and to a lesser extent in the liver. The remaining isoproterenol is excreted as follows: 1% to 2% unchanged, 1% to 2% free methylated metabolite, and small amounts of metabolites in the bile.

Plasma levels following inhalation of phenylephrine have not been reported. Following oral and intravenous administrations, the average half-life was about 2.5 hours. Phenylephrine is metabo­lized in the liver and intestine by the enzyme monoamine oxidase. About 80% of a dose is recovered in the urine, primarily as phenolic conjugates and m-hydroxymandelic acid. About 16% of a dose is excreted as unchanged drug following intravenous administration and, due to first pass metabolism, less than 3% is excreted unchanged following oral dosing.

Recent studies in laboratory animals (minipigs, rodents, and dogs) recorded the occurrence of cardiac arrhythmias and sudden death (with histologic evidence of myocardial necrosis) when beta agonists and methylxanthines were concomitantly administered. The significance of these findings when applied to human usage is currently unknown.

Indications And Usage

Duo-Medihaler is indicated for the treatment of bronchospasm associated with acute and chronic asthma and reversible broncho­spasm which may be associated with chronic bronchitis or emphysema.

Contraindications

Duo-Medihaler must not be used by patients with known hyper­sensitivity to sympathomimetics. The use of isoproterenol in patients with pre-existing cardiac arrhythmias associated with tachycardia is contraindicated because the cardiac stimulant effects of the drug may aggravate such disorders.

Warnings

Excessive use of an adrenergic aerosol should be discouraged, as it may lose effectiveness. Occasional patients have been reported to develop severe paradoxical airway resistance with repeated, excessive use of isoproterenol inhalation preparations (see

Precautions

General: As with all sympathomimetic drugs, Duo-Medihaler should be used with great caution in the presence of coronary insufficiency, hypertension, hyperthyroidism, and diabetes.

Information for Patients: Patients who are being treated with DUO­-MEDIHALER should be informed adequately of the dangers of overusage, tolerance and rebound bronchospasm (see

Isoproterenol may cause the patient’s saliva to turn pinkish to red in color. Proper use of Duo-Medihaler oral inhaler should be demonstrated and discussed. Patient Instructions for Use are available with the package insert and should be provided when the medication is dispensed.

As with any drug, patients should be advised against the ingestion of alcohol during treatment.

Drug Interactions: A monoamine oxidase (MAO) inhibitor, a tricyclic antidepressant, or guanethidine may increase the cardiac and pressor effects of phenylephrine and isoproterenol; however, normal volunteers given isoproterenol by inhalation along with an MAO inhibitor or a tricyclic antidepressant had no adverse cardio­vascular effects.

Arrhythmias may result from the concurrent administration of isoproterenol or phenylephrine to patients who are receiving digitalis, epinephrine, cyclopropane, or halogenated hydrocarbon anesthetics.

Beta-adrenergic blocking drugs such as propranolol antagonize the cardiac, bronchodilating, and vasodilating effects of isoproterenol and the stimulating effects of phenylephrine.

Ergot alkaloids may increase blood pressure in patients receiving iso­proterenol or phenylephrine. Phentolamine mesylate (Regitine

Phenothiazine drugs have some alpha-adrenergic blocking activity and may reduce the pressor effects and duration of action of phenylephrine.

Drug/Laboratory Test Interactions: Isoproterenol causes false elevations of bilirubin as measured in vitro by sequential multiple analyzer. An effect on serum bilirubin determinations in patients receiving the drug has not been determined. One case of surrepti­tious self-administration of a 500 mg subcutaneous dose of isopro­terenol resulted in increased urinary excretion of epinephrine, norepinephrine, and vanilmandelic acid. Isoproterenol inhalation may result in enough absorption of the drug to produce increased values for urinary epinephrine. This effect is probably small with standard doses, but is likely to increase with larger doses.

Carcinogencity, Mutagenesis, and Impairment of Fertility: Isoproterenol hydrochloride, phenylephrine bitartrate, or DUO-­MEDIHALER have not been evaluated for carcinogenicity, muta­genicity or impairment of fertility.

Pregnancy: Teratogenic Effects – Pregnancy Category C: Repro­duction studies have not been done with Duo-Medihaler or phenylephrine. Reproduction studies with isoproterenol have been performed in rats and rabbits with aerosol doses (30 minutes per day for 12 days) up to 15 times the human dose and have revealed no evidence of impaired fertility or harm to the fetus. It is also not known whether Duo-Medihaler can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Duo-Medihaler should be given to a pregnant woman only if clearly needed.

Labor and Delivery: Duo-Medihaler has no recognized use during labor and delivery. Phenylephrine administration during late pregnancy or labor may cause fetal anoxia and bradycardia by increasing uterine contractility and decreasing uterine blood flow.

Nursing Mothers: It is not known whether isoproterenol or phenyl­ephrine is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when DUO­MEDIHALER is administered to a nursing woman.

Pediatric Use: Safe and effective use of Duo-Medihaler in children below the age of 12 has not been established.

Geriatric Use: Lower doses in elderly patients may be required due to increased sympathomimetic sensitivity (see

Adverse Reactions

The following adverse effects, listed by organ system in decreasing frequency have been associated with the use of Duo-Medihaler and are similar to those produced by other sympathomimetic agents:

Drug Abuse and Dependence

Drug abuse and dependence have not been reported with DUO­-MEDIHALER.

Overdosage

Isoproterenol: The oral LD

Phenylephrine: The oral LD

Symptoms: The individual patient’s sensitivity to either drug will dictate the overdosage signs. There is reason to believe, however, that the overdosage effects of either drug are antagonized by the other drug in the combination. Severe symptoms of overdosage are more likely to result from parenteral administration of isoproterenol rather than from oral inhalation of isoproterenol and phenylephrine in an aerosol.

Manifestations of acute overdosage include chest pain, dizziness, headache, irregular heartbeat, fast or pounding heartbeat, brady­cardia, nausea or vomiting, restlessness, weakness, flushing, decreased diastolic pressure, convulsions, cerebral hemorrhage, or hypertension.

Treatment: Discontinued dosing allows rapid reversal of adverse effects. Blood pressure and ECG may be monitored and the following treatment used, as appropriate: Tachycardia in asthmatic patients may be treated with cardioselective beta-blockers (meto­prolol or atenolol, but use cautiously since cardioselectivity may not be absolute) and in nonasthmatics with propranolol; brady­cardia may be treated with atropine; blood pressure may be regulated with rapid-acting vasodilators (nitrites, sodium nitro­prusside) or alpha-blocking agents (quinidine, phentolamine). It is not known if isoproterenol or phenylephrine are dialyzable.

Duo-Medihaler Dosage and Administration

Adults: The usual dose for the relief of dyspnea caused by acute bronchospasm is one or two inhalations. Start with a single inhalation. If no relief is evident after two to five minutes, a second inhalation may be taken. For daily maintenance, use one or two inhalations four to six times daily or as directed by the physician. The physician should be careful to instruct the patient in the proper technique of administration so that the number of inhalations per treatment and the frequency of retreatment may be titrated to the patient’s response.

No more than two inhalations should be taken at any one time, nor more than six inhalations in any one hour during a 24-hour period, unless advised by the physician. Lower doses in elderly patients may be required due to increased sympathomimetic sensi­tivity. Each depression of the valve delivers through the oral adapter 0.16 mg isoproterenol hydrochloride and 0.24 mg phenylephrine bitartrate.

Children: Safety and effectiveness for children under 12 years have not yet been established (see

DIRECTIONS FOR USE

Before each use, remove dust cap and inspect mouthpiece for foreign objects. Shake Duo-Medihaler.

Replace dust cap after each use.

How supplied

Duo-Medihaler is an aerosol device which delivers 0.16 mg of isoproterenol hydrochloride and 0.24 mg of phenylephrine bitar­trate through the oral adapter with each depression of the valve.

15-ml vial and oral adapter, containing 21.0 gm, a minimum of 300 actuations

NDC 0089-0735-21).

15-ml refill vial only, containing 21.0 gm, a minimum of 300 actu­ations (NDC 0089-0735-11).

Note: The indented statement below is required by the Federal government’s Clean Air Act for all products containing or manu­factured with chlorofluorocarbons (CFC’s).

WARNING: Contains trichloromonofluoromethane, dichlorodifluoromethane, and dichlorotetrafluoroethane, substances which harm public health and environment by destroying ozone in the upper atmosphere.

A notice similar to the above WARNING has been placed in the “Patient Instructions for Use” of this product pursuant to EPA regulations.

CAUTION

Federal law prohibits dispensing without prescription. CONTENTS UNDER PRESSURE. Do not puncture or incinerate container Store at controlled room temperature between 15°C and 30°C. (59°F and 86°F). KEEP OUT OF THE REACH OF CHILDREN.

3M Pharmaceuticals

More Duo-Medihaler resources

Posted in bronchodilator combinations Tags: , No Comments »

Duo-Medihaler

Posted by admin on November 9th, 2009

Duo-Medihaler

Inhalation Aerosol

PHARMACIST: Tear off ‘Patient Instructions for Use” and dispense with product.

Description

Duo-Medihaler (isoproterenol hydrochloride and phenylephrine bitartrate) is a combination of two sympathomimetics administered by oral inhalation for the treatment of bronchoconstriction. Each metered dose of the aerosol delivers through the oral adapter 0.16 mg isoproterenol hydrochloride and 0.24 mg phenylephrine bitartrate of appropriate particle size (the majority less than 5 μ). This drug product also cortains cetylpyridinium chloride, dichloro­difluoromethane, dichlorotetrafluoroethane, sorbitan trioleate, and trichloromonofluoromethane. Chemically, isoproterenol hydrochlo­ride is 4-[1-hydroxy-2-[(1-methytethyl)amino]ethyl]-1,2-benzene­diol hydrochloride and phenylephrine bitartrate is (-)-m-hydroxy­-a-[(methylamino) methyl]benzyl alcohol bitartrate.

Structural formulae:

Clinical Pharmacology

Isoproterenol acts directly on beta-adrenergic receptors and phenylephrine acts directly on alpha-adrenergic receptors. The beta-adrenergic effects stem from the release of cyclic AMP following activation of the enzyme adenyl cyclase. Alpha-adren­ergic effects probably result from inhibition of adenyl cyclase. Isoproterenol produces bronchodilatation, systemic vasodilation, mild hypotension, and tachycardia. Phenylephrine produces mild bronchodilatation, systemic vasoconstriction, mild hypertension, and bradycardia. These two drugs appear to act synergistically to allow the expression of each product’s ability to relax bronchial smooth muscle. The vasoconstrictor effect of phenylephrine reduces bronchiolar blood flow thereby producing a decongestant effect, promotes retention of the drug in the bronchial mucosa, and blocks the tachycardia of isoproterenol. After oral inhalation of the combination, the pulmonary effects occur within a few minutes and persist up to three hours.

Studies demonstrate that the ventilatory effects of isoproterenol­phenylephrine are superior to those obtained with the administration of isoproterenol alone. Because isoproterenol is a potent vasodilator that lowers blood pressure and acts upon the heart to increase cardiac output and pulse rate, its combination with phenylephrine results in a product with fewer cardiovascular effects. Studies have shown the absence of tachycardia and hypotension.

Isoproterenol alone often lowers arterial blood oxygen (PO

Pharmacokinetics: The average half-life for isoproterenol admin­istered by aerosol was five minutes. A plasma concentration of 0.03 ng/ml was found within minutes following an inhalation dose of 500 mcg isoproterenol.

Isoproterenol excretion following oral or inhalation administration is primarily renal. When given by inhalation, the major metabolite is the sulfate conjugate of the drug. When the drug is administered directly into the bronchial tree, it is inactivated by the enzyme catechol-o-methyl transferase, and the predominant metabolite is 3-o-methylisoproterenol sulfate. The explanation for this difference is supported by the observation that most (90%) of an aerosol dose is deposited in the mouth, swallowed, and converted to its sulfate conjugate in the gut wall, and to a lesser extent in the liver. The remaining isoproterenol is excreted as follows: 1% to 2% unchanged, 1% to 2% free methylated metabolite, and small amounts of metabolites in the bile.

Plasma levels following inhalation of phenylephrine have not been reported. Following oral and intravenous administrations, the average half-life was about 2.5 hours. Phenylephrine is metabo­lized in the liver and intestine by the enzyme monoamine oxidase. About 80% of a dose is recovered in the urine, primarily as phenolic conjugates and m-hydroxymandelic acid. About 16% of a dose is excreted as unchanged drug following intravenous administration and, due to first pass metabolism, less than 3% is excreted unchanged following oral dosing.

Recent studies in laboratory animals (minipigs, rodents, and dogs) recorded the occurrence of cardiac arrhythmias and sudden death (with histologic evidence of myocardial necrosis) when beta agonists and methylxanthines were concomitantly administered. The significance of these findings when applied to human usage is currently unknown.

Indications And Usage

Duo-Medihaler is indicated for the treatment of bronchospasm associated with acute and chronic asthma and reversible broncho­spasm which may be associated with chronic bronchitis or emphysema.

Contraindications

Duo-Medihaler must not be used by patients with known hyper­sensitivity to sympathomimetics. The use of isoproterenol in patients with pre-existing cardiac arrhythmias associated with tachycardia is contraindicated because the cardiac stimulant effects of the drug may aggravate such disorders.

Warnings

Excessive use of an adrenergic aerosol should be discouraged, as it may lose effectiveness. Occasional patients have been reported to develop severe paradoxical airway resistance with repeated, excessive use of isoproterenol inhalation preparations (see

Precautions

General: As with all sympathomimetic drugs, Duo-Medihaler should be used with great caution in the presence of coronary insufficiency, hypertension, hyperthyroidism, and diabetes.

Information for Patients: Patients who are being treated with DUO­-MEDIHALER should be informed adequately of the dangers of overusage, tolerance and rebound bronchospasm (see

Isoproterenol may cause the patient’s saliva to turn pinkish to red in color. Proper use of Duo-Medihaler oral inhaler should be demonstrated and discussed. Patient Instructions for Use are available with the package insert and should be provided when the medication is dispensed.

As with any drug, patients should be advised against the ingestion of alcohol during treatment.

Drug Interactions: A monoamine oxidase (MAO) inhibitor, a tricyclic antidepressant, or guanethidine may increase the cardiac and pressor effects of phenylephrine and isoproterenol; however, normal volunteers given isoproterenol by inhalation along with an MAO inhibitor or a tricyclic antidepressant had no adverse cardio­vascular effects.

Arrhythmias may result from the concurrent administration of isoproterenol or phenylephrine to patients who are receiving digitalis, epinephrine, cyclopropane, or halogenated hydrocarbon anesthetics.

Beta-adrenergic blocking drugs such as propranolol antagonize the cardiac, bronchodilating, and vasodilating effects of isoproterenol and the stimulating effects of phenylephrine.

Ergot alkaloids may increase blood pressure in patients receiving iso­proterenol or phenylephrine. Phentolamine mesylate (Regitine

Phenothiazine drugs have some alpha-adrenergic blocking activity and may reduce the pressor effects and duration of action of phenylephrine.

Drug/Laboratory Test Interactions: Isoproterenol causes false elevations of bilirubin as measured in vitro by sequential multiple analyzer. An effect on serum bilirubin determinations in patients receiving the drug has not been determined. One case of surrepti­tious self-administration of a 500 mg subcutaneous dose of isopro­terenol resulted in increased urinary excretion of epinephrine, norepinephrine, and vanilmandelic acid. Isoproterenol inhalation may result in enough absorption of the drug to produce increased values for urinary epinephrine. This effect is probably small with standard doses, but is likely to increase with larger doses.

Carcinogencity, Mutagenesis, and Impairment of Fertility: Isoproterenol hydrochloride, phenylephrine bitartrate, or DUO-­MEDIHALER have not been evaluated for carcinogenicity, muta­genicity or impairment of fertility.

Pregnancy: Teratogenic Effects – Pregnancy Category C: Repro­duction studies have not been done with Duo-Medihaler or phenylephrine. Reproduction studies with isoproterenol have been performed in rats and rabbits with aerosol doses (30 minutes per day for 12 days) up to 15 times the human dose and have revealed no evidence of impaired fertility or harm to the fetus. It is also not known whether Duo-Medihaler can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Duo-Medihaler should be given to a pregnant woman only if clearly needed.

Labor and Delivery: Duo-Medihaler has no recognized use during labor and delivery. Phenylephrine administration during late pregnancy or labor may cause fetal anoxia and bradycardia by increasing uterine contractility and decreasing uterine blood flow.

Nursing Mothers: It is not known whether isoproterenol or phenyl­ephrine is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when DUO­MEDIHALER is administered to a nursing woman.

Pediatric Use: Safe and effective use of Duo-Medihaler in children below the age of 12 has not been established.

Geriatric Use: Lower doses in elderly patients may be required due to increased sympathomimetic sensitivity (see

Adverse Reactions

The following adverse effects, listed by organ system in decreasing frequency have been associated with the use of Duo-Medihaler and are similar to those produced by other sympathomimetic agents:

Drug Abuse and Dependence

Drug abuse and dependence have not been reported with DUO­-MEDIHALER.

Overdosage

Isoproterenol: The oral LD

Phenylephrine: The oral LD

Symptoms: The individual patient’s sensitivity to either drug will dictate the overdosage signs. There is reason to believe, however, that the overdosage effects of either drug are antagonized by the other drug in the combination. Severe symptoms of overdosage are more likely to result from parenteral administration of isoproterenol rather than from oral inhalation of isoproterenol and phenylephrine in an aerosol.

Manifestations of acute overdosage include chest pain, dizziness, headache, irregular heartbeat, fast or pounding heartbeat, brady­cardia, nausea or vomiting, restlessness, weakness, flushing, decreased diastolic pressure, convulsions, cerebral hemorrhage, or hypertension.

Treatment: Discontinued dosing allows rapid reversal of adverse effects. Blood pressure and ECG may be monitored and the following treatment used, as appropriate: Tachycardia in asthmatic patients may be treated with cardioselective beta-blockers (meto­prolol or atenolol, but use cautiously since cardioselectivity may not be absolute) and in nonasthmatics with propranolol; brady­cardia may be treated with atropine; blood pressure may be regulated with rapid-acting vasodilators (nitrites, sodium nitro­prusside) or alpha-blocking agents (quinidine, phentolamine). It is not known if isoproterenol or phenylephrine are dialyzable.

Duo-Medihaler Dosage and Administration

Adults: The usual dose for the relief of dyspnea caused by acute bronchospasm is one or two inhalations. Start with a single inhalation. If no relief is evident after two to five minutes, a second inhalation may be taken. For daily maintenance, use one or two inhalations four to six times daily or as directed by the physician. The physician should be careful to instruct the patient in the proper technique of administration so that the number of inhalations per treatment and the frequency of retreatment may be titrated to the patient’s response.

No more than two inhalations should be taken at any one time, nor more than six inhalations in any one hour during a 24-hour period, unless advised by the physician. Lower doses in elderly patients may be required due to increased sympathomimetic sensi­tivity. Each depression of the valve delivers through the oral adapter 0.16 mg isoproterenol hydrochloride and 0.24 mg phenylephrine bitartrate.

Children: Safety and effectiveness for children under 12 years have not yet been established (see

DIRECTIONS FOR USE

Before each use, remove dust cap and inspect mouthpiece for foreign objects. Shake Duo-Medihaler.

Replace dust cap after each use.

How supplied

Duo-Medihaler is an aerosol device which delivers 0.16 mg of isoproterenol hydrochloride and 0.24 mg of phenylephrine bitar­trate through the oral adapter with each depression of the valve.

15-ml vial and oral adapter, containing 21.0 gm, a minimum of 300 actuations

NDC 0089-0735-21).

15-ml refill vial only, containing 21.0 gm, a minimum of 300 actu­ations (NDC 0089-0735-11).

Note: The indented statement below is required by the Federal government’s Clean Air Act for all products containing or manu­factured with chlorofluorocarbons (CFC’s).

WARNING: Contains trichloromonofluoromethane, dichlorodifluoromethane, and dichlorotetrafluoroethane, substances which harm public health and environment by destroying ozone in the upper atmosphere.

A notice similar to the above WARNING has been placed in the “Patient Instructions for Use” of this product pursuant to EPA regulations.

CAUTION

Federal law prohibits dispensing without prescription. CONTENTS UNDER PRESSURE. Do not puncture or incinerate container Store at controlled room temperature between 15°C and 30°C. (59°F and 86°F). KEEP OUT OF THE REACH OF CHILDREN.

3M Pharmaceuticals

More Duo-Medihaler resources

Posted in bronchodilator combinations Tags: , No Comments »

Advair Diskus

Posted by admin on November 9th, 2009

Advair Diskus Powder

Long-acting beta-agonists such as salmeterol, an ingredient in Advair Diskus Powder, have been rarely associated with an increased risk of asthma-related death. Advair Diskus Powder should only be used by certain patients with severe asthma or by patients who cannot get adequate control of asthma symptoms by using other asthma-controller medicines (eg, inhaled corticosteroids).

Advair Diskus Powder is used for:

Long-term treatment of asthma and chronic obstructive pulmonary disease (COPD) in certain patients. It may also be used to treat other breathing conditions as determined by your doctor.

Advair Diskus Powder is a long-acting corticosteroid and bronchodilator combination. It works by reducing inflammation and widening the airways in the lungs, which helps you breath more easily.

Do NOT use Advair Diskus Powder if:

Contact your doctor or health care provider right away if any of these apply to you.

Before using Advair Diskus Powder:

Some medical conditions may interact with Advair Diskus Powder. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

Some MEDICINES MAY INTERACT with Advair Diskus Powder. Tell your health care provider if you are taking any other medicines, especially any of the following:

This may not be a complete list of all interactions that may occur. Ask your health care provider if Advair Diskus Powder may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Advair Diskus Powder:

Use Advair Diskus Powder as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Advair Diskus Powder.

Important safety information:

Possible side effects of Advair Diskus Powder:

All medicines may cause side effects, but many people have no, or minor, side effects.

Diarrhea; dizziness; headache; mild muscle or bone pain; nausea; nervousness; throat irritation; tremor; vomiting.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); behavior changes; blurred vision or other vision changes; chest pain; choking; fast or irregular heartbeat; hoarseness; numbness or tingling in hands or feet; seizures; severe muscle weakness, cramps, or spasms; severe or persistent bone pain; severe or persistent dizziness or headache; signs of infection (eg, fever, chills, persistent headache/sore throat, ear pain, increased mucus production or change in mucus color); swelling or tightness in the throat; trouble sleeping; unusual tiredness or weakness; vaginal odor or discharge; weight gain; white patches or sores on the tongue or mouth; worsening of asthma symptoms (eg, increased wheezing, coughing, chest tightness, shortness of breath).

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects at

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (

Store Advair Diskus Powder between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Advair Diskus Powder out of the reach of children and away from pets.

General information:

This information is a summary only. It does not contain all information about Advair Diskus Powder. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

More Advair Diskus Powder resources

Compare Advair Diskus Powder with other medications for the treatment of:

Posted in bronchodilator combinations Tags: , No Comments »

Advair Diskus

Posted by admin on November 9th, 2009

Advair Diskus Powder

Long-acting beta-agonists such as salmeterol, an ingredient in Advair Diskus Powder, have been rarely associated with an increased risk of asthma-related death. Advair Diskus Powder should only be used by certain patients with severe asthma or by patients who cannot get adequate control of asthma symptoms by using other asthma-controller medicines (eg, inhaled corticosteroids).

Advair Diskus Powder is used for:

Long-term treatment of asthma and chronic obstructive pulmonary disease (COPD) in certain patients. It may also be used to treat other breathing conditions as determined by your doctor.

Advair Diskus Powder is a long-acting corticosteroid and bronchodilator combination. It works by reducing inflammation and widening the airways in the lungs, which helps you breath more easily.

Do NOT use Advair Diskus Powder if:

Contact your doctor or health care provider right away if any of these apply to you.

Before using Advair Diskus Powder:

Some medical conditions may interact with Advair Diskus Powder. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

Some MEDICINES MAY INTERACT with Advair Diskus Powder. Tell your health care provider if you are taking any other medicines, especially any of the following:

This may not be a complete list of all interactions that may occur. Ask your health care provider if Advair Diskus Powder may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Advair Diskus Powder:

Use Advair Diskus Powder as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Advair Diskus Powder.

Important safety information:

Possible side effects of Advair Diskus Powder:

All medicines may cause side effects, but many people have no, or minor, side effects.

Diarrhea; dizziness; headache; mild muscle or bone pain; nausea; nervousness; throat irritation; tremor; vomiting.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); behavior changes; blurred vision or other vision changes; chest pain; choking; fast or irregular heartbeat; hoarseness; numbness or tingling in hands or feet; seizures; severe muscle weakness, cramps, or spasms; severe or persistent bone pain; severe or persistent dizziness or headache; signs of infection (eg, fever, chills, persistent headache/sore throat, ear pain, increased mucus production or change in mucus color); swelling or tightness in the throat; trouble sleeping; unusual tiredness or weakness; vaginal odor or discharge; weight gain; white patches or sores on the tongue or mouth; worsening of asthma symptoms (eg, increased wheezing, coughing, chest tightness, shortness of breath).

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects at

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (

Store Advair Diskus Powder between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Advair Diskus Powder out of the reach of children and away from pets.

General information:

This information is a summary only. It does not contain all information about Advair Diskus Powder. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

More Advair Diskus Powder resources

Compare Advair Diskus Powder with other medications for the treatment of:

Posted in bronchodilator combinations Tags: , No Comments »

Combivent

Posted by admin on November 9th, 2009

Combivent

Generic Name: albuterol and ipratropium (inhalation) (al BYOO ter ol and ip ra TRO pee um)

What is Combivent?

Combivent contains a combination of albuterol and ipratropium. Albuterol and ipratropium are bronchodilators that relax muscles in the airways and increase air flow to the lungs.

Combivent is used to prevent bronchospasm in people with chronic obstructive pulmonary disease (COPD) who are also using other medicines to control their condition.

Combivent may also be used for other purposes not listed in this medication guide.

Important information about Combivent

Do not use Combivent if you are allergic to it, or to atropine (Atreza, Sal-Tropine), soybeans, peanuts, or other food products that contain soya lecithin.

Call your doctor right away if you feel that this medicine is not working as well as usual, or if it makes your condition worse. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

Extreme heat can cause the medicine canister to burst. Do not store your inhaler in your car on hot days. Do not throw an empty canister into open flame.

Before using Combivent

Do not use Combivent if you are allergic to it, or to atropine (Atreza, Sal-Tropine), soybeans, peanuts, or other food products that contain soya lecithin.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use Combivent:

heart disease, high blood pressure, or congestive heart failure;

a seizure disorder such as epilepsy;

diabetes;

overactive thyroid;

glaucoma;

enlarged prostate, problems with urination; or

FDA pregnancy category C. It is not known whether Combivent is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether albuterol or ipratropium pass into breast milk or if it could harm a nursing baby. Do not use Combivent without telling your doctor if you are breast-feeding a baby.

How should I use Combivent?

Use Combivent exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

Combivent may increase the risk of asthma-related death. It is critical that you use only the prescribed dose of this medicine and follow all patient instructions for safe use of the medication.

Combivent comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

When using the inhaler device for the first time, prime it by spraying 2 test sprays into the air, away from your face. Also prime the inhaler if you have not used it for 3 days or longer.

The instructions below are for standard use of the inhaler and nebulizer devices. Your doctor may want you to use your device differently. Be sure you understand all instructions that are specific to your use of Combivent.

To use the inhaler:

If you use more than one inhalation at a time, wait at least 2 minutes before using the second inhalation.

Keep your inhaler clean and dry, and store it with the cap on the mouthpiece. Clean your inhaler once a week by removing the canister and placing the mouthpiece under warm running water for at least 30 seconds. Allow the parts to dry before putting the inhaler back together.

To use the solution with a nebulizer:

Measure the correct amount of medicine using the dropper provided, or use the proper number of ampules. Place the liquid into the medication chamber of the nebulizer. If using a medicine dropper, do not allow the dropper to touch any surface including your hands or the nebulizer.

Attach the mouthpiece or face mask to the drug chamber. Then, attach the drug chamber to the compressor. Sit upright in a comfortable position. Place the mouthpiece into your mouth or put the face mask on, covering your nose and mouth. Breathe in slowly and evenly until you have inhaled all of the medicine (usually 5 to 15 minutes). The treatment is complete when no more mist is formed by the nebulizer and the drug chamber is empty.

Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

Call your doctor right away if you feel that this medicine is not working as well as usual, or if it makes your condition worse. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

To be sure Combivent is helping your condition, your lung function will need to be tested on a regular basis. It is important that you not miss any scheduled visits to your doctor.

It is important to use Combivent regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. Keep using all of your other medications as prescribed by your doctor.

Store Combivent at room temperature away from moisture and heat. Extreme heat can cause the medicine canister to burst. Do not store it in your car on hot days. Do not throw an empty canister into open flame.

Keep track of the number of sprays you have used and throw away the inhaler canister after 200 sprays, even if it feels like there is still medicine in it.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of Combivent can be fatal. Overdose symptoms may include chest pain or heavy feeling, rapid or uneven heart rate, pain spreading to the arm or shoulder, nausea, sweating, weakness, or general ill feeling.

What should I avoid while using Combivent?

Avoid getting Combivent in your eyes. If this does happen, rinse the eyes with water and seek medical attention.

Combivent side effects

Stop using Combivent and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Combivent and call your doctor at once if you have any of these serious side effects:

bronchospasm (wheezing, chest tightness, trouble breathing), especially after starting a new canister of this medicine;

chest pain and fast, pounding, or uneven heart beats;

swelling of your ankles or feet;

pain or burning with urination; or

increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure).

Less serious Combivent side effects may include:

headache, dizziness, nervousness;

drowsiness or sleep problems (insomnia);

cough, hoarseness, sore throat, runny or stuffy nose;

dry mouth, unusual taste in your mouth;

tremors, numbness or tingly feeling;

nausea, vomiting, upset stomach, diarrhea, constipation; or

blurred vision.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Combivent?

Before using Combivent, tell your doctor if you are taking any of the following medicines:

atropine (Donnatal, and others);

belladonna;

clidinium (Quarzan);

dicyclomine (Bentyl);

glycopyrrolate (Robinul);

hyoscyamine (Anaspaz, Cystospaz, Levsin, and others);

mepenzolate (Cantil);

methantheline (Provocholine);

methscopolamine (Pamine), scopolamine (Transderm-Scop);

propantheline (Pro-Banthine);

a beta-blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), metoprolol (Lopressor), propranolol (Inderal), and others;

a diuretic (water pill);

a stimulant, ADHD medication, diet pills, or over-the-counter cold or allergy medicines; or

an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

This list is not complete and there may be other drugs that can interact with Combivent. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Posted in bronchodilator combinations Tags: , No Comments »

Combivent

Posted by admin on November 9th, 2009

Combivent

Generic Name: albuterol and ipratropium (inhalation) (al BYOO ter ol and ip ra TRO pee um)

What is Combivent?

Combivent contains a combination of albuterol and ipratropium. Albuterol and ipratropium are bronchodilators that relax muscles in the airways and increase air flow to the lungs.

Combivent is used to prevent bronchospasm in people with chronic obstructive pulmonary disease (COPD) who are also using other medicines to control their condition.

Combivent may also be used for other purposes not listed in this medication guide.

Important information about Combivent

Do not use Combivent if you are allergic to it, or to atropine (Atreza, Sal-Tropine), soybeans, peanuts, or other food products that contain soya lecithin.

Call your doctor right away if you feel that this medicine is not working as well as usual, or if it makes your condition worse. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

Extreme heat can cause the medicine canister to burst. Do not store your inhaler in your car on hot days. Do not throw an empty canister into open flame.

Before using Combivent

Do not use Combivent if you are allergic to it, or to atropine (Atreza, Sal-Tropine), soybeans, peanuts, or other food products that contain soya lecithin.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use Combivent:

heart disease, high blood pressure, or congestive heart failure;

a seizure disorder such as epilepsy;

diabetes;

overactive thyroid;

glaucoma;

enlarged prostate, problems with urination; or

FDA pregnancy category C. It is not known whether Combivent is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether albuterol or ipratropium pass into breast milk or if it could harm a nursing baby. Do not use Combivent without telling your doctor if you are breast-feeding a baby.

How should I use Combivent?

Use Combivent exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

Combivent may increase the risk of asthma-related death. It is critical that you use only the prescribed dose of this medicine and follow all patient instructions for safe use of the medication.

Combivent comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

When using the inhaler device for the first time, prime it by spraying 2 test sprays into the air, away from your face. Also prime the inhaler if you have not used it for 3 days or longer.

The instructions below are for standard use of the inhaler and nebulizer devices. Your doctor may want you to use your device differently. Be sure you understand all instructions that are specific to your use of Combivent.

To use the inhaler:

If you use more than one inhalation at a time, wait at least 2 minutes before using the second inhalation.

Keep your inhaler clean and dry, and store it with the cap on the mouthpiece. Clean your inhaler once a week by removing the canister and placing the mouthpiece under warm running water for at least 30 seconds. Allow the parts to dry before putting the inhaler back together.

To use the solution with a nebulizer:

Measure the correct amount of medicine using the dropper provided, or use the proper number of ampules. Place the liquid into the medication chamber of the nebulizer. If using a medicine dropper, do not allow the dropper to touch any surface including your hands or the nebulizer.

Attach the mouthpiece or face mask to the drug chamber. Then, attach the drug chamber to the compressor. Sit upright in a comfortable position. Place the mouthpiece into your mouth or put the face mask on, covering your nose and mouth. Breathe in slowly and evenly until you have inhaled all of the medicine (usually 5 to 15 minutes). The treatment is complete when no more mist is formed by the nebulizer and the drug chamber is empty.

Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

Call your doctor right away if you feel that this medicine is not working as well as usual, or if it makes your condition worse. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

To be sure Combivent is helping your condition, your lung function will need to be tested on a regular basis. It is important that you not miss any scheduled visits to your doctor.

It is important to use Combivent regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. Keep using all of your other medications as prescribed by your doctor.

Store Combivent at room temperature away from moisture and heat. Extreme heat can cause the medicine canister to burst. Do not store it in your car on hot days. Do not throw an empty canister into open flame.

Keep track of the number of sprays you have used and throw away the inhaler canister after 200 sprays, even if it feels like there is still medicine in it.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of Combivent can be fatal. Overdose symptoms may include chest pain or heavy feeling, rapid or uneven heart rate, pain spreading to the arm or shoulder, nausea, sweating, weakness, or general ill feeling.

What should I avoid while using Combivent?

Avoid getting Combivent in your eyes. If this does happen, rinse the eyes with water and seek medical attention.

Combivent side effects

Stop using Combivent and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Combivent and call your doctor at once if you have any of these serious side effects:

bronchospasm (wheezing, chest tightness, trouble breathing), especially after starting a new canister of this medicine;

chest pain and fast, pounding, or uneven heart beats;

swelling of your ankles or feet;

pain or burning with urination; or

increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure).

Less serious Combivent side effects may include:

headache, dizziness, nervousness;

drowsiness or sleep problems (insomnia);

cough, hoarseness, sore throat, runny or stuffy nose;

dry mouth, unusual taste in your mouth;

tremors, numbness or tingly feeling;

nausea, vomiting, upset stomach, diarrhea, constipation; or

blurred vision.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Combivent?

Before using Combivent, tell your doctor if you are taking any of the following medicines:

atropine (Donnatal, and others);

belladonna;

clidinium (Quarzan);

dicyclomine (Bentyl);

glycopyrrolate (Robinul);

hyoscyamine (Anaspaz, Cystospaz, Levsin, and others);

mepenzolate (Cantil);

methantheline (Provocholine);

methscopolamine (Pamine), scopolamine (Transderm-Scop);

propantheline (Pro-Banthine);

a beta-blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), metoprolol (Lopressor), propranolol (Inderal), and others;

a diuretic (water pill);

a stimulant, ADHD medication, diet pills, or over-the-counter cold or allergy medicines; or

an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

This list is not complete and there may be other drugs that can interact with Combivent. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Posted in bronchodilator combinations Tags: , No Comments »

Symbicort

Posted by admin on November 9th, 2009

Symbicort

Generic Name: budesonide and formoterol inhalation (bue DES oh nide and for MOE te rol)

What is Symbicort?

Symbicort conatins a comination of budesonide and formoterol. Budesonide is a steroid that reduces inflammation in the body. Formoterol is a long-acting bronchodilator that relaxes muscles in the airways to improve breathing.

Symbicort is used to prevent bronchospasm in people with asthma or chronic obstructive pulmonary disease (COPD).

Symbicort inhalation may also be used for other purposes not listed in this medication guide.

Important information about Symbicort

Do not use Symbicort to treat an asthma attack that has already begun. It will not work fast enough to reverse your symptoms. Use only a fast-acting inhalation medicine to treat an asthma attack. Symbicort may increase the risk of asthma-related death. It is critical that you use only the prescribed dose of Symbicort and follow all patient instructions for safe use. Talk with your doctor about your individual risks and benefits in using Symbicort.

Asthma is usually treated with a combination of different drugs. To best treat your condition, use all of your medications as directed by your doctor.

Seek medical attention if you think any of your asthma medications are not working as well as usual. An increased need for medication could be an early sign of a serious asthma attack.

What should I discuss with my healthcare provider before using Symbicort?

You should not use Symbicort if you are allergic to budesonide (Entocort, Pulmicort, Rhinocort) or formoterol (Foradil, Perforomist).

Symbicort may increase the risk of asthma-related death. It is critical that you use only the prescribed dose of this medicine and follow all patient instructions for safe use. Talk with your doctor about your individual risks and benefits in using Symbicort.

If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before using Symbicort, tell your doctor if you are allergic to budesonide or formoterol, or if you have:

heart disease or high blood pressure;

epilepsy or other seizure disorder;

diabetes;

herpes infection of the eyes;

tuberculosis;

any active infection;

a metabolic disorder (such as low potassium levels in your blood); or

a thyroid disorder.

FDA pregnancy category C. It is not known whether Symbicort is harmful to an unborn baby. Before using this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. Budesonide can pass into breast milk and could harm a nursing baby. Do not use Symbicort without telling your doctor if you are breast-feeding a baby.

Budsesonide can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using Symbicort. Do not give this medication to a child younger than 12 years old.

Long-term use of a steroid medicine may lead to bone loss (osteoporosis). Other factors such as smoking, lack of exercise, poor nutrition, and family history of osteoporosis can increase your risk of bone loss. Talk with your doctor if you have any of these risk factors.

How should I use Symbicort?

Asthma is usually treated with a combination of different drugs. To best treat your condition, use all of your medications as directed by your doctor.

Use Symbicort exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Using too much can make your asthma worse. Follow the directions on your prescription label.

Do not use Symbicort to treat an asthma attack that has already begun. It will not work fast enough. Use only a fast-acting inhalation medicine to treat an asthma attack. Talk with your doctor if any of your asthma medications do not seem to work as well in treating or preventing asthma attacks.

Symbicort comes with patient instructions for safe and effective use. Follow these directions carefully. This device is not to be used with a spacer. Ask your doctor or pharmacist if you have any questions. Always rinse your mouth after using the Symbicort inhaler.

Prime the Symbicort inhaler before the first use by pumping 2 test sprays into the air, away from your face. Shake the inhaler for at least 5 seconds before each spray. Prime the inhaler if it has not been used for longer than 7 days, or if the inhaler has been dropped.

It may take up to 2 weeks of using Symbicort before your symptoms improve. For best results, keep using the medication as directed. Call your doctor if your symptoms do not improve after the first week of treatment, or if your symptoms get worse.

Your dosage needs may change if you have surgery, are ill, are under stress, or have recently had an asthma attack. Do not change your doses or medication schedule without advice from your doctor.

Seek medical attention if you think any of your asthma medications are not working as well as usual. An increased need for medication could be an early sign of a serious asthma attack. If you use a peak flow meter at home, call your doctor if your numbers are lower than normal.

If you also use a steroid medication, do not stop using the steroid suddenly or you may have unpleasant withdrawal symptoms. You may also have withdrawal symptoms if you stop using Symbicort after using it over a long period of time. Talk to your doctor about how to avoid withdrawal symptoms when you stop using any asthma medication.

Carry an ID card or wear a medical alert bracelet stating that you have asthma, in case of an emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you may need to be treated with certain medications during a severe asthma attack.

To be sure Symbicort is not causing harmful effects, your doctor will need to check your progress on a regular basis. Your eyes may also need to be checked for cataracts or glaucoma. Do not miss any scheduled visits to your doctor.

Do not try to clean or take apart the Symbicort inhaler. Throw it away when the medicine runs out. Do not float the medicine canister in water. The dose indicator on the inhaler will turn red when there are 10 doses left in the device. Get your prescription refilled before you run out of medicine completely. Always use the new device provided with the medication when you get your prescription filled.

Store Symbicort at room temperature, away from moisture, light, and heat. Always keep the cover on the Symbicort inhaler when you are not using it. Keep the medicine canister away from open flame or high heat, such as in a car on a hot day. The canister may explode if it gets too hot. Do not puncture or burn an empty inhaler canister.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose can cause redness around your nose, runny nose, trouble breathing, nervousness, muscle cramps, dry mouth, nausea, vomiting, sleep problems (insomnia), tremors, chest pain, fast or pounding heartbeats, fainting, and seizure (convulsions).

What should I avoid while using Symbicort?

Avoid using other long-acting inhaled bronchodilators such as salmeterol (Advair, Serevent) or formoterol (Foradil Aerolizer) while you are using Symbicort.

Using a steroid can lower the blood cells that help your body fight infections. This can make it easier for you to get sick from being around others who are ill. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medicines.

Symbicort side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

worsening asthma symptoms;

chest pain, fast or pounding heartbeats, tremors, nervousness;

wheezing, throat irritation, choking, or other breathing problems after using Symbicort;

signs of infection such as fever, chills, sore throat, flu symptoms, easy bruising or bleeding, unusual weakness;

blurred vision, eye pain, or seeing halos around lights;

white patches or sores in your mouth or throat; or

dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Less serious Symbicort side effects may include:

headache;

back pain;

nausea, vomiting, diarrhea, upset stomach;

back pain, muscle cramps;

sore throat, stuffy nose;

joint or muscle pain; or

changes in your voice.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Symbicort?

Before using Symbicort tell your doctor if you are taking any of the following medicines:

antibiotics such as azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (E-Mycin, E.E.S., Erythrocin, Ery-Tab), or telithromycin (Ketek);

antifungal medications such as ketoconazole (Nizoral), or itraconazole (Sporanox);

an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate);

antidepressants such as amitriptyline (Elavil, Etrafon), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil);

a beta-blocker such as acebutolol (Sectral), atenolol (Tenormin), betaxolol (Betoptic, Kerlone), bisoprolol (Zebeta), carteolol (Cartrol), carvedilol (Coreg), esmolol (Brevibloc), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), penbutolol (Levatol), pindolol (Visken), propranolol (Inderal, InnoPran), sotalol (Betapace), or timolol (Blocadren, Timoptic); or

a diuretic (water pill) such as bumetanide (Bumex), chlorthalidone (Hygroton, Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril), indapamide (Lozol), metolazone (Mykrox, Zarxolyn), torsemide (Demadex).

This list is not complete and there may be other drugs that can interact with Symbicort. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Posted in bronchodilator combinations Tags: , No Comments »

Symbicort

Posted by admin on November 9th, 2009

Symbicort

Generic Name: budesonide and formoterol inhalation (bue DES oh nide and for MOE te rol)

What is Symbicort?

Symbicort conatins a comination of budesonide and formoterol. Budesonide is a steroid that reduces inflammation in the body. Formoterol is a long-acting bronchodilator that relaxes muscles in the airways to improve breathing.

Symbicort is used to prevent bronchospasm in people with asthma or chronic obstructive pulmonary disease (COPD).

Symbicort inhalation may also be used for other purposes not listed in this medication guide.

Important information about Symbicort

Do not use Symbicort to treat an asthma attack that has already begun. It will not work fast enough to reverse your symptoms. Use only a fast-acting inhalation medicine to treat an asthma attack. Symbicort may increase the risk of asthma-related death. It is critical that you use only the prescribed dose of Symbicort and follow all patient instructions for safe use. Talk with your doctor about your individual risks and benefits in using Symbicort.

Asthma is usually treated with a combination of different drugs. To best treat your condition, use all of your medications as directed by your doctor.

Seek medical attention if you think any of your asthma medications are not working as well as usual. An increased need for medication could be an early sign of a serious asthma attack.

What should I discuss with my healthcare provider before using Symbicort?

You should not use Symbicort if you are allergic to budesonide (Entocort, Pulmicort, Rhinocort) or formoterol (Foradil, Perforomist).

Symbicort may increase the risk of asthma-related death. It is critical that you use only the prescribed dose of this medicine and follow all patient instructions for safe use. Talk with your doctor about your individual risks and benefits in using Symbicort.

If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before using Symbicort, tell your doctor if you are allergic to budesonide or formoterol, or if you have:

heart disease or high blood pressure;

epilepsy or other seizure disorder;

diabetes;

herpes infection of the eyes;

tuberculosis;

any active infection;

a metabolic disorder (such as low potassium levels in your blood); or

a thyroid disorder.

FDA pregnancy category C. It is not known whether Symbicort is harmful to an unborn baby. Before using this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. Budesonide can pass into breast milk and could harm a nursing baby. Do not use Symbicort without telling your doctor if you are breast-feeding a baby.

Budsesonide can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using Symbicort. Do not give this medication to a child younger than 12 years old.

Long-term use of a steroid medicine may lead to bone loss (osteoporosis). Other factors such as smoking, lack of exercise, poor nutrition, and family history of osteoporosis can increase your risk of bone loss. Talk with your doctor if you have any of these risk factors.

How should I use Symbicort?

Asthma is usually treated with a combination of different drugs. To best treat your condition, use all of your medications as directed by your doctor.

Use Symbicort exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Using too much can make your asthma worse. Follow the directions on your prescription label.

Do not use Symbicort to treat an asthma attack that has already begun. It will not work fast enough. Use only a fast-acting inhalation medicine to treat an asthma attack. Talk with your doctor if any of your asthma medications do not seem to work as well in treating or preventing asthma attacks.

Symbicort comes with patient instructions for safe and effective use. Follow these directions carefully. This device is not to be used with a spacer. Ask your doctor or pharmacist if you have any questions. Always rinse your mouth after using the Symbicort inhaler.

Prime the Symbicort inhaler before the first use by pumping 2 test sprays into the air, away from your face. Shake the inhaler for at least 5 seconds before each spray. Prime the inhaler if it has not been used for longer than 7 days, or if the inhaler has been dropped.

It may take up to 2 weeks of using Symbicort before your symptoms improve. For best results, keep using the medication as directed. Call your doctor if your symptoms do not improve after the first week of treatment, or if your symptoms get worse.

Your dosage needs may change if you have surgery, are ill, are under stress, or have recently had an asthma attack. Do not change your doses or medication schedule without advice from your doctor.

Seek medical attention if you think any of your asthma medications are not working as well as usual. An increased need for medication could be an early sign of a serious asthma attack. If you use a peak flow meter at home, call your doctor if your numbers are lower than normal.

If you also use a steroid medication, do not stop using the steroid suddenly or you may have unpleasant withdrawal symptoms. You may also have withdrawal symptoms if you stop using Symbicort after using it over a long period of time. Talk to your doctor about how to avoid withdrawal symptoms when you stop using any asthma medication.

Carry an ID card or wear a medical alert bracelet stating that you have asthma, in case of an emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you may need to be treated with certain medications during a severe asthma attack.

To be sure Symbicort is not causing harmful effects, your doctor will need to check your progress on a regular basis. Your eyes may also need to be checked for cataracts or glaucoma. Do not miss any scheduled visits to your doctor.

Do not try to clean or take apart the Symbicort inhaler. Throw it away when the medicine runs out. Do not float the medicine canister in water. The dose indicator on the inhaler will turn red when there are 10 doses left in the device. Get your prescription refilled before you run out of medicine completely. Always use the new device provided with the medication when you get your prescription filled.

Store Symbicort at room temperature, away from moisture, light, and heat. Always keep the cover on the Symbicort inhaler when you are not using it. Keep the medicine canister away from open flame or high heat, such as in a car on a hot day. The canister may explode if it gets too hot. Do not puncture or burn an empty inhaler canister.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose can cause redness around your nose, runny nose, trouble breathing, nervousness, muscle cramps, dry mouth, nausea, vomiting, sleep problems (insomnia), tremors, chest pain, fast or pounding heartbeats, fainting, and seizure (convulsions).

What should I avoid while using Symbicort?

Avoid using other long-acting inhaled bronchodilators such as salmeterol (Advair, Serevent) or formoterol (Foradil Aerolizer) while you are using Symbicort.

Using a steroid can lower the blood cells that help your body fight infections. This can make it easier for you to get sick from being around others who are ill. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medicines.

Symbicort side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

worsening asthma symptoms;

chest pain, fast or pounding heartbeats, tremors, nervousness;

wheezing, throat irritation, choking, or other breathing problems after using Symbicort;

signs of infection such as fever, chills, sore throat, flu symptoms, easy bruising or bleeding, unusual weakness;

blurred vision, eye pain, or seeing halos around lights;

white patches or sores in your mouth or throat; or

dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Less serious Symbicort side effects may include:

headache;

back pain;

nausea, vomiting, diarrhea, upset stomach;

back pain, muscle cramps;

sore throat, stuffy nose;

joint or muscle pain; or

changes in your voice.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Symbicort?

Before using Symbicort tell your doctor if you are taking any of the following medicines:

antibiotics such as azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (E-Mycin, E.E.S., Erythrocin, Ery-Tab), or telithromycin (Ketek);

antifungal medications such as ketoconazole (Nizoral), or itraconazole (Sporanox);

an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate);

antidepressants such as amitriptyline (Elavil, Etrafon), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil);

a beta-blocker such as acebutolol (Sectral), atenolol (Tenormin), betaxolol (Betoptic, Kerlone), bisoprolol (Zebeta), carteolol (Cartrol), carvedilol (Coreg), esmolol (Brevibloc), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), penbutolol (Levatol), pindolol (Visken), propranolol (Inderal, InnoPran), sotalol (Betapace), or timolol (Blocadren, Timoptic); or

a diuretic (water pill) such as bumetanide (Bumex), chlorthalidone (Hygroton, Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril), indapamide (Lozol), metolazone (Mykrox, Zarxolyn), torsemide (Demadex).

This list is not complete and there may be other drugs that can interact with Symbicort. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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DuoNeb

Posted by admin on November 9th, 2009

DuoNeb

Generic Name: albuterol and ipratropium (inhalation) (al BYOO ter ol and ip ra TRO pee um)

What is DuoNeb?

DuoNeb contains a combination of albuterol and ipratropium. Albuterol and ipratropium are bronchodilators that relax muscles in the airways and increase air flow to the lungs.

DuoNeb is used to prevent bronchospasm in people with chronic obstructive pulmonary disease (COPD) who are also using other medicines to control their condition.

DuoNeb may also be used for other purposes not listed in this medication guide.

Important information about DuoNeb

Do not use the DuoNeb if you are allergic to albuterol or ipratropium, or to atropine (Atreza, Sal-Tropine).

Call your doctor right away if you feel that DuoNeb is not working as well as usual, or if it makes your condition worse. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

Before using DuoNeb

Do not use the DuoNeb if you are allergic to albuterol or ipratropium, or to atropine (Atreza, Sal-Tropine).

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use DuoNeb:

heart disease, high blood pressure, or congestive heart failure;

a seizure disorder such as epilepsy;

diabetes;

overactive thyroid;

glaucoma;

enlarged prostate, problems with urination; or

FDA pregnancy category C. It is not known whether DuoNeb is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether albuterol and ipratropium passes into breast milk or if it could harm a nursing baby. Do not use DuoNeb without telling your doctor if you are breast-feeding a baby.

How should I use DuoNeb?

Use DuoNeb exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

DuoNeb may increase the risk of asthma-related death. It is critical that you use only the prescribed dose of this medicine and follow all patient instructions for safe use of the medication. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Take DuoNeb exactly as prescribed by your doctor. Do not change your dose or how often you use this medicine without talking to your doctor. Inhale DuoNeb through your mouth and into your lungs using a machine called a nebulizer.

To use the DuoNeb solution with a nebulizer:

Measure the correct amount of medicine using the dropper provided, or use the proper number of ampules. Place the liquid into the medication chamber of the nebulizer. If using a medicine dropper, do not allow the dropper to touch any surface including your hands or the nebulizer.

Attach the mouthpiece or face mask to the drug chamber. Then, attach the drug chamber to the compressor. Sit upright in a comfortable position. Place the mouthpiece into your mouth or put the face mask on, covering your nose and mouth. Breathe in slowly and evenly until you have inhaled all of the medicine (usually 5 to 15 minutes). The treatment is complete when no more mist is formed by the nebulizer and the drug chamber is empty.

Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

Call your doctor right away if you feel that DuoNeb is not working as well as usual, or if it makes your condition worse. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

To be sure DuoNeb is helping your condition, your lung function will need to be tested on a regular basis. It is important that you not miss any scheduled visits to your doctor.

It is important to use this medication regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. Keep using all of your other medications as prescribed by your doctor.

Store DuoNeb at room temperature away from moisture and heat.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of DuoNeb can be fatal. Overdose symptoms may include chest pain or heavy feeling, rapid or uneven heart rate, pain spreading to the arm or shoulder, nausea, sweating, weakness, or general ill feeling.

What should I avoid while using DuoNeb?

Avoid getting this medication in your eyes. If this does happen, rinse the eyes with water and seek medical attention.

DuoNeb side effects

Stop using this medication and get emergency medical help if you have any of these signs of an allergic reaction to DuoNeb: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using DuoNeb and call your doctor at once if you have any of these serious side effects:

bronchospasm (wheezing, chest tightness, trouble breathing), especially after starting a new canister of this medicine;

chest pain and fast, pounding, or uneven heart beats;

swelling of your ankles or feet;

pain or burning with urination; or

increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure).

Less serious DuoNeb side effects may include:

headache, dizziness, nervousness;

drowsiness or sleep problems (insomnia);

cough, hoarseness, sore throat, runny or stuffy nose;

dry mouth, unusual taste in your mouth;

tremors, numbness or tingly feeling;

nausea, vomiting, upset stomach, diarrhea, constipation; or

blurred vision.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect DuoNeb?

Tell your doctor about all other medications you use, especially:

atropine (Donnatal, and others);

belladonna;

clidinium (Quarzan);

dicyclomine (Bentyl);

glycopyrrolate (Robinul);

hyoscyamine (Anaspaz, Cystospaz, Levsin, and others);

mepenzolate (Cantil);

methantheline (Provocholine);

methscopolamine (Pamine), scopolamine (Transderm-Scop);

propantheline (Pro-Banthine);

a diuretic (water pill);

a stimulant, ADHD medication, diet pills, or over-the-counter cold or allergy medicines; or

an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

This list is not complete and there may be other drugs that can interact with DuoNeb. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Posted in bronchodilator combinations Tags: , No Comments »

DuoNeb

Posted by admin on November 9th, 2009

DuoNeb

Generic Name: albuterol and ipratropium (inhalation) (al BYOO ter ol and ip ra TRO pee um)

What is DuoNeb?

DuoNeb contains a combination of albuterol and ipratropium. Albuterol and ipratropium are bronchodilators that relax muscles in the airways and increase air flow to the lungs.

DuoNeb is used to prevent bronchospasm in people with chronic obstructive pulmonary disease (COPD) who are also using other medicines to control their condition.

DuoNeb may also be used for other purposes not listed in this medication guide.

Important information about DuoNeb

Do not use the DuoNeb if you are allergic to albuterol or ipratropium, or to atropine (Atreza, Sal-Tropine).

Call your doctor right away if you feel that DuoNeb is not working as well as usual, or if it makes your condition worse. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

Before using DuoNeb

Do not use the DuoNeb if you are allergic to albuterol or ipratropium, or to atropine (Atreza, Sal-Tropine).

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use DuoNeb:

heart disease, high blood pressure, or congestive heart failure;

a seizure disorder such as epilepsy;

diabetes;

overactive thyroid;

glaucoma;

enlarged prostate, problems with urination; or

FDA pregnancy category C. It is not known whether DuoNeb is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether albuterol and ipratropium passes into breast milk or if it could harm a nursing baby. Do not use DuoNeb without telling your doctor if you are breast-feeding a baby.

How should I use DuoNeb?

Use DuoNeb exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

DuoNeb may increase the risk of asthma-related death. It is critical that you use only the prescribed dose of this medicine and follow all patient instructions for safe use of the medication. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Take DuoNeb exactly as prescribed by your doctor. Do not change your dose or how often you use this medicine without talking to your doctor. Inhale DuoNeb through your mouth and into your lungs using a machine called a nebulizer.

To use the DuoNeb solution with a nebulizer:

Measure the correct amount of medicine using the dropper provided, or use the proper number of ampules. Place the liquid into the medication chamber of the nebulizer. If using a medicine dropper, do not allow the dropper to touch any surface including your hands or the nebulizer.

Attach the mouthpiece or face mask to the drug chamber. Then, attach the drug chamber to the compressor. Sit upright in a comfortable position. Place the mouthpiece into your mouth or put the face mask on, covering your nose and mouth. Breathe in slowly and evenly until you have inhaled all of the medicine (usually 5 to 15 minutes). The treatment is complete when no more mist is formed by the nebulizer and the drug chamber is empty.

Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

Call your doctor right away if you feel that DuoNeb is not working as well as usual, or if it makes your condition worse. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

To be sure DuoNeb is helping your condition, your lung function will need to be tested on a regular basis. It is important that you not miss any scheduled visits to your doctor.

It is important to use this medication regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. Keep using all of your other medications as prescribed by your doctor.

Store DuoNeb at room temperature away from moisture and heat.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of DuoNeb can be fatal. Overdose symptoms may include chest pain or heavy feeling, rapid or uneven heart rate, pain spreading to the arm or shoulder, nausea, sweating, weakness, or general ill feeling.

What should I avoid while using DuoNeb?

Avoid getting this medication in your eyes. If this does happen, rinse the eyes with water and seek medical attention.

DuoNeb side effects

Stop using this medication and get emergency medical help if you have any of these signs of an allergic reaction to DuoNeb: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using DuoNeb and call your doctor at once if you have any of these serious side effects:

bronchospasm (wheezing, chest tightness, trouble breathing), especially after starting a new canister of this medicine;

chest pain and fast, pounding, or uneven heart beats;

swelling of your ankles or feet;

pain or burning with urination; or

increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure).

Less serious DuoNeb side effects may include:

headache, dizziness, nervousness;

drowsiness or sleep problems (insomnia);

cough, hoarseness, sore throat, runny or stuffy nose;

dry mouth, unusual taste in your mouth;

tremors, numbness or tingly feeling;

nausea, vomiting, upset stomach, diarrhea, constipation; or

blurred vision.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect DuoNeb?

Tell your doctor about all other medications you use, especially:

atropine (Donnatal, and others);

belladonna;

clidinium (Quarzan);

dicyclomine (Bentyl);

glycopyrrolate (Robinul);

hyoscyamine (Anaspaz, Cystospaz, Levsin, and others);

mepenzolate (Cantil);

methantheline (Provocholine);

methscopolamine (Pamine), scopolamine (Transderm-Scop);

propantheline (Pro-Banthine);

a diuretic (water pill);

a stimulant, ADHD medication, diet pills, or over-the-counter cold or allergy medicines; or

an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

This list is not complete and there may be other drugs that can interact with DuoNeb. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Posted in bronchodilator combinations Tags: , No Comments »
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