7 Nebulizer Uses + Side Effects, Precautions & Reviews

How Effective Are Mucolytics in Treating COPD?

7 Nebulizer Uses + Side Effects, Precautions & Reviews

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Mucolytics are a class of drugs used to help break up and thin mucus, making it easier to clear from the airways.

They are used to treat respiratory conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, and other conditions including common colds marked by excess mucus and a productive cough.

 Types of mucoactive agents include expectorants, mucolytics, mucoregulators, and mucokinetics, and they are often taken orally or breathed in via a nebulizer. Mucolytics work best if taken consistently.

Overproduction of mucus in the lungs—usually seen with COPD or sometimes with a lower respiratory infection—is caused by inflammation that results in an increase in both the number and size of so-called goblet cells that line the air passages. While goblet cells normally secrete mucus as a form of protection, with COPD, for example, the excessive production can clog the passages, making it harder to breathe.

One way of clearing this buildup is with an oral or nebulized drug called a mucolytic. Mucolytics work by dissolving the chemical bonds within the secretions, breaking them so they can be more readily coughed up.

Your doctor may prescribe or recommend that you use a mucolytic if thick mucus is a substantial contributor to your symptoms. Generally, you would take only one mucolytic and they are usually used short term, but some people need to take a mucolytic repeatedly if the condition recurs.

While mucolytics are not considered part of the current standard of care for COPD treatment, the 2017 guidelines issued by the Global Initiative for Obstructive Lung Disease (GOLD) suggest that the drugs may be useful in people who can't take inhaled corticosteroids. They may also be helpful for those who have difficulty with handheld inhalers.

Given the concerns about the safety of long-term corticosteroid use, there have been suggestions that mucolytics may be appropriate in advanced COPD, wherein the risk of exacerbation is high irrespective of steroid use. Mucolytics may, in these cases, help reduce the number of exacerbations and offer some improvement in the quality of life.

Mucolytics can be taken orally in a tablet or syrup formulation, or inhaled through a nebulizer. Some of the more common types of mucolytics include:

  • Mucinex (guaifenesin)
  • Carbocisteine
  • Pulmozyme (dornase alfa)
  • Erdosteine
  • Mecysteine
  • Bromhexine
  • Hyperosmolar saline
  • Mannitol powder

The various types of mucolytic agents each have a different action:

  • Expectorants increase airway water to help with mucus clearing.
  • Mucoregulators increase the movement of mucus via cough.
  • Mucokinetics suppress the mechanisms causing excess mucus secretions.

Carbocisteine, for example, is a mucolytic that acts on the metabolism of the goblet cells and also offers antioxidant and anti-inflammatory benefits. Guaifenesin, by contrast, increases the water content of the mucus, thinning it out so that it can be coughed up.

Your doctor would determine which mucolytic you take your symptoms and the other medication you take.

Most mucolytics are very safe, but should not be used in children under 6. Do not take mucolytics if you have a stomach ulcer.

Consult your doctor or pharmacist before taking mucolytics if you are pregnant or breastfeeding.

Dosage of mucolytics depends on the type of drug you're taking and the condition you're taking it for, in addition to whether you're taking a pill, liquid, or using a nebulizer. As some mucolytics don't stay in the system very long, you may need to take them consistently for a period of time.

Talk to your doctor about the proper dosage, delivery method, and duration for your condition.

The side effects can also vary both by drug type and formulation. Broadly speaking, nausea and diarrhea are the most common side effects associated with tablets, while liquids may also cause bronchial spasms and rashes. Nebulized formulations can similarly cause a sore throat, runny nose, and the formation of white patches in the mouth or lips.

By and large, mucolytics are considered safe and associated with a low risk of adverse events. With that being said, it's always important to speak with your doctor about any side effects, interactions, or contraindications associated with a mucolytic product, whether prescribed or purchased over the counter. 

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Aaron SD. Mucolytics for COPD: negotiating a slippery slope towards proof of efficacy. Eur Respir J. 2017;50(4) doi:10.1183/13993003.01465-2017

  2. Singanayagam A, Glanville N, Girkin JL, et al. Corticosteroid suppression of antiviral immunity increases bacterial loads and mucus production in COPD exacerbations. Nat Commun. 2018;9(1):2229. doi:10.1038/s41467-018-04574-1

  3. Global Initiative for Chronic Obstructive Lung Disease. Pocket guide to COPD diagnosis, management, and prevention: a guide for health care professionals (2017 report). 2017

  4. Ko FW, Chan KP, Hui DS, et al. Acute exacerbation of COPD. Respirology. 2016;21(7):1152-65. doi:10.1111/resp.12780

  5. Decramer M, Dekhuijzen PN, Troosters T, et al. The bronchitis randomized on NAC cost-utility study (BRONCUS): hypothesis and design. BRONCUS-trial committee. Eur Respir J. 2001;17(3):329-36. doi:10.1183/09031936.01.17303290

  6. Zeng Z, Yang D, Huang X, Xiao Z. Effect of carbocisteine on patients with COPD: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2017;12:2277–2283. doi:10.2147/COPD.S140603

  7. Albrecht HH, Dicpinigaitis PV, Guenin EP. Role of guaifenesin in the management of chronic bronchitis and upper respiratory tract infections. Multidiscip Respir Med. 2017;12:31. doi:10.1186/s40248-017-0113-4

  8. Yoon H, Lee DH. Mucolytics as adjuvant agent to improve helicobacter pylori eradication rate: still long and winding road to positive results. Gut Liver. 2015;9(3):257–258. doi:10.5009/gnl15117

Additional Reading

  • Poole PJ, Black PN. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2003;(2):CD001287. doi:10.1002/14651858.CD001287

Source: https://www.verywellhealth.com/mucolytics-definition-and-example-copd-914793

Ipratropium Bromide 250 micrograms/1ml Nebuliser Solution

7 Nebulizer Uses + Side Effects, Precautions & Reviews

This information is intended for use by health professionals

Ipratropium Bromide 250 micrograms/1ml Nebuliser Solution

Ipratropium Bromide 500 micrograms/2ml Nebuliser Solution.

Each ampoule contains ipratropium bromide at 250 micrograms/1ml i.e. 250 micrograms in 1ml and 500 micrograms in 2ml.

For a full list of excipients, see section 6.1.

Nebuliser Solution.

A clear, colourless solution.

Ipratropium bromide is indicated for the treatment of reversible bronchospasm associated with chronic obstructive pulmonary disease (COPD).

Ipratropium bromide is indicated, when used concomitantly with inhaled beta2-agonists, for treatment of reversible airways obstruction as in acute and chronic asthma.

This medicinal product is for inhalation use only.

The dosage should be adapted to the individual needs of the patient. In children aged 12 years and under, only Ipratropium Bromide Nebuliser Solution 1 ml should be used. The following doses are recommended:

Adults (including the elderly) and children over 12 years of age:

250 – 500 micrograms (i.e. one vial of 250 micrograms in 1 ml or one vial of 500 micrograms in 2ml) 3 to 4 times daily. The exact starting dose may vary depending on local guidelines.

For treatment of acute bronchospasm, 500 micrograms.

Repeated doses can be administered until the patient is stable. The time interval between the doses may be determined by the physician.

It is advisable not to exceed the recommended daily dose during either acute or maintenance treatment. Daily doses exceeding 2 mg in adults and children over 12 years of age should only be given under medical supervision.

Children 6 – 12 years of age:

250 micrograms (i.e. one vial of 250 micrograms in 1ml) up to a total daily dose of 1mg (4 vials).

The time interval between doses may be determined by the physician.

Children 0 – 5 years of age (for treatment of acute asthma only):

125 – 250 micrograms (i.e. half to one vial of 250 micrograms in 1ml) up to a total daily dose of 1 mg (4 vials).

Ipratropium bromide should be administered no more frequently than 6 hourly in children under 5 years of age.

For acute bronchospasm, repeated doses may be administered until the patient is stable.

If therapy does not produce a significant improvement or if the patient's condition gets worse, medical advice must be sought. In the case of acute or rapidly worsening dyspnoea (difficulty in breathing) a doctor should be consulted immediately.

Ipratropium bromide may be combined with a short-acting beta2-agonist in the same nebuliser chamber, for simultaneous administration where co-administration is required, in line with local prescribing guidelines. The solution should be used as soon as possible after mixing and any unused solution should be discarded.

Ipratropium bromide can be administered using a range of commercially available nebulising devices. The dose of nebuliser solution may need to be diluted according to local prescribing guidelines and in order to obtain a final volume suitable for the particular nebuliser being used (usually 2 – 4 ml); if dilution is necessary use only sterile sodium chloride 0.9% solution.

Known hypersensitivity to atropine or ipratropium bromide.

Use of the nebuliser solution should be subject to close medical supervision during initial dosing.

Caution is advocated in the use of anticholinergic agents in patients with narrow-angle glaucoma, or with prostatic hyperplasia or bladder-outflow obstruction.

As patients with cystic fibrosis may be prone to gastro-intestinal motility disturbances, ipratropium bromide, as with other anticholinergics, should be used with caution in these patients.

Immediate hypersensitivity reactions following the use of ipratropium bromide have been demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, oropharyngeal oedema and anaphylaxis.

There have been isolated reports of ocular complications (i.e. mydriasis, increased intra-ocular pressure, narrow-angle glaucoma, eye pain) when aerosolised ipratropium bromide, either alone or in combination with an adrenergic beta2-agonist, has come into contact with the eyes during nebuliser therapy.

Eye pain or discomfort, blurred vision, visual halos or coloured images in association with red eyes from conjunctival congestion and corneal oedema may be signs of acute narrow-angle glaucoma. Should any combination of these symptoms develop, treatment with miotic drops should be initiated and specialist advice sought immediately.

Patients must be instructed in the correct administration of ipratropium bromide. Care must be taken not to allow the solution or mist to enter the eyes.

It is recommended that the nebulised solution is administered via a mouthpiece. If this is not available and a nebuliser mask is used, it must fit properly.

Patients who may be predisposed to glaucoma should be warned specifically to protect their eyes.

There is evidence that the administration of ipratropium bromide with beta-adrenergic drugs and xanthine preparations may produce an additive bronchodilatory effect.

The risk of acute glaucoma in patients with a history of narrow-angle glaucoma (see Special Warnings and Precautions for Use) may be increased when nebulised ipratropium bromide and beta2-agonists are administered simultaneously.

The safety of ipratropium bromide during human pregnancy has not been established.

The benefits of using ipratropium bromide during a confirmed or suspected pregnancy must be weighed against the possible hazards to the unborn child.

Preclinical studies have shown no embryotoxic or teratogenic effects following inhalation or intranasal application at doses considerably higher than those recommended in man.

It is not known whether ipratropium bromide is excreted into breast milk. It is unly that ipratropium bromide would reach the infant to an important extent, however caution should be exercised when ipratropium bromide is administered to nursing mothers.

The most common non-respiratory adverse reactions reported in clinical trials are headache, nausea (with or without vomiting) and dryness of the mouth.

Common (>1/100, 1/1000, 1/10,000,

Source: https://www.medicines.org.uk/emc/product/3213/smpc

Sodium chloride (inhalation) Uses, Side Effects & Warnings – Drugs.com

7 Nebulizer Uses + Side Effects, Precautions & Reviews

Generic Name: sodium chloride (inhalation) (SOE dee um KLOR ide)
Brand Name:Hyper-Sal, NebuSal, Sodium Chloride, Inhalation

Medically reviewed by Drugs.com on Nov 25, 2019 – Written by Cerner Multum

What is sodium chloride inhalation?

Sodium chloride is the chemical name for salt. Sodium chloride can reduce some types of bacteria in certain body secretions, such as saliva.

Sodium chloride inhalation is used to produce sputum (mucus, or phlegm) from the mouth to help improve lung function in people with cystic fibrosis, or to collect sputum for medical testing. This medication may also be used to dilute other medications inhaled through a nebulizer.

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

Before you use sodium chloride, tell your doctor about all your medical conditions and allergies. Also make sure your doctor knows if you are pregnant or breast-feeding. In some cases, you may not be able to use sodium chloride, or you may need to adjust your dose or take special precautions.

Tell your doctor about all other medications you use, especially potassium supplements, diuretics, steroids, blood pressure medications, or medications that contain sodium (such as Alka-Seltzer or Zegrid).

Tell your caregiver right away if you have chest pain, trouble breathing, swelling in your hands or feet, tiredness, muscle twitching, confusion, uneven heart rate, extreme thirst, increased or decreased urination, leg discomfort, muscle weakness or limp feeling, or if you feel you might pass out.

You should not use this medication if you have ever had an allergic reaction to sodium chloride.

To make sure sodium chloride is safe for you, tell your doctor if you have:

FDA pregnancy category C. It is not known whether sodium chloride inhalation 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 sodium chloride passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Sodium chloride inhalation is given using a nebulizer. You will inhale the medication through a face mask, mouth piece, or other device connected to the nebulizer.

Your doctor, nurse, or other healthcare provider can show you how to properly use the nebulizer.

Sodium chloride is a liquid that is placed into the medication chamber of the nebulizer. A mouthpiece or face mask is then attached to the drug chamber, along with an air compressor.

To prepare for inhaling sodium chloride through a nebulizer, you may be given another inhaled medication to prevent bronchospasm (muscle contractions within the airways of the lungs). Your doctor may also ask you to blow your nose, rinse your mouth with water, or wipe the inside of your mouth with a tissue. Follow your doctor's instructions carefully for best results.

In most cases, you will use this medication while you are sitting upright in a comfortable position. Breathe slowly and evenly while you are using the mask, mouthpiece, or other breathing device. You may also be given a nose clip to wear that will close your nasal passages so that you inhale only through your mouth.

If you are using this medication as part of a sputum test, you will need to spit about every 5 minutes or as directed by your healthcare provider. Cough deeply from your chest to produce an optimal specimen for testing.

Continue breathing through the nebulizer for as long as directed by your doctor. Once you have completed the inhalation for the prescribed amount of time, throw away any liquid that is left in the medicine chamber. Do not save it for later use.

If you store sodium chloride at home, keep it at room temperature away from moisture and heat.

Since sodium chloride inhalation is sometimes used only as needed, you may not be on a dosing schedule. If you are using the medication regularly, use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Tell your caregiver right away if you have:

  • chest pain, trouble breathing;
  • a light-headed feeling, you might pass out;
  • swelling in your hands or feet;
  • tiredness, muscle twitching;
  • confusion, uneven heart rate, extreme thirst, increased or decreased urination, leg discomfort, muscle weakness or limp feeling.

Other common side effects may include a salty taste or slight burning or irritation in your mouth.

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.

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with sodium chloride, especially:

This list is not complete. Other drugs may interact with sodium chloride, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Remember, keep this and all other medicines the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 2.02.

Medical Disclaimer

Source: https://www.drugs.com/mtm/sodium-chloride-inhalation.html

Duoneb (Ipratropium Bromide and Albuterol Sulfate): Uses, Dosage, Side Effects, Interactions, Warning

7 Nebulizer Uses + Side Effects, Precautions & Reviews

DuoNeb®
(ipratropium bromide 0.5 mg/albuterol sulfate 3.0 mg*) Inhalation Solution

*Equivalent to 2.5 mg albuterol base

Patient's Instructions for Use

Read this patient information completely every time your prescription is filled as information may have changed. Keep these instructions with your medication as you may want to read them again.

DuoNeb (ipratropium bromide and albuterol sulfate) should only be used under the direction of a physician. Your physician and pharmacist have more information about DuoNeb (ipratropium bromide and albuterol sulfate) and the condition for which it has been prescribed. Contact them if you have additional questions.

Storing your Medicine

Store DuoNeb (ipratropium bromide and albuterol sulfate) between 2°C and 25°C (36°F and 77°F). Vials should be protected from light before use, therefore, keep unused vials in the foil pouch or carton. Do not use after the expiration (EXP) date printed on the carton.

Dose

DuoNeb (ipratropium bromide and albuterol sulfate) is supplied as a single-dose, ready-to-use vial containing 3 mL of solution. No mixing or dilution is needed. Use one new vial for each nebulizer treatment.

FOLLOW THESE DIRECTIONS FOR USE OF YOUR NEBULIZER/COMPRESSOR OR THE DIRECTIONS GIVEN BY YOUR HEALTHCARE PROVIDER. A TYPICAL EXAMPLE IS SHOWN BELOW.

Instructions for Use

1. Remove one vial from the foil pouch. Place remaining vials back into pouch for storage.

2. Twist the cap completely off the vial and squeeze the contents into the nebulizer reservoir (Figure 1).

Figure 1

3. Connect the nebulizer to the mouthpiece or face mask (Figure 2).

Figure 2

4. Connect the nebulizer to the compressor.

5. Sit in a comfortable, upright position; place the mouthpiece in your mouth (Figure 3) or put on the face mask (Figure 4); and turn on the compressor.

Figure 3

Figure 4

6. Breathe as calmly, deeply and evenly as possible through your mouth until no more mist is formed in the nebulizer chamber (about 5-15 minutes). At this point, the treatment is finished.

7. Clean the nebulizer (see manufacturer's instructions).

DuoNeb®
(DOO-o-neb) (Ipratropium Bromide 0.5 mg/Albuterol Sulfate 3.0 mg*) Inhalation Solution

*Equivalent to 2.5 mg albuterol base

Read the patient information that comes with DuoNeb® (ipratropium bromide and albuterol sulfate) before you start using it and each time you get a refill. There may be new information. This leaflet does not take the place of talking with your doctor about your medical condition or your treatment.

What is DuoNeb® (ipratropium bromide and albuterol sulfate) ?

DuoNeb® (ipratropium bromide and albuterol sulfate) is a combination of two medicines called bronchodilators. DuoNeb® (ipratropium bromide and albuterol sulfate) contains albuterol sulfate, which is a beta-adrenergic agonist, and ipratropium bromide, which is an anticholinergic.

These two medicines work together to help open the airways in your lungs.

DuoNeb® (ipratropium bromide and albuterol sulfate) is used to help treat airway narrowing (bronchospasm) that happens with chronic obstructive pulmonary disease (COPD) in adult patients who need to use more than one bronchodilator medicine.

Who should not use DuoNeb® (ipratropium bromide and albuterol sulfate) ?

Do not use DuoNeb® (ipratropium bromide and albuterol sulfate) if you: Are allergic to any of the ingredients in DuoNeb (ipratropium bromide and albuterol sulfate) or to atropine. The active ingredients are albuterol sulfate and ipratropium bromide. See the end of this leaflet for a complete list of ingredients in DuoNeb® (ipratropium bromide and albuterol sulfate) .

DuoNeb® (ipratropium bromide and albuterol sulfate) has not been studied in patients younger than 18 years of age.

What should I tell my doctor before I start using DuoNeb® (ipratropium bromide and albuterol sulfate) ?

Tell your doctor about all of your conditions, including if you:

  • Have heart problems. This includes coronary artery disease and heart rhythm problems.
  • Have high blood pressure
  • Have diabetes
  • Have or had seizures
  • Have a thyroid problem called hyperthyroidism
  • Have an eye problem called narrow-angle glaucoma
  • Have liver or kidney problems
  • Have problems urinating due to bladder-neck blockage or an enlarged prostate (men)
  • Are pregnant or planning to become pregnant. It is not known if DuoNeb® (ipratropium bromide and albuterol sulfate) can harm your unborn baby. You and your doctor will have to decide if DuoNeb® (ipratropium bromide and albuterol sulfate) is right for you during a pregnancy.
  • Are breastfeeding. It is not known if DuoNeb® (ipratropium bromide and albuterol sulfate) passes into your milk or if it can harm your baby. You and your doctor should decide whether you should take DuoNeb® (ipratropium bromide and albuterol sulfate) or breastfeed, but not both.

Tell your doctor about all the medicines you take including prescription and nonprescription medicines, vitamins and herbal supplements. DuoNeb® (ipratropium bromide and albuterol sulfate) and other medicines can interact. This may cause serious side effects. Especially tell your doctor if you take:

  • Other medicines that contain anticholinergics such as ipratropium bromide. This also includes medicines used for Parkinson's disease.
  • Other medicines that contain beta-agonists such as albuterol sulfate. These are usually used to treat airway narrowing (bronchospasm).
  • Medicines called beta-blockers. These are usually used for high blood pressure or heart problems.
  • Medicines called “water pills” (diuretics)
  • Medicines for depression called monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants.

Ask your doctor or pharmacist if you are not sure if you take any of these types of medicines. Know the medicines you take. Keep a list of them and show it to your doctor and pharmacists when you get a new medicine.

How should I use DuoNeb® (ipratropium bromide and albuterol sulfate) ?

  • Read the Patient's Instructions for Use that you get with your prescription. Talk to your doctor or pharmacist if you have any questions.
  • Take DuoNeb® (ipratropium bromide and albuterol sulfate) exactly as prescribed by your doctor. Do not change your dose or how often you use DuoNeb® (ipratropium bromide and albuterol sulfate) without talking to your doctor. Inhale DuoNeb® (ipratropium bromide and albuterol sulfate) through your mouth and into your lungs using a machine called a nebulizer.
  • DuoNeb® (ipratropium bromide and albuterol sulfate) may help to open your airways for up to 5 hours after taking this medicine. If DuoNeb® (ipratropium bromide and albuterol sulfate) does not help your airway narrowing (bronchospasm) or your bronchospasm gets worse, call your doctor right away or get emergency help if needed.

What should I avoid while using DuoNeb® (ipratropium bromide and albuterol sulfate) ?

Do not get DuoNeb® (ipratropium bromide and albuterol sulfate) in your eyes. Be careful not to spray DuoNeb® (ipratropium bromide and albuterol sulfate) in your eyes while you are using your nebulizer. DuoNeb® (ipratropium bromide and albuterol sulfate) can cause the following short-term eye problems:

  • Enlarged pupils
  • Blurry vision
  • Eye pain

DuoNeb® (ipratropium bromide and albuterol sulfate) can cause a serious eye problem called narrow-angle glaucoma or worsen the narrow-angle glaucoma you already have.

What are the possible side effects with DuoNeb® (ipratropium bromide and albuterol sulfate) ?

DuoNeb® (ipratropium bromide and albuterol sulfate) may cause the following serious side effects:

  • Worsening of the narrowing in your airways (bronchospasm). This side effect can be life-threatening and has happened with both of the medicines that are in DuoNeb® (ipratropium bromide and albuterol sulfate) . Stop DuoNeb® (ipratropium bromide and albuterol sulfate) and call your doctor right away or get emergency help if your breathing problems get worse while or after using DuoNeb® (ipratropium bromide and albuterol sulfate) .
  • Serious and life-threatening allergic reactions. Symptoms of a serious allergic reaction include:

The most common side effects with DuoNeb® (ipratropium bromide and albuterol sulfate) include lung disease, sore throat, chest pain, constipation, diarrhea, bronchitis, urinary tract infection, leg cramps, nausea, upset stomach, voice changes, and pain.

These are not all the side effects with DuoNeb® (ipratropium bromide and albuterol sulfate) . For a complete list, ask your doctor or pharmacist.

How should I store DuoNeb® (ipratropium bromide and albuterol sulfate) ?

  • Store DuoNeb® (ipratropium bromide and albuterol sulfate) between 36° and 77°F (2° and 25°C). Protect from light. Keep the unused vials in the foil pouch or carton.
  • Safely discard DuoNeb® (ipratropium bromide and albuterol sulfate) that is out-of-date or no longer needed.
  • Keep DuoNeb® (ipratropium bromide and albuterol sulfate) and all medicines the reach of children.

General advice about DuoNeb® (ipratropium bromide and albuterol sulfate)

Medicines are sometimes prescribed for conditions that are not mentioned in the patient information leaflets. Do not use DuoNeb® (ipratropium bromide and albuterol sulfate) for a condition for which it was not prescribed. Do not give DuoNeb® (ipratropium bromide and albuterol sulfate) to other people, even if they have the same symptoms you have. It may harm them.

This leaflet summarizes the most important information about DuoNeb® (ipratropium bromide and albuterol sulfate) . If you would more information, talk with your doctor.

You can ask your doctor or pharmacist for information about DuoNeb® (ipratropium bromide and albuterol sulfate) that is written for healthcare professionals.

You can also call the company that makes DuoNeb® (ipratropium bromide and albuterol sulfate) toll free at 1-800-755-5560 or visit their website at www.dey.com.

What are the ingredients in DuoNeb®?

Active Ingredients: ipratropium bromide and albuterol sulfate

Inactive Ingredients: sodium chloride, hydrochloric acid, and edetate sodium, USP.

Source: https://www.rxlist.com/duoneb-drug.htm

Drugs & Medications

7 Nebulizer Uses + Side Effects, Precautions & Reviews

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

ipratropium 0.5 mg-albuterol 3 mg (2.5 mg base)/3 mL nebulization soln

color colorless shape No data. imprint No data.

Source: https://www.webmd.com/drugs/2/drug-6291-4304/ipratropium-albuterol-inhalation/ipratropium-albuterol-salbutamol-solution-inhalation/details

Inhaled corticosteroids: managing side effects

7 Nebulizer Uses + Side Effects, Precautions & Reviews

Source: Prof. P Motta / Dept of Anatomy / University

Inhaled corticosteroids (ICSs) are indicated in the management of asthma and chronic obstructive pulmonary disease (COPD), which affects the alveoli and pulmonary blood vessels

In this article you will learn:

  • The side effects associated with high-dose inhaled corticosteroids
  • Which patients require an inhaled corticosteroid card
  • Advice for patients starting inhaled corticosteroid therapy

Inhaled corticosteroids (ICSs) are indicated in the management of most patients with asthma and some patients with chronic obstructive pulmonary disease (COPD)[1],[2].  NHS data for 2013–2014 suggests that, in England, of the 242 million ICS-containing inhalers dispensed at a cost of almost £355m, 39% were for high-dose inhalers.

A high dose of ICS is defined as ≥1,000mcg beclometasone dipropionate (BDP) equivalent per day.

Fluticasone propionate, mometasone and the newer ultrafine particle BDP hydrofluoroalkane (HFA) inhalers (i.e. QVAR and Fostair) are considered twice as potent as standard BDP inhalers.

However, dose equivalents are approximate, and the dose delivered will depend on other factors such as inhaler technique.

The British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) and Global Initiative for Asthma (GINA) guidelines recommend the use of ICSs to reduce symptoms, improve lung function, reduce the frequency of severe exacerbations, including hospital and ICU admissions, and decrease the risk of mortality[3]. For more information, see ‘Asthma: management’ in Clinical Pharmacist (November 2014), available at www.pharmaceutical-journal.com.

Patients with asthma who do not use an ICS regularly have poorer outcomes. A national review of asthma deaths in the UK in 2014 found that patients with asthma who did not use an ICS were at significantly greater risk of death[4].

In contrast, the place of an ICS in COPD is more uncertain. A Cochrane review[5] did not find a clinically meaningful benefit of ICS use in terms of preventing exacerbations, improving lung function or health-related quality of life in patients with stable COPD.

A clinical review of the risk-to-benefit ratio of ICSs in patients with COPD[6]  concluded that their use (particularly at high dose) in a typically older cohort, frequently with co-morbidities, put COPD patients at increased risk of ICS-associated side-effects.

A further Cochrane review in 2012 warned that their use should be ‘weighed up against their significant side-effect profile’[7].

The reason for this difference in efficacy may be related to the mechanism of action of ICS. In asthma, inflammation is primarily caused by eosinophils, while in stable COPD neutrophils are predominant[8]. Corticosteroids are more effective in reducing eosinophilic inflammation, which may explain this difference in clinical response.

Initiation

Patients who require prolonged high-dose ICS are at risk of systemic side effects, particularly immunosuppression and adrenal suppression, and should be issued with a corticosteroid treatment card[9] (see ‘Doses of ICS that require a corticosteroid card in adults’). An ICS-specific card for patients, alongside guidance on counselling points for health professionals, has been developed by the London Respiratory Network and is available to download at www.pharmaceutical-journal.com.

Patients who are using high-dose ICS should be advised to inform the healthcare team responsible for their treatment if they fall ill for any reason, as this may affect the dose required.

In addition, they should see a GP if they have symptoms that could be related to ICS treatment (e.g.

worsening fatigue, muscle weakness, loss of appetite, unintentional weight loss, dizziness, unexplained nausea, vomiting and diarrhoea).

All patients taking ICS who have never had chickenpox should be advised to avoid people with chickenpox or shingles, and to see a doctor if they come in contact with someone with either illness and then feel unwell.

Inhaled corticosteroids do not usually interact with other medicines. However, they are metabolised by the cytochrome P450 isoenzyme CYP3A4, and some medicines (e.g. telaprevir, ritonavir and itraconazole) may increase plasma concentrations of inhaled budesonide and fluticasone, which increases the patient’s risk of adrenal suppression.

Patients who smoke may require higher doses of ICS compared with non-smokers for the same therapeutic effect[10]. It is therefore important that all smokers using an ICS should be offered help to stop smoking, as this may reduce the dose required by the patient and minimise the risk of side effects.

Treatment with high-dose ICS can result in clinically significant suppression of endogenous cortisol. A systematic review and meta-analysis of 13 studies[11] evaluated the effect of several inhaled and oral corticosteroids in patients’ 8am cortisol level and established similar suppression rates between inhaled fluticasone propionate and oral prednisolone.

The analysis suggested 1,000mcg of inhaled fluticasone propionate was approximately equivalent to 10mg oral prednisolone and at this dose, half of the patients were sufficiently suppressed to be unable to mount the necessary adrenal response to stress. Therefore all patients taking an oral corticosteroid for more than three weeks or ‘prolonged high dose inhaled steroids’ should have the dose tapered gradually.

*Fluticasone furoate 92mcg once daily is approximately equivalent to fluticasone propionate 250mcg twice daily. This could be interpreted as being equivalent to 1,000mcg of beclomethasone dipropionate, but caution is advised as direct comparator studies have not been published.

  • Dosage equivalents are approximate and dose delivered will depend on other factors such as inhaler technique
  • Encourage patients to use appropriate breathing techniques according to inhaler device e.g.: ’slow and steady’ for an aerosol inhaler, “quick and deep” for a dry powder inhaler
  • If a patient is using nasal corticosteroids and an ICS, they should be assessed individually. For example,for a patient taking nasal corticosteroids and 800–1,000mcg of BDP equivalent/day, a corticosteroid safety card is recommended.
  • Before prescribing, patients should always have their therapy reviewed for continued appropriateness and if necessary, issued an ICS card.

High-dose ICS safety card

Local ICS side effects can be distressing and may affect adherence to treatment. They include a sore throat, hoarse voice and opportunistic oral candidiasis infection.

All patients using ICS should be advised to rinse out their mouth with water (spitting out the rinse) and brush their teeth after using their device, which will reduce the risk of developing a sore throat or hoarseness. Spacer devices can also be used to reduce oropharyngeal deposition of drug particles, and should be recommended for all ICS multi-dose inhalers[12].

Patients using ICS who present with white patches (plaques) in their mouth should be referred to their GP, as this could be oral candidiasis and will require treatment with a topical antifungal (e.g. nystatin liquid or amphotericin lozenges), or may be a sign of a more serious condition.

Systemic side effects may be dose-related, or more pronounced in patients with co-morbidities (e.g. diabetes, osteopenia) or COPD. A dose-related increase in the risk of developing type 2 diabetes and its subsequent complications has been reported[13], and data have shown an association between high-dose ICS and tuberculosis[14].

Patients with COPD are at a higher risk of developing pneumonia than people who do not have COPD[15], and this risk appears to be further amplified in patients using ICS[16], particularly at high doses.

A Cochrane review was unable to determine a statistically significant difference in incidence of pneumonia, mortality or serious adverse events between patients prescribed fluticasone propionate, budesonide or BDP[17].

All patients with COPD should be offered a pneumococcal vaccination and the annual influenza vaccination.

High-dose ICS may increase the risk of fractures in COPD[18]. However, the British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) asthma guidelines advise bone mineral density monitoring and treatment only for adults on long-term or frequent courses of corticosteroid tablets, and not those on ICS.

Dose optimisation

The main strategy to minimise the risk of ICS-induced side effects is dose optimisation. In most patients with asthma, there is limited evidence that increasing the dose of ICS above 800mcg BDP equivalent per day improves asthma control, although high doses are associated with an increased risk of adverse events[19].

The BTS/SIGN guidelines recommend that the dose of any ICS should be reduced by 25–50% in patients with good asthma control (i.e. no exacerbations for three months), to the lowest dose that controls symptoms[2]. It is unly a patient with asthma would have their ICS completely withdrawn.

Before increasing the dose of an ICS, it is important to check the patient’s adherence to therapy, and to improve ICS delivery to the lungs. This can be done by optimising the patient’s inhaler technique, or by using a metered dose inhaler (MDI) with a spacer device, which can improve lung deposition.

Grainne d’Ancona is a Principal Pharmacist at Guy’s and St Thomas’ NHS Foundation Trust.

Source: https://www.pharmaceutical-journal.com/cpd-and-learning/learning-article/inhaled-corticosteroids-managing-side-effects/20067896.article

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