Iprasol Inhelar

Indications

This inhalation aerosol is prescribed for patients with chronic obstructive pulmonary disease (COPD) who are currently using a regular aerosol bronchodilator but still experience bronchospasm. It is intended as a secondary bronchodilator to improve breathing.

Pharmacology

This inhalation aerosol combines Salbutamol (as Sulfate) and Ipratropium Bromide in an environmentally-friendly hydrofluoroalkane (HFA) based inhaler, free from chlorofluorocarbons (CFCs) which contribute to ozone layer depletion.

Salbutamol is a short-acting beta2-adrenergic bronchodilator, while Ipratropium Bromide acts as an anticholinergic bronchodilator. Together, they work synergistically: Ipratropium Bromide inhibits the increase in cyclic guanosine monophosphate caused by acetylcholine binding to muscarinic receptors on bronchial smooth muscle. This combination reduces bronchospasm through two distinct mechanisms—anticholinergic and sympathomimetic—offering enhanced bronchodilation compared to using either medication alone.

Dosage

Adults (including the elderly): Inhale 2 puffs of this aerosol four times daily. Additional puffs may be taken as needed, but do not exceed 12 puffs in a 24-hour period unless directed otherwise by a physician.

Use the medication as prescribed by your doctor.

Administration

Proper inhaler use is crucial for effective treatment. Incorrect use may reduce the amount of medication reaching the lungs. Follow these steps to ensure proper use:

1. Remove the cap.
2. Shake the inhaler vigorously for at least six times before each use.
3. If the inhaler is new or hasn’t been used for over a week, shake it well and release one puff into the air to ensure it’s working.
4. Exhale fully and hold the inhaler upright.
5. Place the actuator between your teeth and close your lips around the mouthpiece.
6. While breathing in deeply and slowly, press down firmly on the canister to release the medication.
7. Remove the inhaler from your mouth and hold your breath for at least 10 seconds or as long as comfortable.
8. If more than one puff is prescribed, wait 1 minute between puffs. Shake the inhaler well and repeat steps 4 to 7.
9. Replace the cap after use. Rinse your mouth with water after each treatment.
10. Check your technique in a mirror. If you see a white mist, you may not have sealed your lips properly around the mouthpiece or you might not be breathing in as you press the can. Repeat the steps carefully if needed.

Inhaler Cleaning Instructions: Clean the inhaler weekly by removing the canister and rinsing the plastic actuator and cap with warm water (do not submerge the metal canister). Dry thoroughly before reassembling.

Use the medication as prescribed by your doctor.

Interaction

This inhalation aerosol can be used alongside other medications such as sympathomimetic bronchodilators, methylxanthines, and steroids for COPD treatment. However, formal drug interaction studies have not been conducted. Caution is advised when combining with other anticholinergic or sympathomimetic agents due to potential cardiovascular risks. Extreme caution is also recommended when using with non-potassium sparing diuretics, monoamine oxidase inhibitors, or tricyclic antidepressants.

Contraindications

This inhalation aerosol is contraindicated in individuals with a known hypersensitivity to Soya-Lecithin or related products, such as soybean and peanut, or to any other components of the drug. It is also contraindicated in patients allergic to atropine or its derivatives.

Side Effects

Salbutamol may cause mild tremors and headaches, typically resolving with continued use. Rare side effects include muscle cramps, hypersensitivity reactions, angioedema, urticaria, bronchospasm, and hypotension.

Ipratropium Bromide may occasionally cause headaches, influenza, chest pain, nausea, shortness of breath, coughing, pharyngitis, or sinusitis.

Pregnancy & Lactation

Ipratropium Bromide: Classified as Pregnancy Category B, with no demonstrated teratogenic effects.

Salbutamol: Classified as Pregnancy Category C, with teratogenic effects observed in animal studies.

There are no well-controlled studies on the use of this inhalation aerosol in pregnant women. It should be used during pregnancy only if the potential benefits outweigh the risks to the fetus. The excretion of the components in human milk is unknown; therefore, caution is advised when administering to nursing mothers.

Use in Special Populations

Use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder-neck obstruction. Patients with convulsive disorders, hyperthyroidism, diabetes mellitus, or unusual sensitivity to sympathomimetic amines should also use this inhaler cautiously.

Overdose Effects

Overdosage primarily relates to Salbutamol Sulfate, potentially leading to anginal pain, hypertension, hypokalemia, and tachycardia.

Therapeutic Class

Combined bronchodilators.

Storage Conditions

Do not puncture, break, or incinerate the pressurized canister even when empty. Store in a cool, dry place away from direct sunlight and heat. Keep out of reach of children and away from eyes.