Berodual

Berodual - a bronchodilator drug with a combined effect. Has an inhalation form.

[1], [2]

Indications of the beroduala

It is used in the treatment of the following diseases:

• has a different nature of bronchial asthma (endogenous or allergic form or caused by physical stress);
• pathology of pulmonary tissues in the chronic stage, against which there is a bronchospastic syndrome;
• Chronic bronchitis, which is accompanied by a patency disorder of bronchopulmonary ways;
• pulmonary emphysema;
• other pathologies of respiratory organs (obstructive chronic nature), accompanied by curable obstruction of the respiratory ducts;
• preventive rehabilitation of nosological forms that affect the respiratory system;
• preparation of a lumen inside the respiratory ducts before administration of corticosteroids, antibiotics or other mucolytics (using aerosol).

[3]

Release form

The release occurs in the form of an inhalation solution - in flakonchikah-droppers with capacity of 2 ml (thus in 1 ml contains 20 drops). In a pack - 1 bottle with a solution.

It is also produced under the guise of a special aerosol with metered inhalations, in cans with a nozzle, a capacity of 10 ml (corresponding to 200 sprays - 1 serving is equal to 1 sputtering). Inside the box - 1 can of medicine.

[4]

Pharmacodynamics

The mechanism of medicinal action of the drug is based on the effects of two bioactive components, which are part of the therapeutic mixture used in hospitals in pulmonology.

Bromide Ipratropium is an ammonium derivative having a cholinolytic effect. Bronchodilation occurs as a result of local therapeutic effects, because the substance is administered in the form of fine particles - by inhaling an inhalation solution or an aerosol. The bioactive element prevents the secretion of acetylcholine (this is the main conductor of parasympathetic synapses), which normalizes the calcium values inside the cell structures. All this makes it possible to neutralize the influence of the vagus nerve, and in addition to expand the bronchial lumen.

Fenoterol hydrobromide activates the stimulation of β-adrenergic receptors, and the selectivity of drug exposure is determined by the quantitative factor. Small portions of the bioactive element selectively affect β2-terminations, which is required when using Berodual with conservative therapy of bronchopulmonary disease.

The biochemical effect of fenoterol is based on the counteraction of the following agents - metacholine with histamine, as well as cold air and allergens with animal and vegetable origin (a particular situation with the slowing of the manifestation of hypersensitivity of an immediate nature). Immediately after the use of drugs in the therapeutic dosage, the release of inflammatory conductors from the labrocytes is blocked, which results in the relaxation of the smooth muscles of the bronchial tract, and at the same time the local channel of the vessels. In addition, there is an increase in the activity of mucociliary clearance.

Separately, it is necessary to note the effect of fenoterol on the heart, because after penetration into the main circulatory system, the bioactive element is able to interact with the β-adrenergic receptors located inside the myocardium. This can cause the development of such symptoms:

• increased heart rate;
• progressive increase in activity of the muscular organ;
• Prolongation of QT-interval values on the ECG.

The combination of two actively acting bronchodilators makes it possible to achieve the desired medication effect by means of different therapeutic mechanisms, because the targets for the action of the active elements are different.

The complementary effect of fenoterol with ipratropium helps to achieve the desired therapeutic result, manifested in the form of potentiating the spasmolytic reaction of bronchial muscles and their expansion, necessary for the stable functioning of the organism.

[5], [6]

Pharmacokinetics

As a result of the active inhalation of the therapeutic solution, an improvement in the work of the bronchopulmonary tract rather quickly occurs, even though only 10-39% of the accepted dose settles in the tissue of the respiratory system (the remainder of the drug remains on the inhaler nozzle, in the mouth, respiratory tract).

The medicinal effect of bromide ipratropium develops over 15 minutes and looks like an increase in the volume of forced expiration in 1 second (this is an important characteristic by which the normal function of the respiratory system is evaluated), and in addition the maximum rate of exhalation produced is 15%.

Peak values of this bioactive element are observed even after 1-2 hours after spraying. In this case, the therapeutic effect of the substance is maintained for 6 hours.

The overall bioavailability of fenoterol is slightly lower than ipratropium, which is about 1.5%. But, since Berodual is a medicine with a local type of effect, the more important parameter for the therapy is the speed of the medicamentous effect after inhalation, which is approximately equal to the speed of the first acting element of the drug.

Dosing and administration

Use of a medicine in the form of an aerosol.

Before using the inhaler, it is necessary to exhale slowly and deeply. Next, grasp the mouthpiece of the canister with the lips so that its mouthpiece is deployed downward, and the arrow - vice versa, up. Then you need to press the bottom of the cylinder to release a 1-ounce portion of the drug, then take a deep breath - this is necessary to increase the interaction area of the bioactive elements of the drug and the structures of the respiratory ducts.

After the end of the procedure, you need to put a protective cap on the can.

In the case of non-use of the medication for the last 3 or more days, it is required to press the nozzle before the application of the cloud of a medicinal spray before the procedure.

Dosage dimensions of the aerosol inhaler.

For children from 6 years old and adults with an exacerbation of an attack, a portion of 2 sprays is needed. If there is no improvement after 5 minutes, two more such inhalations should be performed. If such a treatment scheme still does not bring results, it is urgent to turn to specialists for help.

If a prolonged conservative recovery is performed, 1-2 inhalation procedures are performed three times a day. It should be borne in mind that the total number of inhalations per day should not exceed 8 times.

Application of an inhalation solution of drugs.

This drug form of the drug requires the use of special medical instruments - an apparatus such as a nebulizer. This device allows to spray therapeutic solutions in the form of a fine-dispersed cloud.

Before applying the solution, it is necessary to find out the correct scheme of dilution of the inhalation substance, because exactly this factor determines the effectiveness of the effect and completeness of the medicinal possibilities of the active elements of the medicament.

Usually 0.9% saline is used for dilution, since it has a composition that is as close as possible to the composition of the aqueous plasma dosage. It is strictly forbidden to use distilled water for breeding, because this can cause serious complications. To recommended portions of drugs should add up to 3-4 ml of saline.

General therapeutic regimens for the conservative use of an inhalation solution.

To adolescents over 12 years of age and adults with the elimination of attacks of an acute nature - apply in the amount of 20-80 drops (1-4 ml of solution) four times a day. If therapy lasts for a long time - 20-40 drops (1-2 ml of solution) are required up to 4 times / day. To treat a moderate degree of bronchospastic syndrome, to facilitate the ventilation of the bronchopulmonary tract, 10 drops of material (0.5 ml of solution) should be administered.

Children within the age of 6-12 years are prescribed to prevent an attack of 10-20 drops of LS (0.5-1 ml of solution). If there is a serious form of the disease, you can increase the size of the portion to 40-60 drops (2-3 ml of solution). In the case of a long course of treatment (for example, cough of an allergic nature), four-fold application of 10-20 drops of the drug (0.5-1 ml of solution) per day is prescribed.

For children younger than 6 years of age, weighing less than 22 kg, dosage sizes should be selected individually, taking into account the parameters offered by the treatment course - 25 μg / kg ipratropium and 50 μg / kg fenoterol (total portion size is no more than 0.5 ml), with taking up to 3 times / day.

[10], [11]

Use of the beroduala during pregnancy

No reliable tests were performed on the ability of the active elements to affect the pregnant woman or the fetus in any way, but the preclinical results of the use of fenoterol with ipratropium indicate that the bioactive substances do not have a negative effect on the physiological processes occurring within the female body.

It is forbidden to use Berodual only on the 1st and 3rd trimesters, because fenoterol has a retarding effect on the uterine musculature. Accordingly, this component of the drug can inhibit labor or create conditions for artificial hypotension - this fact can adversely affect the early stage of ontogeny.

There is clinical evidence that the substance fenoterol can pass into the mother's milk during lactation. At the same time, there is no such information about ipratropium. In connection with this, nursing mothers are required to prescribe the drug only in exceptional cases and with great care.

Contraindications

Among the contraindications:

• heightened sensitivity in relation to a drug (acquired or hereditary);
• problems with the rhythm of cardiac function (similar to tachyarrhythmia);
• obstructive form of cardiomyopathy of hypertrophic character;
• hypersensitivity to the active and additional elements that are part of the drug.

With increased precautionary measures (for example, it is recommended to take a course of conservative therapy in a specialized hospital in pulmonology), it is necessary to prescribe a medicine in the presence of such painful conditions in a person:

• glaucoma of a closed angle;
• heart failure;
• increased values of blood pressure;
• IHD;
• diabetes;
• the presence in the anamnesis of myocardial infarction, which occurred during the last 3 months;
• marked degree of damage to peripheral and cerebral blood flow;
• thyrotoxicosis;
• obstruction in the neck of the ureter (having a special organogenic form);
• pheochromocytoma or other tumors, the formation of which depends on hormones;
• benign prostatic hyperplasia;
• cystic fibrosis.

[7], [8]

Side effects of the beroduala

Side-effects of drug use are related to the fact that its active elements have extremely high biochemical activity - due to the fact that they have cholinolytic and β-adrenergic effects. In addition, the use of the drug may lead to the appearance of local irritation (this effect can occur with any method of inhalation).

Often, the use of the drug causes such side effects - headaches, dry mouth mucosa, an intentional tremor, dizziness, pharyngitis with a cough, tachycardia, and in addition, vomiting, a disturbance in the sound-forming function, nausea, a subjective feeling of intense palpitation or a feeling of nervousness, systolic blood pressure.

Other negative reactions:

• disorders of the function of the CCC: various arrhythmias (including ciliary), myocardial ischemia, supraventricular tachycardia, an increase in the level of diastolic blood pressure;
• lesions affecting the visual organs: an increase in IOP, an accommodation disorder, glaucoma, swelling in the cornea, mydriasis, pain, visual fogging, the appearance of a weak halo around the objects visible to the eye and conjunctival hyperemia;
• disorders in the work of respiratory organs: laryngospasm, dysphonia, irritation in the pharyngeal region, which then develops into puffiness, bronchospastic syndrome, and besides this, a paradoxical spasm of the bronchi;
• immune manifestations: signs of hypersensitivity, as well as anaphylactic symptoms;
• mental disorders and disruptions in the work of the National Assembly: a feeling of nervousness or excitement, mental disorders and hand tremors at the time of conscious movements (in particular, this symptom is noticeable in the implementation of small coordinated movements);
• problems with metabolic processes: reduction of potassium values inside the blood;
• Digestive disorders: glossitis, constipation, stomatitis, diarrhea, swelling in the mouth, as well as a disorder of the adequate function of peristalsis of the gastrointestinal tract;
• lesions of subcutaneous tissues and skin: the appearance of urticaria, Quincke edema of a local nature, as well as itching and intense sweating;
• disorders affecting the system of urination: delay urinary function.

[9],

Overdose

The use of the drug can cause intoxication by its active elements, which arises from overly strong stimulation of the activity of β-adrenergic receptors. In this case, an overdose usually manifests itself by such symptoms:

• subjective feeling of increased heart rate, as well as diagnosed with the help of special devices tachycardia;
• increase or decrease in blood pressure (this depends on the personal predisposition of the patient);
• potentiation of bronchial obstructive pathogenesis;
• an increase in the difference between diastolic and systolic blood pressure values;
• angina pectoris together with the signs observed on its background (for example, a feeling of heaviness in the region behind the sternum);
• cutaneous hyperemia in the face and manifested in its background a feeling of heat;
• non-respiratory acidosis.

In addition, poisoning can develop because of excessive large amounts of ingratropium bromide entering the body, but the strength of its expression is low enough and has a transient nature. With this overdose, a disorder of visual accommodation or dryness of the oral mucosa is noted.

Elective β1-blockers can be used as a specific drug antidote. Having the opposite mechanism of therapeutic effect, these drugs are able to eliminate the pathology, which carries a danger to the life and health of the victim. However, in people with pulmonary obstruction of a chronic nature or bronchial asthma under the influence of bioactive elements with a similar type of therapeutic effect, there is a risk of bronchial blockage. Avoid such a violation can be by careful selection of the required portion.

In addition, such therapeutic procedures as the introduction of tranquilizers (with extremely severe symptoms) and sedatives are carried out. With severe intoxication, an urgent, conservative, intensive sanitation is needed, during which any medications that can provide the assistance required by the victim are used.

[12], [13], [14],

Interactions with other drugs

The regular combined use of Berodual and other anticholinergics has not been investigated, and therefore such a combination is not recommended.

The combined use of the following drugs / categories of drugs can affect the effectiveness of the drug.

Potentiation of properties or an increase in the likelihood of side effects:

• other β-adrenergic substances (any method of application);
• other anticholinergic drugs (any method of use);
• derivatives xanthine (for example, theophylline);
• anti-inflammatory medications (such as corticosteroids);
• MAOI;
• tricyclics;
• anesthetic agents with hydrocarbons of a halogenated nature (among them trichlorethylene, halothane, and also enflurane). In particular, they can potentiate the effect on the CCC function.

Weakening of the therapeutic effect of drugs is observed when combined with β-blockers.

Other likely interactions.

Hypokalemia, which is manifested due to the use of β-adrenomimetics, can be potentiated when combined with corticosteroids, xanthine derivatives and diuretics. This factor must be taken into account during therapy in people with severe forms of permeability of the respiratory ducts.

Hypokalemia can increase the likelihood of arrhythmias in people who take digoxin. At the same time, hypoxia can potentiate the negative effect of hypokalemia in relation to the rhythm of the heartbeat. Therefore, with such treatment it is required to constantly monitor the potassium indices inside the blood.

The likelihood of developing an attack of glaucoma in an acute form increases when spontaneous ipratropium hits the eye area, as well as when combined with β2-adrenoreceptors.

However, the use of Berodual can lead to a weakening of the anti-diabetic properties of hypoglycemic drugs. But this can only be expected if large doses are used, often used for systemic administration (tablets or infusions / injections).

If therapy involves the use of anesthetic inhalation, it should be noted that the use of fenoterol should be performed at least 6 hours before the initiation of anesthesia.

[15], [16], [17]

Storage conditions

Aerosol and inhalation solution Beroduala must be kept in a place that is closed from the access of young children. Temperatures are a maximum of 30 ° C.

[18],

Shelf life

Berodual is allowed to be used for 5 years from the date of release of the drug.

[19], [20], [21]

Reviews

Berodual receives mostly positive feedback about his therapeutic effects - this is also confirmed by theoretical and clinical tests that tested the effectiveness of the effects of bioactive elements of the drug. Nebulizer or aerosol is very convenient and easy to use, which makes it possible to use them without having specific medical skills and knowledge.

Doctors respond positively about the combined effect of the drug, which contributes to the expansion of the bronchial lumen, since the active elements of Berodual combine two different mechanisms of influence on the development of bronchodilation. This is what allows the medicine to successfully combat diseases that affect the respiratory tract, even in the most complex forms of the disease.

Reviews on the use of drugs in children are similar to those for adult patients. Often, parents very actively recommend the use of this drug during conservative therapy, because they have already familiarized with its properties and noticed that inhalations significantly facilitate respiratory processes in the lungs, which significantly improves the health of even the youngest children.