1. Name Of The Medicinal Product
Easyhaler Salbutamol Sulphate 200 micograms per actuation inhalation powder
2. Qualitative And Quantitative Composition
Metered dose delivery 200 mcg of Salbutamol per actuation as Salbutamol Sulphate Ph.Eur.
3. Pharmaceutical Form
White or almost white odourless powder intended for respiratory use by oral inhalation.
4. Clinical Particulars
4.1 Therapeutic Indications
Symptomatic treatment of acute asthma attack. Prevention of exercise-induced bronchospasm. Symptomatic treatment of broncho-asthma and other conditions associated with reversible airways obstruction.
Salbutamol provides a short-acting bronchodilation with fast onset of action in reversible airways obstruction due to asthma.
Easyhaler Salbutamol Sulphate should be used to relieve symptoms when they occur and to prevent them in those circumstances recognised by the patient to precipitate an attack (e.g. before exercise or unavoidable allergen exposure).
Salbutamol is valuable as a rescue medication in mild, moderate or severe asthma, provided that reliance on it does not delay the introduction and use of regular inhaled corticosteroid therapy.
4.2 Posology And Method Of Administration
The preparation is intended for oral inhalation only.
This preparation is particularly useful for patients unable to use metered dose inhalers properly and for patients to whom the use of an inhalation aerosol causes irritation of airways. The lowest effective doses of inhaled Salbutamol are recommended to be used in the treatment of asthma. In long term treatment, it is recommended instead of continual use, to use inhaled Salbutamol only when needed.
Adults and Elderly:
For the relief of acute bronchospasm and for managing intermittent episodes of asthma one inhalation (200 micrograms) may be administered as a single starting dose, this may be increased to two inhalations (400 micrograms).
To prevent exercise-induced bronchospasm or allergen bronchospasm one inhalations (200 micrograms) should be taken before challenge, this dose (200 micrograms) may be repeated if necessary.
Children :
One inhalation (200 micrograms) is the recommended starting dose for the relief of acute bronchospasm, or before exercise or allergen exposure.
On demand use of Easyhaler Salbutamol Sulphate should not exceed four inhalations (800 micrograms) in any 24 hour period.
For optimum results in most patients Easyhaler Salbutamol Sulphate inhaler should be used regularly during asthmatic attacks. The bronchodilator effect of each administration of inhaled salbutamol lasts for four hours, except in patients whose asthma is becoming worse. Such patients should be warned not to increase their usage of salbutamol, but should seek medical advice in case treatment with an inhaled and/or systemic glucocorticosteroid is indicated.
4.3 Contraindications
A history of hypersensitivity to any components of the product. Intravenous or oral salbutamol is used for the management of premature labour uncomplicated by conditions such as placenta praevia, ante-partum haemorrhage or toxaemia of pregnancy, however inhaled salbutamol is not appropriate for management of premature labour.
Salbutamol preparations should not be used for threatened abortion.
4.4 Special Warnings And Precautions For Use
Bronchodilators should not be the only or main treatment in patients with severe or unstable asthma. Severe asthma requires regular medical assessment including lung function testing as the patients are at risk of severe attacks and even death. Physicians should consider using oral corticosteroid therapy or the maximum use of inhaled corticosteroids. Increasing use of bronchodilators, particularly short-acting inhaled ß2-agonists to relieve symptoms indicates deteriorating asthma control (especially if the peak expiratory flow rate value falls and/or becomes irregular).
In the event of a previous effective dose of inhaled salbutamol failing to give relief for at least three hours or if they need more inhalations than usual, the patient should be advised to seek medical advice as soon as possible. In this situation patients should be reassessed and consideration given to an increase in their anti-inflammatory therapy, (e.g. higher doses of inhaled corticosteroids or a course of oral corticosteroids). A regular anti-inflammatory controller medication taken on a daily basis is required as soon as the patient needs inhaled Beta2-agonists more than once a week. Severe episodes of asthma must be treated in the normal way.
As there may be adverse effects associated with excessive dosing, the dosage and frequency of administration should only be increased on medical advice.
Salbutamol should be administered with caution in patients with thyrotoxicosis, cardiac insufficiency, hypokalaemia, myocardial ischaemia, tachyarrhythmia and hypertrophic obstructive cardiomyopathy.
Potentially serious hypokalaemia may result from ß2-agonist therapy, mainly from parenteral and nebulised therapy. Particular caution is advised in acute severe asthma, as this effect may be potentiated by concomitant treatment with xanthine derivatives, steroids, diuretics and by hypoxia. It is recommended that serum potassium levels are monitored in such situations.
Rarely inhalation therapy may cause bronchospasm after dosing. In this event, treatment with Salbutamol must be immediately discontinued and, if need be, replaced with another therapy.
Cardiovascular effects may be seen with sympathomimetic drugs, including salbutamol. There is some evidence from post-marketing data and published literature of rare occurrences of myocardial ischaemia associated with salbutamol. Patients with underlying severe heart disease (e.g. ischaemic heart disease, arrhythmia or severe heart failure) who are receiving salbutamol should be warned to seek medical advice if they experience chest pain or other symptoms of worsening heart disease. Attention should be paid to assessment of symptoms such as dyspnoea and chest pain, as they may be of either respiratory or cardiac origin.
One dose contains less than 10 mg lactose, which probably does not cause symptoms in lactose intolerant patients. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction
Concomitant administration of salbutamol and non-selective ß -blocking drugs such as Propranolol is not recommended.
Patients treated with monoamine oxidase inhibitors or tricyclic antidepressants should be followed clinically in the beginning of salbutamol treatment, because the action of salbutamol on the vascular system may be potentiated.
4.6 Pregnancy And Lactation
Administration of drugs during pregnancy should only be considered if the expected benefit to the mother is greater than any possible risk to the foetus. Salbutamol has been in widespread use for many years in human beings without apparent ill consequences; this includes its well established use in the management of premature labour. However, as with the majority of drugs, there is little published evidence of its safety in the early stages of human pregnancy, but in animal studies there is evidence of some harmful effects on the foetus at very high doses.
As salbutamol is probably excreted in breast milk, its use in nursing mothers requires careful consideration. It is not known whether salbutamol has a harmful effect on the neonate, and so its use should be restricted to situations where it is felt that the expected benefit to the mother outweighs any potential risk to the neonate.
4.7 Effects On Ability To Drive And Use Machines
None Known.
4.8 Undesirable Effects
The undesirable effects caused by normally used inhaled doses of Salbutamol are mild, typical for sympathomimetic agents, and they usually disappear with continued treatment.
Frequencies are defined as: very common (>1/10), common, (>1/100 and <1/10), uncommon (>1/1000 and <1/100), rare (>1/10,000 and <1/1000), very rare (<1/10,000) and not known (cannot be estimated from available data).
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
| |
|
|
| ||
|
| |||
|
|
| ||
|
|
|
4.9 Overdose
Excess repeat use of inhalations may produce adverse effects such as tachycardia, CNS stimulation, tremor, hypokalaemia and hyperglycaemia.
Treatment consists of discontinuation of salbutamol together with appropriate symptomatic therapy. The preferred antidote for overdosage with salbutamol is a cardioselective beta-blocking agent, but beta-blocking drugs should be used with caution in patients with a history of bronchospasm. Hypokalaemia may occur following overdose with salbutamol. Serum potassium levels should be monitored. If hypokalaemia occurs potassium replacement via the oral route should be given. In patients with severe hypokalaemia intravenous replacement may be necessary.
5. Pharmacological Properties
5.1 Pharmacodynamic Properties
Salbutamol is a selective ß 2-adrenergic receptor agonist. The pharmacological effects of salbutamol are at least in part attributable to stimulation through beta-adrenergic receptors of intracellular adenyl cyclase, the enzyme that catalyses the conversion of adenosine triphosphate (ATP) to cyclic-3',5',-adenosine monophosphate (cyclic AMP). Increased cyclic AMP levels are associated with relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from cells, especially from mast cells. Salbutamol also stimulates mucous secretion and mucociliary transport in the respiratory tract. Bronchial effects of inhaled salbutamol can be detected after a few minutes and duration of action is normally 4-6 hours.
Like other ß 2-adrenoceptor agonists salbutamol also has cardiovascular effects in some patients as measured by changes in pulse rate, blood pressure, symptoms and ECG changes. These effects can especially be detected after oral and intravenous administration of salbutamol. Furthermore oral and intravenous salbutamol causes reduction in uterine tonicity which has been associated with pain relief in pregnancy. In addition, salbutamol has some metabolic effects. Especially intravenous and nebulised salbutamol decreases serum potassium concentrations although the effect is generally mild and transient. Salbutamol has also lipolytic effects and it has been shown to cause increases in blood glucose and insulin probably by stimulating glycogenolysis and having a stimulatory effect on ß 2-receptors in pancreas cells.
5.2 Pharmacokinetic Properties
Orally administered salbutamol is well absorbed with peak plasma concentrations occurring 1 to 4 hours after administration. The major proportion of inhaled Salbutamol is swallowed. The fraction that is distributed to the lung (approx. 10-25%) is rapidly seen in the circulation as free unmetabolised drug. The plasma concentrations of inhaled Salbutamol are, however, lower than those produced by usual oral doses.
Salbutamol and its metabolites are rapidly excreted in the urine and faeces with about 80% of the dose being recovered in urine within 24 hours. The elimination half-life of Salbutamol is 2.7 - 5.5 hours after oral and inhaled administration.
5.3 Preclinical Safety Data
The short term toxicity has been tested in different animal species - the mouse, the rat and the dog - at doses extending to several thousand fold higher than the intended human therapeutic dose - maximally in the region of 15 µg/kg daily. The lethal doses via the intravenous route in the rodents range from 50mg/kg, via the peroral route to around 2000 mg/kg and even higher. Thus the agent exhibits low acute systemic toxicity.
Local toxicity on the airway has not been exclusively studied, but the historical evidence based on long clinical use suggests good airway tolerance.
The subacute toxic effects on the cardiac muscle are seen at doses ranging from 0.2 to 3mg/kg. This is a manifestation of the pharmacodynamics of salbutamol at grossly elevated doses.
The doses administered in subchronic toxicity studies have been in the milligram ranges per kilogram - 0.15 to 50 - via the oral route or by inhalation. The species have been the rat (p.o. administration), and the dog (p.o. and inhalation). The toxic signs and symptoms exhibited were, as noted in the paragraph above, related to the mode of action on the adrenergic receptor.
The chronic toxicity, again, is manifested as exaggerated pharmacodynamic effects in animals.
Animal data on reproductive toxicity is quite limited. Sympathomimetics, including salbutamol, are widely used in clinical medicine in patients of fertile age. In spite of this fact, no adverse reproductive effects attributable to salbutamol are reported in the literature.
Embryotoxicity in animal studies seems to be related only to the mouse. In this species the union of the flat bones of the lower part of the skull seem to be involved. The specific mechanism of this has not been fully elucidated.
Foetal toxicity at high single or elevated chronic doses are related to energy metabolism from glycogen. Catecholamines liberate energy in the form of glucose from glycogen stored in liver and muscle. This action is mediated by glycogen synthase and phosphorylase of these tissues. Elevated foetal insulin and glucose levels suggest a higher sensitivity of the foetal pancreas to this stimulation of ß -adrenergic receptors.
The classic airways of mutagenic potential by which this agent has been tested have exhibited no increase in the incidence of mutations.
The potential of increase in the number of neoplasms shows a species and even a strain specificity, as did the effect on the delay in union flat jaw bones. Ovarian leiomyomas, benign tumours of smooth muscle, occur with a significantly higher frequency in the rat, particularly of the Spraque-Dawley strain. The other rodent species do not appear to be affected, suggesting a difference in the susceptibility of the uterine muscle of Spraque-Dawley to ß -adrenergic stimulation.
6. Pharmaceutical Particulars
6.1 List Of Excipients
Lactose Ph.Eur.
6.2 Incompatibilities
None
6.3 Shelf Life
Unopened: 3 years.
After first opening of foil pouch: 6 months.
6.4 Special Precautions For Storage
Store in a dry place at a temperature not exceeding 25°C
6.5 Nature And Contents Of Container
The multidose powder inhaler (Easyhaler) consists of seven plastic parts and a stainless steel spring.
The plastic materials of the inhaler are polyester, LDPE, polycarbonate, acetal, styrene butadiene, polypropylene.
The inhaler is wrapped in laminate foil and packed in a cardboard box.
The starting package contains an inhaler and a protective cover. The maintenance pack contains the dry powder inhaler only.
Pack size: 200 actuations.
6.6 Special Precautions For Disposal And Other Handling
Patients are instructed to perform a rapid and forced inhalation through the Easyhaler device. Patients are instructed not to exhale into the device. illustrated instructions for use accompany each package.
7. Marketing Authorisation Holder
Orion Corporation,
Orionintie 1,
FIN-02200 Espoo,
Finland.
8. Marketing Authorisation Number(S)
PL27925/0003
9. Date Of First Authorisation/Renewal Of The Authorisation
2 June 1998/ 1 June 2003
10. Date Of Revision Of The Text
2 March 2010
No comments:
Post a Comment