Атровент®

General characteristics. Structure:

Active ingredient: 261 mkg a monohydrate bromide ipratropiya (in terms of an ipratropiya bromide of 250 mkg).

Excipients: a benzalkoniya chloride, dinatrium of an edetat a dihydrate, sodium chloride, Acidum hydrochloricum of 1 N, water purified.

I sredstvoit Bronkhodilatiruyushchy

Pharmacological properties:

Pharmacodynamics. Blocks m-holinoretseptory of smooth muscles of a tracheobronchial tree (preferential at the level of large and average bronchial tubes) and suppresses a reflex bronkhokonstriktion. Having structural similarity to acetylcholine molecule, is his competitive antagonist. Effectively prevents the narrowing of bronchial tubes resulting from inhalation of cigarette smoke, cold air, effect of various bronkhospazmiruyushchy substances and also the spasm of bronchial tubes connected with influence of vagus nerves oppresses. At inhalation use has practically no resorptive effect, at the same time only 10% reach small bronchial tubes and alveoluses, and the rest settles in a throat or an oral cavity and is swallowed.

At patients with the bronchospasm connected with a chronic obstructive pulmonary disease (chronic bronchitis and emphysema of lungs) improves indicators of function of external respiration: the volume of the forced exhalation for the first second (OFV1) and the average volume speed of the forced exhalation of 25-75% increases by 15% and more in 15 minutes after administration of drug, the maximum effect is noted in 1-2 hours, and proceeds at most of patients till 6 o'clock.

At patients with bronchial asthma considerable improvement of function of external respiration is noted at 40% of patients (OFV1 increased by 15% and more).

Pharmacokinetics. Absorption - low. It is removed through intestines. It is badly dissolved in fats and poorly gets through biological membranes. In a GIT it is practically not absorbed and removed with a fecal masses. The soaked-up part (small) is metabolized in 8 inactive or poorly active anticholinergic  metabolites  (it is removed  by kidneys).  Does not kumulirut.

Indications to use:

Chronic obstructive pulmonary disease (including chronic obstructive bronchitis, emphysema of lungs); bronchial asthma (average and easy severity).

Route of administration and doses:

(20 drops = about 1 ml, 1 drop = 0,0125 mg ipratropiya of bromide anhydrous)

The mode of dosing is selected individually. During treatment patients have to be under medical observation. If the doctor it is not appointed differently, the following mode of dosing is recommended:

The supporting treatment. Adults (including elderly) and children are more senior than 12 years: On 2,0 ml (40 drops = 0,5 mg) 3-4 times a day. The maximum daily dose - 8,0 ml (2 mg).

Children from 6 to 12 years. Treatment should be carried out under medical observation; on 1,0 ml (20 drops = 0,25 mg) 3-4 times a day. The maximum daily dose - 4 ml (1 mg).

Children up to 6 years. Treatment should be carried out under medical observation; on 0,4-1,0 ml (8-20 drops = 0,1-0,25 mg) 3-4 times a day. The maximum daily dose - 4 ml (1 mg).

Acute bronchospasm. Adults (including elderly) and children are more senior than 12 years. 2,0 ml (40 drops = 0,5 mg); repeated appointments before stabilization of a condition of the patient are possible. The interval between inhalations is defined by the doctor. Атровент® it can be applied together with inhalation (32-adrenomimetikam.

Children from 6 to 12 years. Treatment should be carried out under medical observation. 1,0 ml (20 drops = 0,25 mg); repeated appointments before stabilization of a condition of the patient are possible. The interval between inhalations is defined by the doctor. Атровент®   it can   be applied      together with   inhalation   beta2-adrenomimetika.

Children up to 6 years. Treatment should be carried out under medical observation. 0,4-1,0 ml (8-20 drops = 0,1-0,25 mg); repeated appointments before stabilization of a condition of the patient are possible. The interval between inhalations is defined by the doctor. Атровент® it can be applied together with inhalation beta2-adrenomimetika.

The recommended dose of drug should be diluted with 0,9% chloride sodium solution before achievement of volume of drug of 3-4 ml, to fill in in the nebulizer and to make inhalation. Drug should be diluted with 0,9% chloride sodium solution the every time just before use which remained after inhalation solution pour out.

Dosing can depend on a method of inhalation and a type of the nebulizer. Duration of inhalation can be controlled on an expenditure of divorced volume.

Атровент® solution can be applied to inhalations with use of various nebulizers which are available on sale. When using of the centralized oxygen system solution is better to apply at a flow rate 6-8 liters a minute.

Features of use:

 It is not recommended for the emergency stopping of an attack of suffocation (the broncholitic effect develops later, than at in - adrenostimulyator). Patients   with a mucoviscidosis   have   the increased   probability   of development of delay of motility of digestive tract.

It is recommended not to allow considerable exceeding of the recommended doses, both at treatment of an acute bronchospasm, and at the supporting treatment. If inhalations are insufficiently effective, or the condition of the patient worsened, it is necessary to see a doctor for change of treatment planning. Атровент® solution for inhalations can be used for the combined inhalations along with Ambroxol solution for inhalations, Bromhexine solution for inhalations and Beroteky solution for inhalations.

Drug contains (antibacterial) preservative a benzalkoniya chloride and the stabilizer of dinatrium эдетат which can cause narrowing of a gleam of bronchial tubes. Emergence of a bronchospasm is possible. Patients have to be able to apply correctly Atrovent® solution to inhalations. It is not necessary to allow hits of solution in eyes. The patients predisposed to development of glaucoma should be warned about need of protection of eyes against drug hit especially. For inhalations it is recommended to use nebulizers with a tip for a mouth. When using the nebulizer with a mask, it is necessary to use a mask of the corresponding size.

Pregnancy and lactation. Safety of Atroventa® during pregnancy at the person is not established. At purpose of drug during the possible or confirmed pregnancy it is necessary to consider a ratio of estimated advantage of purpose of drug for mother and possible risk for a fruit.

Data on Atrovent's penetration into breast milk are absent. However as many drugs are removed with breast milk, it is necessary to appoint with care Atrovent® to women in the period of a lactation.

Side effects:

The most frequent undesirable side effects are dryness in a mouth, the headache, disturbance of motility of digestive tract (a lock, diarrhea, nausea, vomiting).

Such undesirable side effects as increase in pulse rate, supraventricular tachycardia, ciliary arrhythmia, heartbeat, accommodation disturbance, ischuria, dizziness meet seldom and have reversible character. At patients with obstructive damage of urinary tract the risk of development of an ischuria increases. There are separate messages on emergence of complications from eyes (such as mydriasis, accommodation paresis, increase in intraocular pressure, especially for patients with closed-angle glaucoma, eye pain) at hit of drug in eyes.

Eye pain or discomfort, indistinct sight, emergence of an aura and color spots before eyes in combination with a conjunctival and corneal hyperemia and hypostasis can be symptoms of an attack of closed-angle glaucoma. In case of emergence any   of these symptoms, it is necessary to appoint the drops narrowing a pupil and to address immediately the ophthalmologist.

As well as at other inhalation therapy, including bronchodilators, sometimes observe cough, local irritation, the paradoxical bronchospasm is more rare.

Such allergic reactions as skin rash, a small tortoiseshell a Quincke's edema, an itch, a paraglossa, lips and a face, a throat spasm, a laryngospasm and anaphylactic reactions can be observed.

Interaction with other medicines:

Beta2-adrenergichesky means and ksantinovy derivatives can strengthen bronkhodilatiruyushchy effect of drug.

The anticholinergic effect amplifies protivoparkinsonichesky means, quinidine, tricyclic antidepressants. At simultaneous use with other anticholinergics - the additive action.

When using Atroventa® of solution for inhalations along with inhalation beta-adrenergic agonists at the patients having closed-angle glaucoma the risk of development of a bad attack of glaucoma increases.

Атровент® it is not necessary to appoint solution for inhalations along with inhalation solution of kromoglitsiyevy acid, considering a possibility of precipitation.

Contraindications:

Hypersensitivity to atropine and its derivatives; hypersensitivity to an ipratropiya to bromide or to other components of drug.

With care - closed-angle glaucoma, obstruction of urinary tract, a prostate hyperplasia; breastfeeding, children's age (up to 6 years).

Overdose:

No specific symptoms of overdose are revealed. Considering the width of therapeutic action and a local route of administration of Atroventa®, emergence of any serious anticholinergic symptoms is improbable. Insignificant manifestations of systemic anticholinergic action, such as dryness in a mouth, accommodation paresis, increase in heart rate are possible.

Symptomatic treatment.

Storage conditions:

List B. At a temperature not above 30 °C not to allow freezing. To store in the place, unavailable to children! Period of validity 3 years. Not to use after the expiry date specified on упаковкеэ.

Issue conditions:

According to the recipe

Packaging:

Solution for inhalations of 0,25 mg/ml. On 20 ml in a glass bottle of amber color with a polyethylene dropper and the screwing-up polypropylene cover with control of the first opening. The bottle with the application instruction is placed in a cardboard pack.