Salpium - Inhaler Ipratropium Bromide + Salbutamol - 20mcg+100mcg/puff 1 200 Puffs Unit(s) / 200 Puffs Unit The ACME Laboratories Ltd. Introduction: Salpium is used for the treatment of chronic obstructive pulmonary disorder (a lung disorder in which the flow of air to the lungs is blocked). It helps in relaxing the muscles of the air passages and making it easier to breathe. It relieves coughing, wheezing and feeling short of breath. Your doctor will tell you how often you need to use your inhaler. The effect of this medicine may be noticeable after a few days but will only reach its maximum after a few weeks. This medicine must be used regularly to be effective, so go on taking it even... Uses of Combimist-L Respules: Chronic obstructive pulmonary disease (COPD) Side effects of Combimist-L Respules: Dryness in mouthBreathlessnessCoughTremorHeadachePalpitationsMuscle cramp How to use Combimist-L Respules: Use this medicine in the dose and duration as advised by your doctor. Check the label for directions before use. Twist off the top of the respule/transpule and squeeze all the liquid into the nebulizer. It should be used right away after opening. How Combimist-L Respules works: Salpium is a combination of two medicines: Salbutamol/Albuterol and Ipratropium. Salbutamol/Albuterol is a bronchodilator while Ipratropium is an anticholinergic. They work by relaxing the muscles in the airways and widen the airways. Together, they make breathing easier. Indication: Chronic obstructive pulmonary disease, Asthma Adult Dose: Inhalation Chronic obstructive pulmonary disease Adult: Inhalation: 100 mcg/20 mcg (1 actuation of metered-dose inhaler) q6hr; not to exceed 6 actuations/day Nebulizer solution: Initially, 3 ml every 6 hr. Max: 3 ml every 4 hr. One ampoule as required for the relief of symptoms or as directed. Up to three to four ampoules daily. Child Dose: Safety and efficacy not established Contraindication: The combination of Salbutamol & Ipratropium Bromide is contraindicated in patients with hypertrophic obstructive cardiomyopathy and tachyarrhythmia and in patients with a history of hypersensitivity to atropine or its derivatives, or to any other component of the product. Mode of Action: Ipratropium bromide is an anticholinergic agent that inhibits vagally-mediated reflexes by antagonising the action of acetylcholine. It prevents the increases in intracellular concentration of cyclic guanosine monophosphate (cyclic GMP) which are brought about by interaction of acetylcholine with the muscarinic receptors on bronchial smooth muscle. Salbutamol is a direct-acting beta 2-adrenergic agent. It acts on the airway smooth muscle resulting in bronchodilation. Precaution: May cause paradoxical bronchospasm. Caution when used in patients who are sensitive to sympathomimetic agents. Caution when used in patients with CV disease as beta-agonists may increase BP, heart rate and risk of arrhythmias. Monitor blood glucose in diabetics. Monitor serum potassium levels especially in patients who are on concurrent treatment with xanthine derivatives, steroids or diuretics. Caution when used in patients with narrow angle glaucoma, hyperthyroidism, prostatic hyperplasia, bladder neck obstruction, seizure disorders, renal or hepatic impairment. Safety and efficacy have not been established in children <12 yr. Increased risk of GI motility disturbance in patients with cystic fibrosis.... Side Effect: >10% Bronchitis (2-12%) 1-10% Upper respiratory tract infection (1-10%),Lung disease (6%),Headache (3-6%),Dyspnea (2-5%),Nasopharyngitis (4%),Cough (3-4%),Pharyngitis (2-4%),Pain (1-3%),Chest pain (2.6%),Sinusitis (2.3%),Nausea (1-2%),Diarrhea (1.8%),Urinary tract infection (1.6%),Influenza (1.4%),Leg cramps (1.4%),Nausea (1.4%),Pneumonia (1.4%),Rhinitis (1.1%) <1% Allergic-type reactions, such as skin reactions (eg, rash, pruritus, urticaria [including giant urticaria]), angioedema (eg, of tongue, lips, face), laryngospasm, and anaphylaxis Angina,Arrhythmia,Arthralgia,Dizziness,Dry mouth,Dyspepsia,Dysphonia,Edema,Fatigue,Hypertension,Insomnia,Nervousness,Palpitation,Paresthesia,Tachycardia,Tremor,Vomiting Potentially Fatal: Anaphylactic reactions such as angioedema of tongue, lips or face and laryngospasm. Interaction: May have additive anticholinergic effects when used with psychotropics; may decrease effect of propranolol. Increased CV effects (tachycardia, palpitations) when used with MAOIs, TCAs and amphetamines.