HealthCare

Bambuterol is an oral prodrug of terbutaline with a prolonged duration of bronchodilator action that allows once-daily administration. It is an inactive site-specific prodrug that delivers active terbutaline only to the target tissue i.e., lung. It is a very effective long acting beta-adrenoceptor agonist. Clinical studies have shown that bambuterol is as effective as other oral and inhaled i2-agonists including salbutamol, terbutaline and Salmeterol, and theophylline(both conventional and controlled release formulations). Bambuterol is commercially available from the pharmacy major AstraZeneca under the trade names Bambec and Oxeol.

Bambuterol is used in maintenance treatment of bronchial asthma, Nocturnal asthma, and Chronic Obstructive Pulmonary Disease (COPD) . The typical dosage for adults is 10mg tablet once daily in the evening, may be increased to 20mg after 1-2 weeks.

Contraindications: Hypersensitivity to any of the ingredients or terbutaline, Hepatic impairment liver, cirrhosis or severely impaired liver function. Special Precautions: Dose should be reduced in patient with severely impaired renal function; care should be taken while prescribing bambuterol in patients with genetic deficiencies of plasma cholinesterase, caution should be implemented in patients with severe ischaemic heart failure. In case of Pregnancy and lactation: it is not recommended. Side effects include Tremor, headache, muscle cramps, palpitation, fatigue and insomnia. Generally, these effects were mild in nature and their incidence decreased with time.

Drug Interactions: Bambuterol reversibly inhibits plasma cholinesterase which prolongs the neuromuscular blockade induced by succinylcholine by upto four times. Hypertensive crisis and other adverse effects occur frequently with the concur rent use of bambuterol with monoamine oxidase inhibitors, bambuterol may partly or totally inhibit
the effect of p-blockers.

SALMETEROL is a selective long acting beta -2 adrenoceptor agonist. Provides effective protection against histamine induced bronchodilation . Its effect lasts for as much as 12hrs. Salmeterol is marketed  by GlaxoSmithKline under the brand name SEREVENT . The other popular inhaler Advair is a salmeterol fluticasone formulation.

Salmeterol is used in the treatment of chronic obstructive pulmonary disease (copd) and reversible airways obstructions in asthma. It is available as metered dosage inhaler. Dosage: For Adults: 2 inhalations (50 microgram) twice daily. And for Severe airway obstruction: 4 inhalations (100 micrograms) twice daily.

Contra-1ndlcations of Salmeterol include Hypersensitivity. Special precautions to be taken in patients  and their lung function should be monitored while taking Salmeterol  as it is not a replacement for oral or inhaled corticosteroids but use is complimentary to them. Salmeterol is not designed to relieve acute asthma symptoms. Serevent/ Salmeterol inhalers not recommended for children under 4 years and in Pregnant women & those lactating it should be used only when clearly indicated.
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Side effects of Salmeterol include Tremor, tachycardia, subjective palpitations and headache. Salmeterol has Drug Interactions with steroid and Diuretics causing Hypokalemia. Its Effects are antagonized by non-selective betablockers and less so by cardioselective betablockers.  It also has potentiation of vascular effects with MAOIs and tricyclic antidepressants. In November of 2005, the American FDA released a health advisory alerting the public to findings that show the use of Long-acting ß2-agonists like Salmeterol could lead to a worsening of symptoms, and in some cases death.

 Lovastatin belongs to statin class of drugs and is used for lowering cholesterol (hypolipidemic agent). Lovastatin is absorbed from GIT.   It under goes extensive first pass metabolism in liver which is it’s primary site of action.    It is highly bound to plasma protein.    Absorption is reduced by approxi 30% in empty stomach than with food. Lovastatin  is available under brand names like Mevacor, Advicor, Altocor , Altoprev and Statosan.

Lovastatin inhibits 3-hydroxy-3methylglutaryl-coenzyme A reductase (HMG-CoA reductase). It is the enzyme which catalyzes the conversion of HMG-CoA to mevalonate which is a required building block for cholesterol biosynthesis. Lovastatin effectively interferes with its production by acting as a competitive inhibitor for HMG-CoA which binds to the HMG-CoA reductase. Lovastatin, is inactive in the native form, the form in which it is administered. It  is hydrolysed to the β-hydroxy acid form in the body and it becomes active only in this form.

Lovastatin is eliminted primarily through fecal route which is the 83% of orally administered dose, 10% of drug is eliminated by renal route. Indication : As an adjunct to diet for the reduction of elevated total & LDL cholesterol in patients of primary hypercholesterolemia, for reduction of elevated  LDL cholesterol levels in patients with combined  hypercholesterolemia  and hypertriglyceridemia.

 Dosage : 10-80 mg/day in single or divided doses. Contraindications of Lovastatin include Hypersensitivity, Active liver disease or unexplained persistent elevations of serum, transaminases, pregnancy & nursing. Special Precaution has to be taken during : Pregnancy & Lactation.

Side effects of Lovastatin are  : Flatulence, diarrhoea, constipation, nausea, abdominal pain, cramps, dyspepsia, heart burn,  dysgeusia,  myopathy,        myalgia, rhabdbmyolysis, blurred vision, headache, dizziness, rashes, impotence, insomnia.

Lovastatin  has Drug interactions  with Anticoagulants, coumarin-or indandione derivative, HMG-COA reductase inhibitors,   cyclosporine   erythromycin,   Gemfibrozil, immunosuppresants or niacin.