HealthCare

Orciprenaline also known as metaproterenol is a bronchodilator used in the treatment of asthma. Orciprenaline is a moderately selective beta2-adrenergic receptor agonist that stimulates receptors of the smooth muscle in the lungs, uterus, and vasculature supplying skeletal muscle, with minimal or no effect on alpha-adrenergic receptors. The pharmacologic effects of beta adrenergic agonist drugs, such as orciprenaline, are at least in part attributable to stimulation through beta adrenergic receptors of intracellular adenyl cyclase, the enzyme which catalyzes the conversion of ATP to cAMP. Increased cAMP levels are associated with relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from many cells, especially from mast cells.

Pirbuterol commercially available as Maxair is a beta-2 adrenergic bronchodilator used in the treatment of asthma, available (as perbuterol acetate) as a breath-activated metered-dose inhaler. MAXAIR AUTOHALER is a pressurized metered-dose aerosol unit for oral inhalation. It provides a fine-particle suspension of maxair acetate in the propellant mixture of trichioro-monofluoromethane and dichlorodifluoromethane, with sorbitan trioleate. Each actuation delivers 253 mcg of maxair (as maxair acetate) from the valve and 200 mcg of maxair (as maxair acetate) from the mouthpiece. The unit is breath-actuated such that the medication is delivered automatically during inspiration without the need for the patient to coordinate actuation with inspiration.

Maxair is used to treat wheezing and shortness of breath that commonly occur with lung problems (e.g., asthma, chronic obstructive pulmonary disease-COPD). Controlling these symptoms can decrease time lost from work or school. maxair is a bronchodilator (beta-2 receptor agonist) that works by opening breathing passages to make breathing easier. This medicine comes in an inhaler that automatically releases a puff of medicine when you inhale. The inhaler allows the drug to reach deep into the lungs for the most benefit. Because this type of inhaler is used differently than other types, be sure to follow directions closely.

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Indacaterol is an ultra long acting beta-adrenoceptor agonist currently undergoing research. It needs only be taken once a day, unlike the currently available Formoterol and Salmeterol. Such drugs are used in the treatment of chronic obstructive pulmonary disease and asthma.

Indacaterol by Novartis is an effective and well-tolerated treatment of asthma and chronic obstructive pulmonary disease (COPD) over 24 hours with a rapid onset of action. The combination of 24-hour efficacy and a reassuring safety profile suggests that in time, a once-daily dose of indacaterol could become a new standard of care for bronchodilation in asthma and COPD. Indacaterol could be the first beta2-agonist to be taken only once-daily providing full 24 hour symptom control with a single administration, in contrast to currently-available long-acting beta2-agonists (LABAs) such as salmeterol and formoterol which have to be taken twice-daily.

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Xopenex as a bronchodilator is used to treat asthma and COPD. In general, xopenex has similar pharmacokinetic and pharmacodynamic properties to albuterol; however, its manufacturer, Sepracor, has implied (although not directly claimed) that the presence of only the R-enantiomer produces fewer side effects.

Physicians sometimes elect to use xopenex in patients with a history of supraventricular tachycardia or other arrhythmias because it is thought that xopenex may produce less direct effects on beta-adrenergic receptors in the heart. For similar reasons, some pediatricians also use xopenex for patients who experience hyperactivity or jitteriness from racemic albuterol.

The use of xopenex over the more traditionally used racemic albuterol is controversial among health care professionals. That using xopenex instead of albuterol produces less direct effect on beta adrenergic receptors and/or fewer cardiac side effects has been suggested, but not consistently demonstrated by long term, well-designed clinical trials.

There are differing opinions on whether there is sufficient therapeutic benefit to using xopenex that outweighs the 5-10 times higher price tag. In general, it appears that if a clinician and patient feel that a low dose of racemic mixture is causing undesirable side effects, xopenex may be a viable alternative. xopenex was originally available only as a solution for nebulizer and eventually become available as a CFC-free metered dose inhaler under the trade name Xopenex HFA (xopenex tartrate) Inhalation Aerosol.

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DOXOFYLLINE is a  Methylxanthines group of drug which are phosphodiesterase inhibitors. The other type of methylxanthines are caffeine, theobromine, as well as, theophylline. Doxofylline is a new generation long acting oral methylxanthine derivative. The bronchodilating activities of doxofylline have been clearly demonstrated in  patients with either bronchial asthma or chronic obstructive pulmonary disease ( COPD). Unlike other bronchodilators doxofylline does not have of direct stimulatory effects. This is import because the arrhythmogenic actions of bronchodilators may have a negative impact on the survival of patients with respiratory diseases. Currently Methylxanthines are used as second line of treatment for Asthma.

Doxofylline  Methylxanthines is used for the maintenance therapy in patients suffering with Asthma and Chronic Obstructive Pulmonary Disease (COPD). The normal dosage for adult is 400mg once a day. Single dose administration in the evening reduces nocturnal symptoms and helps to keep the patients complaint free during the day. However in certain cases 400mg twice daily is recommended on the basis of the clinical response.

Contraindications of Doxofylline  Methylxanthines include Hypersensitivity,doxofulline and other methylxanthine derivatives.Methylxanthines are not recommended for therapy for asthma exacerbations.

There are no major Side effects and warnings of Doxofylline  Methylxanthines. It has has a prolonged

bronchodilator effects,and unlike theophylline it has least adenosine interactions. It has no CNS and

CVS side effects.There is no sleep disturbances and no effects on gastric secretions with doxofylline.It is highly safe in smokers. The side effects of doxofylline are similar to taking excess amount of caffeine. The common side effects are Stomach upset, Heartburn,Trouble sleeping (insomnia), Headache, Nervousness or irritability, Rapid heart rate (tachycardia) and Rapid breathing (tachypnea).People taking doxofulline  medication may be able to reduce these side effects by avoiding caffeine.Serious (toxic) side effects are seen in some people like Nausea and vomiting.,Seizures,Low blood sugar and  Irregular heartbeat (arrhythmia).

• Tiotropium Bromide is a long-acting specific Muscarinic receptor antagonist. It is commercially available under brand name Spiriva. Boehringer Ingelheim Pharmaceuticals holds the patent for Spiriva. Tiotropium Bromide opens the respiratory tract and makes breathing easier. Tiotropium acts on the lungs, where it blocks muscarinic receptors on the muscle surrounding the airways.  The natural chemical in the body the Acetylcholine normally acts on these receptors, causing the muscle in the airways to constrict and the airways to narrow. In chronic obstructive lung diseases (COPD), the airways are narrowed, and this makes breathing in and out difficult. Tiotropium blocks the muscarinc receptors in the lungs and therefore stops the action of acetylcholine on them.

 
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This allows the muscle around the airways to relax and the airways to open. This makes it easier for people with COPD to breathe. Tiotropium is taken using an inhaler device and inhaling the medicine allows it to act directly in the lungs where it is needed most. It also reduces the potential for side effects in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if it is taken by mouth.

 Tiotropium should not be used to relieve an attack of breathing difficulty. Instead, it should be used regularly each day to keep the airways open and help prevent breathing difficulties. The medicine works over 24 hours so it is best to always take it at the same time of day.Spiriva is indicated in Chronic obstructive     pulmonary disease (COPD). The normal dosage is Inhalation of the contents of one rotacap once daily.

Titropium is contraindicated in Hypersensitivity. Special Precautions: Spiriva should not be used for the initial treatment of acute episodes of bronchospasm, i.e., rescue therapy.. It Should not be used in pregnant or nursing women. Side effects of Spiriva include dry mouth, dry throat, increased heart rate, blurred vision, glaucoma, urinary difficulty, urinary retention, narrow-angle glaucoma, prostatic hyperplasia or bladder-neck obstruction and constipation.

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.