Ipraterol-aeronative aerosol for inhalation 20mcg+50mcg 200 doses buy in Moscow at a price of 388 rubles

Buy Ipraterol-aeronative aerosol for inhalation 20mcg+50mcg 200 doses in pharmacies

Trade name of the drug:

Ipraterol-aeronative.

International non-proprietary non-proprietary or generic name:

ipratropium bromide + fenoterol.

Composition for 1 dose:

Active ingredients:

Ipratropium bromide 0.021 mg monohydrate (in terms of ipratropium bromide) (0.020 mg) Fenoterol hydrobromide 0.050 mg

Excipients:

Absolute ethanol 15.300 mg Citric acid monohydrate 0.005 mg; Triethyl citrate 0.150 mg; Propellant R 134a (1,1,1,2-tetrafluoroethane) 44.470 mg

Pharmacological properties

Pharmacodynamics

The drug Ipraterol-aeronativ contains two components with bronchodilator activity: ipratropium bromide, an m-anticholinergic blocker, and fenoterol, a β2-adrenergic agonist.

Bronchodilation following inhaled ipratropium bromide is due primarily to local rather than systemic anticholinergic effects.

Ipratropium bromide is a quaternary ammonium derivative with anticholinergic (parasympatholytic) properties. Ipratropium bromide inhibits reflexes caused by the vagus nerve. Anticholinergics prevent an increase in the intracellular concentration of calcium ions, which occurs due to the interaction of acetylcholine with muscarinic receptors of bronchial smooth muscles. The release of calcium ions is mediated by a system of secondary mediators, which include inositol triphosphate (ITP) and diacylglycerol (DAG).

In patients with bronchospasm associated with chronic obstructive pulmonary diseases (chronic bronchitis and emphysema), significant improvement in lung function (increase in forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) by 15% or more) is observed within 15 minutes, the maximum effect is achieved after 1-2 hours and lasts in most patients up to 6 hours after administration.

Ipratropium bromide does not have a negative effect on mucus secretion in the respiratory tract, mucociliary clearance and gas exchange.

Fenoterol selectively stimulates β2-adrenergic receptors at a therapeutic dose. Stimulation of β1-adrenergic receptors occurs when high doses are used. Fenoterol relaxes the smooth muscles of the bronchi and blood vessels and counteracts the development of bronchospastic reactions caused by the influence of histamine, methacholine, cold air and allergens (immediate hypersensitivity reactions). Immediately after administration, fenoterol blocks the release of mediators of inflammation and bronchial obstruction from mast cells. In addition, when using fenoterol in doses of 0.6 mg, an increase in mucociliary clearance was noted.

The β-adrenergic (stimulating β-adrenergic receptors) effect of the drug on cardiac activity, such as an increase in the frequency and strength of heart contractions, is due to the vascular effect of fenoterol, stimulation of β2-adrenergic receptors of the heart, and when using doses exceeding therapeutic doses, stimulation of β1-adrenergic receptors. As with the use of other β-adrenergic drugs, a prolongation of the QTc interval is observed when using high doses. When fenoterol was used via metered-dose aerosol inhalers (MDIs), the effect was inconsistent and occurred at doses higher than recommended. However, following administration of fenoterol via nebulizers (inhalation solution in unit dose vials), systemic exposure may be higher than when using the drug via a MDI at recommended doses. The clinical significance of these observations has not been established. The most commonly reported effect of β-adrenergic agonists is tremor. In contrast to the effects on bronchial smooth muscle, tolerance may develop to the systemic effects of β-adrenergic receptor agonists; the clinical significance of this manifestation is not clear. Tremor is the most common adverse effect with β-adrenergic agonists. When these two active substances are used together, the bronchodilator effect is achieved by acting on various pharmacological targets. These substances complement each other; as a result, the antispasmodic effect on the bronchial muscles is enhanced and a greater breadth of therapeutic action is provided for bronchopulmonary diseases accompanied by constriction of the airways. The complementary effect is such that to achieve the desired effect, a lower dose of the β-adrenergic component is required, which allows you to individually select an effective dose with virtually no side effects.

Fenoterol relaxes the smooth muscles of the bronchi and blood vessels and counteracts the development of bronchospastic reactions caused by the influence of histamine, methacholine, cold air and allergens (immediate hypersensitivity reactions). Immediately after administration, fenoterol blocks the release of inflammatory and bronchoconstrictive mediators from mast cells. In addition, when using fenoterol in doses of 0.6 mg, an increase in mucociliary clearance is observed.

Tremor is the most common adverse effect with β-adrenergic agonists. In contrast to the effects on bronchial smooth muscle, tolerance may develop to the systemic effects of β-adrenergic agonists, but the clinical significance of this phenomenon has not been identified.

When ipratropium bromide and fenoterol are used together, the bronchodilator (bronchodilator) effect is achieved by acting on various pharmacological targets. These active substances complement each other, as a result, the antispasmodic effect on the bronchial muscles is enhanced and a greater breadth of therapeutic action is provided for bronchopulmonary diseases accompanied by airway obstruction. The complementary effect is such that to achieve the desired effect, a lower dose of the β-adrenergic component is required, which allows you to individually select an effective dose with a virtually complete absence of adverse reactions.

In acute bronchoconstriction, the effect of the drug develops quickly, which allows its use in acute attacks of bronchospasm.

Pharmacokinetics

There is no evidence that the pharmacokinetics of a combination product containing ipratropium bromide and fenoterol differs from that of each of the individual components.

Suction

When administered via inhalation, ipratropium bromide is characterized by extremely low absorption from the mucous membrane of the respiratory tract. The concentration of ipratropium bromide in blood plasma is at the lower limit of definition, and it can only be measured when using high doses of the active substance. After inhalation, 10-30% of the administered dose of ipratropium bromide usually enters the lungs (depending on the dosage form and method of inhalation). Most of the dose is swallowed and enters the gastrointestinal tract.

The portion of the dose of ipratropium bromide that enters the lungs quickly reaches the systemic circulation (within a few minutes). Total renal excretion (over 24 hours) of the parent compound is approximately 46% of the intravenous dose, less than 1% of the oral dose, and approximately 3-13% of the inhalation dose. Based on these data, it is calculated that the total systemic bioavailability of ipratropium bromide administered by inhalation is 2% and 7-28%, respectively.

Kinetic parameters describing the distribution of ipratropium bromide were calculated based on its plasma concentrations after intravenous administration. A rapid two-phase decrease in plasma concentration is observed. The apparent volume of distribution during steady state (Css) is approximately 176 L (≈ 2.4 L/kg). The drug binds to plasma proteins to a minimal extent (less than 20%). Ipratropium bromide, which is a quaternary amine, does not penetrate the blood-brain barrier. The half-life during the terminal phase is approximately 1.6 hours.

The total clearance of ipratropium bromide is 2.3 l/min, and the renal clearance is 0.9 l/min. After intravenous administration, approximately 60% of the dose is metabolized by oxidation, mainly in the liver. Cumulative renal excretion (over 6 days) of the isotopically labeled dose (including parent compound and all metabolites) was 72.1% after intravenous administration, 9.3% after oral administration, and 3.2% after inhalation administration. The total isotope-labeled dose excreted through the intestine was 6.3% after intravenous administration, 88.5% after oral administration, and 69.4% after inhalation administration. Thus, excretion of the isotope-labeled dose after intravenous administration occurs primarily through the kidneys. The half-life of the parent compound and metabolites is 3.6 hours. The main metabolites excreted in the urine bind weakly to muscarinic receptors and are considered inactive.

Depending on the method of inhalation and the inhalation system used, about 10-30% of fenoterol reaches the lower respiratory tract, and the rest is deposited in the upper respiratory tract and swallowed. As a result, some amount of inhaled fenoterol enters the gastrointestinal tract. Absorption is biphasic - 30% of fenoterol is rapidly absorbed with a half-life (T1/2) of 11 minutes, and 70% is absorbed slowly with a T1/2 of 120 minutes. There is no correlation between fenoterol plasma concentrations achieved after inhalation and the pharmacodynamic time-effect curve. The long-term (3-5 hours) bronchodilator effect of the drug after inhalation, comparable to the corresponding effect achieved after intravenous administration, is not supported by high concentrations of fenoterol in the systemic circulation. After oral administration, about 60% of fenoterol is absorbed. The time to reach maximum concentration in blood plasma is 2 hours.

Distribution

Ipratropium bromide, a quaternary amine, is poorly soluble in fats and poorly penetrates biological membranes. Does not accumulate. Ipratropium bromide binds to plasma proteins to a minimal extent (less than 20%). There is no data on the possibility of ipratropium bromide passing through the placental barrier and into breast milk.

Fenoterol is intensively distributed throughout organs and tissues. The connection with blood plasma proteins is 40-55%. Fenoterol, unchanged, penetrates the placental barrier and is excreted in breast milk.

Metabolism

Ipratropium bromide is metabolized by oxidation primarily in the liver. Up to 8 metabolites of ipratropium bromide are known, which weakly bind to muscarinic receptors and are considered inactive.

Fenoterol is metabolized in the liver. After 24 hours, 60% of the intravenously administered dose and 35% of the oral dose are excreted in the urine. This proportion of fenoterol undergoes biotransformation due to the “first pass” effect through the liver, as a result of which the bioavailability of the drug after oral administration drops to approximately 1.5%. This explains the fact that the ingested amount of the drug has virtually no effect on the concentration of the active substance in the blood plasma achieved after inhalation. The biotransformation of fenoterol in humans occurs primarily through conjugation with sulfates in the intestinal wall.

Removal

Ipratropium bromide is excreted primarily through the intestines and also through the kidneys. About 25% is excreted unchanged, the rest in the form of metabolites.

Fenoterol is excreted by the kidneys and bile in the form of inactive sulfate conjugates. When administered parenterally, fenoterol is excreted according to a three-phase model with half-lives of 0.42 minutes, 14.3 minutes and 3.2 hours.

Pharmacokinetics in selected patient groups

The pharmacokinetics of a combination drug containing ipratropium bromide and fenoterol in patients with diabetes mellitus, elderly and older patients, children, as well as in patients with impaired liver and kidney function.

Indications for use

Chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, bronchial asthma (mild to moderate severity).

Carefully

The drug Ipraterol-aeronativ should be used with caution in patients with diseases such as angle-closure glaucoma, arterial hypertension, diabetes mellitus, recent myocardial infarction (within the last 3 months), heart and vascular diseases such as chronic heart failure, coronary heart disease , arrhythmias, aortic stenosis, severe lesions of the cerebral and peripheral arteries, hyperthyroidism, pheochromocytoma, prostatic hyperplasia, bladder neck obstruction, cystic fibrosis, II and III trimesters of pregnancy, breastfeeding period. The drug Ipraterol-aeronativ should be used with caution in children and adolescents aged 6 to 18 years.

Use during pregnancy and breastfeeding

Data from preclinical studies and existing clinical experience with the use of a combination of fenoterol and ipratropium bromide have shown that the active ingredients included in the combination drug do not have a negative effect during pregnancy. The possibility of an inhibitory effect of fenoterol on uterine contractility should be taken into account. The drug Ipraterol-aeronativ is contraindicated in the first trimester of pregnancy (possible weakening of labor). The drug Ipraterol-aeronativ should be used with caution in the second and third trimesters of pregnancy.

Fenoterol passes into breast milk. Data confirming that ipratropium bromide passes into breast milk have not been obtained. The safety of the drug during breastfeeding has not been established. In this regard, the use of the drug Ipraterol-aeronativ during breastfeeding is possible only if the potential benefit to the mother outweighs the potential risk to the child.

Directions for use and doses

The dose should be selected individually.

Unless otherwise directed by a physician, the following doses are recommended:

Adults and children over 6 years old

Treatment of attacks

In most cases, two inhalation doses of the aerosol are sufficient to relieve symptoms. If breathing relief does not occur within 5 minutes, you can use an additional 2 inhalation doses.

If there is no effect after 4 inhalation doses and additional inhalations are required, seek immediate medical attention.

Intermittent and long-term therapy

1-2 inhalations per dose, up to 8 inhalations per day (on average 1-2 inhalations 3 times a day). For bronchial asthma, the drug should be used only as needed.

The drug Ipraterol-aeronativ should be used in children only as prescribed by a doctor and under the supervision of adults (see section “Special instructions”).

Instructions for inhalation

Patients should be instructed on the correct use of the metered dose aerosol.

The drug Ipraterol-aeronativ is intended for inhalation use only.

Before using the inhaler for the first time or if the inhaler has not been used for a week or longer, check its operation. To do this, remove the protective cap from the mouthpiece of the inhaler, shake the inhaler well and press the balloon, releasing one stream of the drug into the air.

Carrying out inhalation

Step 1. Remove the protective cap from the inhaler mouthpiece as shown in Figure 1. Step 2. Shake the inhaler vigorously. Step 3: Exhale slowly and completely. Do not exhale into the inhaler! Step 4: Hold the balloon as shown in Figure 2 and wrap your lips tightly around the mouthpiece. The cylinder must be pointing upside down! Step 5. Inhale as deeply as possible, while quickly pressing the bottom of the balloon until one inhalation dose is released. Step 6: Hold your breath for a few seconds, then remove the mouthpiece from your mouth and exhale slowly through your nose. Step 7. Place the protective cap on the inhaler mouthpiece.

Repeat steps 2–6 for a second inhalation dose, if necessary.

Cleaning the inhaler

The inhaler mouthpiece should be cleaned regularly (once a week).

Remove the metal can from the plastic case and rinse the case and cap with warm water. Do not use hot water. Dry thoroughly, but do not use heating devices. Place the can back into the case and put on the cap. Do not immerse the metal can in water.

The cylinder is designed for 200 inhalations. After this, the cylinder should be replaced.

The use of the drug in children should be supervised by adults.

It is recommended to pinch the child's nostrils to prevent inhalation through the nose during inhalation.

Warning: the plastic mouthpiece is designed specifically for the drug Ipraterol-aeronativ and serves for precise dosing of the drug. The mouthpiece should not be used with other metered dose aerosols. Also, you cannot use the drug Ipraterol-aeronativ with any other adapters, except for the mouthpiece supplied with the drug.

The contents of the cylinder are under pressure. The cylinder must not be opened and heated above 50 °C!

Side effect

Many of the listed adverse reactions may be a consequence of the anticholinergic and β-adrenergic properties of the drug Ipraterol-aeronativ. The use of the drug Ipraterol-aeronativ, like any inhalation therapy, can cause local irritation.

The most common adverse reactions are cough, dry mouth, headache, tremor, pharyngitis, nausea, dizziness, dysphonia, tachycardia, palpitations, vomiting, increased systolic blood pressure and nervousness.

The adverse reactions presented below are listed according to the damage to organs and organ systems and the frequency of occurrence. The incidence of adverse reactions is estimated as follows:

very common - ≥ 1/10, common - ≥ 1/100 and uncommon - ≥ 1/1,000 and rare - ≥ 1/10,000 and very rare - unspecified frequency (cannot be calculated from the available data). occurring “very often” – > 10%; “often” – > 1% and 0.1% and 0.01% and

Immune system disorders: rarely - hypersensitivity reactions, anaphylactic reactions. Metabolic and nutritional disorders: rarely – hypokalemia, metabolic acidosis. Mental disorders: infrequently – nervousness; rarely – anxiety, mental disturbances. Nervous system disorders: uncommon – headache, dizziness, tremor. Visual disorders: rarely - glaucoma, increased intraocular pressure, impaired accommodation, mydriasis, blurred vision, eye pain, corneal edema, conjunctival hyperemia, the appearance of a halo around objects and colored spots before the eyes. Cardiac disorders: uncommon – tachycardia, palpitations; rarely - arrhythmias, atrial fibrillation, supraventricular tachycardia, myocardial ischemia. Disorders of the respiratory system, chest and mediastinal organs: often – cough; uncommon – pharyngitis, dysphonia; rarely - bronchospasm, pharyngeal irritation, pharyngeal edema, laryngospasm, paradoxical bronchospasm, dry throat. Gastrointestinal disorders: uncommon – vomiting, dry mouth, nausea; rarely - stomatitis, glossitis, gastrointestinal motility disorders, diarrhea, constipation, swelling of the oral cavity. Disorders of the skin and subcutaneous tissues: rarely - urticaria, skin rash, itching, angioedema, increased sweating. Musculoskeletal and connective tissue disorders: rarely - muscle weakness, myalgia, muscle spasm. Renal and urinary tract disorders: rarely – urinary retention. Laboratory and instrumental data: infrequently - increased systolic blood pressure; rarely – increased diastolic blood pressure.

Overdose

Symptoms

Symptoms of overdose are usually related to the effects of fenoterol. Symptoms may appear due to excessive stimulation of β-adrenergic receptors. The most likely occurrence is tachycardia, palpitations, tremor, arterial hypertension or hypotension, an increase in the difference between systolic and diastolic blood pressure, an increase in pulse pressure, increased angina pain, arrhythmias to the face, metabolic acidosis, hypokalemia, a feeling of heaviness in the chest, increased bronchial obstruction . Possible symptoms of an overdose of ipratropium bromide (such as dry mouth, impaired eye accommodation), given the wide breadth of the therapeutic effect of the drug and the local method of administration, are usually mild and transient in nature.

Treatment

It is necessary to stop taking the drug Ipraterol-aeronativ. Data from monitoring the acid-base balance of the blood should be taken into account. It is recommended to prescribe sedatives, anxiolytic drugs (tranquilizers), and in severe cases, intensive therapy.

As a specific antidote, it is possible to use β-blockers, preferably selective β1-blockers. However, one should be aware of the possible increase in bronchial obstruction under the influence of beta-blockers and carefully select the dose for patients with bronchial asthma or chronic obstructive pulmonary disease due to the risk of developing severe bronchospasm, which can be fatal.

Interaction with other drugs

Long-term simultaneous use of the drug Ipraterol-aeronativ with other anticholinergic drugs is not recommended due to the lack of data.

Concomitant use of other β-adrenomimetic and anticholinergic drugs, incl. systemic action, and xanthine derivatives (for example, theophylline) can enhance the bronchodilator effect of the drug Ipraterol-aeronativ and lead to increased adverse reactions.

It is possible to significantly weaken the bronchodilator effect of the drug Ipraterol-aeronativ with the simultaneous administration of β-blockers.

Hypokalemia associated with the use of β-adrenergic agonists can be enhanced by the simultaneous administration of xanthine derivatives, glucocorticosteroids and diuretics. This fact should be given special attention when treating patients with severe forms of obstructive airway diseases. Hypokalemia may lead to an increased risk of arrhythmias in patients receiving digoxin. In addition, hypoxia may enhance the negative effects of hypokalemia on heart rate. In such cases, it is recommended to monitor the concentration of potassium in the blood plasma.

Beta2-adrenergic drugs should be prescribed with caution to patients receiving monoamine oxidase inhibitors and tricyclic antidepressants, as these drugs can enhance the effect of beta-adrenergic drugs.

Inhalation of general anesthetics such as halogenated hydrocarbon anesthetics (halothane, trichlorethylene, enflurane) may increase the adverse cardiovascular effects of beta-adrenergic agents.

Combined use of the drug with cromoglycic acid and/or glucocorticosteroids increases the effectiveness of therapy.

Long-term simultaneous use of the drug Ipraterol-aeronativ with other anticholinergic drugs is not recommended due to the lack of data. Concomitant use of other β-adrenomimetic anticholinergics that enter the systemic circulation or xanthine derivatives (for example, theophylline) may lead to increased side effects. and anticholinergic drugs, incl. systemic action, and xanthine derivatives (for example, theophylline) can enhance the bronchodilator effect of the drug Ipraterol-aeronativ and lead to increased adverse reactions.

It is possible to significantly weaken the bronchodilator effect of the drug Ipraterol-aeronativ with the simultaneous administration of β-blockers.

Inhalation of general anesthetics such as halogenated hydrocarbon anesthetics and anesthetics. for example (halothane, trichlorethylene, enflurane) may increase the adverse effects of β-adrenergic drugs on the cardiovascular system.

Combined use of the drug with cromoglycic acid and/or glucocorticosteroids increases the effectiveness of therapy.

special instructions

If shortness of breath (difficulty breathing) suddenly increases rapidly, you should consult a doctor immediately.

In children, the drug Ipraterol-aeronativ should be used only as prescribed by a doctor and under the supervision of adults. Use in children under 6 years of age is contraindicated due to lack of experience with use.

Hypersensitivity

After using the drug Ipraterol-aeronativ, immediate hypersensitivity reactions may occur, signs of which in rare cases may include: urticaria, angioedema, rash, bronchospasm, oropharyngeal edema, anaphylactic shock.

Paradoxical bronchospasm

The drug Ipraterol-aeronativ, like other inhaled drugs, can cause paradoxical bronchospasm, which can be life-threatening. In case of development of paradoxical bronchospasm, the use of the drug Ipraterol-aeronativ should be stopped immediately and switched to alternative therapy.

Long-term use

- in patients with bronchial asthma, the drug Ipraterol-aeronativ should be used only as needed; in patients with mild COPD, symptomatic treatment may be preferable to regular use; - in patients suffering from bronchial asthma, one should remember the need to carry out or intensify anti-inflammatory therapy to control the inflammatory process of the respiratory tract and the course of the disease.

Regular use of increasing doses of drugs containing β2-adrenergic agonists, such as the drug Ipraterol-aeronativ, to relieve bronchial obstruction can cause uncontrolled worsening of the disease. In case of increased bronchial obstruction, increasing the dose of β2-adrenergic agonists, including the drug Ipraterol-aeronativ, more than recommended for a long period of time is not only not justified, but also dangerous. To prevent life-threatening worsening of the disease, a review of the patient's treatment plan and adequate anti-inflammatory therapy with inhaled glucocorticosteroids should be considered.

Other sympathomimetic bronchodilators should be prescribed concomitantly with Ipraterol-Aeronativ only under medical supervision.

Gastrointestinal disorders

In patients with a history of cystic fibrosis, gastrointestinal motility disorders are possible.

Visual disorders

The drug Ipraterol-aeronativ should be used with caution in patients predisposed to angle-closure glaucoma. There are isolated reports of complications from the organ of vision (for example, increased intraocular pressure, mydriasis, angle-closure glaucoma, eye pain) that developed when inhaled ipratropium bromide (or ipratropium bromide in combination with β2-adrenergic agonists) entered the eyes. Symptoms of acute angle-closure glaucoma may include pain or discomfort in the eyes, blurred vision, the appearance of a halo around objects and colored spots in front of the eyes, combined with swelling of the cornea and redness of the eyes due to conjunctival hyperemia. If any combination of these symptoms develops, the use of eye drops that reduce intraocular pressure and immediate consultation with a specialist is indicated. Patients should be instructed on the correct use of the inhaled drug Ipraterol-aeronativ. To prevent the solution from getting into the eyes, it is recommended that the solution used with a nebulizer be inhaled through the mouthpiece. If there is no mouthpiece, a mask that fits tightly to the face should be used. Patients predisposed to developing glaucoma should take special care to protect their eyes.

Systemic effects

For diseases such as recent myocardial infarction, diabetes mellitus with inadequate glycemic control, severe organic diseases of the heart and blood vessels, hyperthyroidism, pheochromocytoma or urinary tract obstruction (for example, with prostatic hyperplasia or bladder neck obstruction), Ipraterol-aeronative should Use only after a careful risk/benefit assessment, especially when using doses higher than recommended.

Effect on the cardiovascular system

There have been rare cases of myocardial ischemia when taking β2-adrenergic agonists. Patients with concomitant serious heart disease (for example, coronary heart disease, arrhythmias, or severe heart failure) receiving Ipraterol Aeronative should be warned to consult a doctor if they experience heart pain or other symptoms indicating worsening of heart disease. It is necessary to pay attention to symptoms such as shortness of breath and chest pain, as they can be of both cardiac and pulmonary etiology.

Hypokalemia

When using β2-agonists, hypokalemia may occur (see section "Overdose").

In athletes, the use of the drug Ipraterol-aeronativ due to the presence of fenoterol in its composition can lead to positive results of doping tests.

Impact on the ability to drive vehicles and machinery

There have been no studies of the effect of a combination drug containing ipratropium bromide and fenoterol on the ability to drive vehicles and operate machinery. Since the use of the drug may cause the development of such undesirable reactions as dizziness, nervousness, tremor, disturbance of eye accommodation, mydriasis and blurred vision, caution should be exercised when driving vehicles and machinery, as well as when engaging in other potentially hazardous activities that require increased concentration. and speed of psychomotor reactions.

IPRATEROL

Treatment with IPRATEROL, solution for inhalation should be started and carried out under medical supervision, for example in a hospital. Treatment at home may be prescribed in exceptional cases (severe symptoms or experienced patients taking high doses). Use should be discontinued when sufficient relief of symptoms is achieved.

The contents of the bottle should be used within 6 months after opening.

Adults and children over 12 years of age:

To treat an attack of bronchial obstruction, depending on the severity of the attack, it is recommended to use from 1 ml (24 drops) to 2.5 ml (60 drops), followed by dilution with saline to a volume of 3-4 ml.

In extremely severe cases, it is possible to use up to 4.0 ml (100 drops), followed by dilution with saline to a volume of 3-4 ml.

To prevent asthma attacks from physical exertion or when contact with an allergen is expected, it is recommended to use 0.1-0.2 ml (2-3 drops) 10-15 minutes before physical activity/contact, followed by dilution with 2-3 ml of saline.

Children from 6 to 12 years old:

To treat an attack of bronchial obstruction, depending on the severity of the attack, it is recommended to use from 0.5 ml (12 drops) to 2.0 ml (48 drops), followed by dilution with saline to a volume of 3-4 ml.

To prevent asthma attacks from physical exertion or when contact with allergens is expected, it is recommended to use 0.1-0.2 ml (2-3 drops) 10-15 minutes before physical activity/contact, followed by dilution with 2-3 ml of saline.

Children under 6 years old:

Due to the limited information on the use of the drug in this age group, treatment is carried out only under the supervision of a physician, prescribing the drug at the lowest dose of 0.1 ml (2 drops) per kg of body weight, up to a maximum of 0.5 ml (12 drops), with subsequent dilution with physiological solution to a volume of 3-4 ml. The recommended dose should be diluted with physiological saline solution to a final volume of 3-4 ml and administered by inhalation using a nebulizer until the solution runs out; inhalation will last about 6-7 minutes. The solution can also be used without dilution. The solution must be prepared each time before use; any remains must be destroyed.

The dosage may also depend on the method of administration of the drug and the characteristics of the nebulizer. When using particles with a size of 5 microns, a dose reduction is possible. The duration of inhalation can also be adjusted by the volume of dilution. The solution can be administered using a wide range of nebulizers. If oxygen tents are used, the recommended flow rate is 6-8 L/min.

If necessary, inhalation can be repeated at intervals of at least 4 hours.

Not recommended for use in children under 6 years of age

Unscrew the plastic cap.
Place the number of drops recommended by your doctor into the nebulizer chamber.
If directed by a doctor or pharmacist, add the prescribed amount of 0.9% sodium chloride to the nebulizer chamber and add this solution using a syringe.

4) Slowly rotate the nebulizer chamber to mix the liquids and attach the nebulizer to the mouthpiece or face mask, then connect the nebulizer to the air pump or oxygen source. 5) Start therapy. Sit up straight in a comfortable position. Breathe calmly and deeply through the mask or mouthpiece until steam stops forming in the nebulizer chamber. This usually takes up to 10-15 minutes. It is important to select a mask to prevent steam from getting into your eyes.6) Follow the instructions supplied with the nebulizer and air pump to ensure proper cleaning and maintenance of the equipment. Keep the nebulizer, nebulizer chamber, and face mask clean to minimize microbial contamination.7) Store the medicinal product at a temperature not exceeding 25°C. You must remember: · IPRATEROL inhalation solution is prescribed to treat your specific condition. Do not give this medicine to other people. · Do not take any other medicines without a doctor's prescription. Tell your doctor, dentist or pharmacist that you are taking IPRATEROL, inhalation solution. The solution should be used with a nebulizer. Do not inject or take the solution orally. · Do not allow steam from the nebulizer to get into your eyes. Patients with glaucoma should use a mouthpiece or goggles to prevent vapors from entering the eyes. · Keep medications away from children. Overdose: In case of overdose, consult a doctor or the nearest emergency room (do not drive yourself). Take the labeled bottle of medication with you. Missed dose: If you miss a dose, do not worry. Take your next dose on your regular schedule. Do not double the dose.