page199
tion;
CHILD
5–12 years, 50 micrograms (2 puffs or 1
blister) twice daily
Chronic obstructive pulmonary disease 50 micr-
ograms (2 puffs or 1 blister) twice daily
Counselling
Advise patients that salmeterol
should not be
used for relief of acute attacks, not to exceed prescribed
dose, and to follow manufacturer’s directions; if a previously
effective dose of inhaled salmeterol fails to provide adequate
relief, a doctor’s advice should be obtained as soon as
possible
Serevent
c
(A&H) A
Accuhaler
c
(dry powder for inhalation),
disk con-
taining 60 blisters of salmeterol (as xinafoate)
50 micrograms/blister with
Accuhaler
c
device,
net
price = £29.26.
Counselling,
administration
Evohaler
c
aerosol inhalation
T,
salmeterol (as
xinafoate) 25 micrograms/metered inhalation,
net
price 120-dose unit = £29.26.
Counselling,
adminis-
tration
Diskhaler
c
(dry powder for inhalation),
disks con-
taining 4 blisters of salmeterol (as xinafoate)
50 micrograms/blister,
net price 15 disks with
Dis-
khaler
c
device = £35.79,
15-disk refill = £35.15.
Counselling,
administration
Compound preparations
For compound preparations containing salmeterol,
see section 3.2
TERBUTALINE SULPHATE
Indications
asthma and other conditions associated
with reversible airways obstruction; premature labour
(section 7.1.3)
Cautions
see notes above
Pregnancy
see p.
170
Breast-feeding
see p.
170
Side-effects
see notes above
Dose
. By mouth (but use by inhalation preferred),
initially
2.5 mg 3 times daily for 1–2 weeks, then up to 5 mg 3
times daily;
CHILD
1 month–7 years 75 micrograms/kg
3 times daily;
7–15 years 2.5 mg 2–3 times daily
. By subcutaneous
or
slow intravenous injection, 250–
500 micrograms up to 4 times daily;
CHILD
2–15 years
10 micrograms/kg to a max.
of 300 micrograms
. By continuous intravenous infusion as a solution
containing 3–5 micrograms/mL,
90–300 micr-
ograms/hour for 8–10 hours;
CHILD
1 month–18 years,
initially 2–4 micrograms/kg as a loading dose, then 1–
10 micrograms/kg/hour according to response and
heart rate (max. 300 micrograms/hour);
high doses
with close monitoring
.
By inhalation of powder (
Turbohaler
c
),
ADULT
and
CHILD
over 5 years, 500 micrograms (1 inhalation); for
persistent symptoms up to 4 times daily (but see
Management of Chronic Asthma table,
p.
172)
. By inhalation of nebulised solution (but see also
Management of Acute Asthma table, p.
173), 5–10 mg
2–4 times daily; additional doses may be necessary in
severe acute asthma;
CHILD
under 5 years 5 mg 2–4
times daily,
5–12 years 5–10 mg 2–4 times daily
[unlicensed dose]
Oral and parenteral
Bricanyl
c
(AstraZeneca) A
Tablets
,
scored,
terbutaline sulphate 5 mg,
net price
100- tab pack= £4.09
Syrup
,
sugar-free,
terbutaline sulphate 1.5 mg/5 mL,
net price 100 mL = £2.00
Injection
,
terbutaline sulphate 500 micrograms/mL,
net price 1-mL amp = 30p;
5-mL amp = £1.40
Inhalation
Counselling
Advise patients not to exceed prescribed dose
and to follow manufacturer’s directions; if a previously
effective dose of inhaled terbutaline fails to provide at least 3
hours relief, a doctor’s advice should be obtained as soon as
possible
Bricanyl
c
(AstraZeneca) A
Turbohaler
c
(= dry powder inhaler),
terbutaline
sulphate 500 micrograms/metered inhalation,
net
price 100-dose unit = £6.92.
Counselling,
administra-
tion
Respules
c
(= single-dose units for nebulisation),
terbutaline sulphate 2.5 mg/mL, net price 20 2-mL
units (5-mg) = £4.04
3.1.1.2
Other adrenoceptor agonists
Ephedrine is less suitable and less safe for
use as a
bronchodilator
than
the
selective
beta
2
agonists,
because it
is
more likely to cause arrhythmias
and
other side-effects;
it should be avoided whenever pos-
sible.
Adrenaline (epinephrine) injection (1 in 1000) is used
in the emergency treatment of
acute allergic and ana-
phylactic reactions (section 3.4.3),
in angioedema (sec-
tion 3.4.3),
and in cardiopulmonary resuscitation (sec-
tion 2.7.3).
Adrenaline solution (1 in 1000)
is used by
nebulisation in the management of
severe croup (sec-
tion 3.1).
EPHEDRINE HYDROCHLORIDE U
Indications
reversible airways obstruction,
but see
notes above
Cautions
hyperthyroidism; diabetes mellitus;
ischaemic heart disease;
hypertension;
elderly;
pro-
static hypertrophy (risk of acute retention);
interac-
tions: Appendix 1 (sympathomimetics)
Renal impairment
use with caution
Pregnancy
manufacturer advises avoid
Breast-feeding
present in milk; manufacturer advises
avoid—irritability and disturbed sleep reported
Side-effects
tachycardia; anxiety,
restlessness,
insomnia; tremor,
arrhythmias,
dry mouth,
and cold
extremities also reported
Dose
. 15–60 mg 3 times daily;
CHILD
up to 1 year 7.5 mg 3
times daily, 1–5 years 15 mg 3 times daily, 6–12 years
30 mg 3 times daily
1
Ephedrine Hydrochloride
(Non-proprietary) A U
Tablets
,
ephedrine hydrochloride 15 mg,
net price 28
= £6.62;
30 mg,
28 = £10.01
1.
For exemptions see
Medicines, Ethics and Practice
, No. 34,
London,
Pharmaceutical Press,
2010 (and subsequent
editions as available)
3.1.2
Antimuscarinic
bronchodilators
Ipratropium can provide short-term relief
in chronic
asthma, but short-acting beta
2
agonists act more quickly
and are preferred.
Ipratropium by nebulisation can be
added to other
standard treatment
in life-threatening
asthma or if acute asthma fails to improve with standard
BNF 61
3.1.2 Antimuscarinic bronchodilators
179
3
Respiratory system