Bronchodilators, Adrenergic (Inhalation)

Proper Use of This Medicine

These medicines come with patient directions. Read them carefully before using the medicine . If you do not understand the directions or if you are not sure how to use the medicine, ask your health care professional to show you what to do. Also, ask your health care professional to check regularly how you use the medicine to make sure you are using it properly.

Use this medicine only as directed. Do not use more of it and do not use it more often than recommended on the label, unless otherwise directed by your doctor . Using the medicine more often may increase the chance of serious unwanted effects. Deaths have occurred when too much inhalation bronchodilator medicine was used.

Keep the spray away from your eyes because it may cause irritation.

Salmeterol and formoterol are used to prevent asthma attacks. They are not used to relieve an attack that has already started . For relief of an asthma attack that has already started, you should use another medicine (not formoterol) that starts working faster than salmeterol does. If you do not have another medicine to use for an attack or if you have any questions about this, check with your doctor . Because the effects of salmeterol and formoterol usually last about 12 hours, doses should never be taken more than two times a day or less than 12 hours apart.

Some epinephrine preparations are available without a doctor's prescription. However, do not use this medicine unless you are seeing a doctor about asthma. Do not use this medicine if you have been hospitalized for asthma treatment or if you are taking a prescription medicine for asthma, unless you have been told to do so by a doctor.

When you use the inhaler for the first time, or if you have not used it in a while, the inhaler may not deliver the right amount of medicine with the first puff. Therefore, before using the inhaler, you may have to test or prime it.

• To test or prime most inhalers :
  • Insert the medicine container (canister) firmly into the clean mouthpiece according to the manufacturer's directions. Check to make sure it is placed properly into the mouthpiece.
  • Take the cap off the mouthpiece and shake the inhaler three or four times.
  • Hold the inhaler well away from you at arm's length and press the top of the canister, spraying the medicine into the air two times. The inhaler will now be ready to provide the right amount of medicine when you use it.
• To use most inhalers :
  • Using your thumb and one or two fingers, hold the inhaler upright, with the mouthpiece end down and pointing toward you.
  • Take the cap off the mouthpiece. Check the mouthpiece to make sure it is clear. Then, gently shake the inhaler three or four times.
  • Breathe out slowly to the end of a normal breath.
  • Use the inhalation method recommended by your doctor:
    • Open-mouth method - Place the mouthpiece about 1 to 2 inches (2 finger widths) in front of your widely opened mouth. Make sure the inhaler is aimed into your mouth so the spray does not hit the roof of your mouth or your tongue.
    • Closed-mouth method - Place the mouthpiece in your mouth between your teeth and over your tongue with your lips closed tightly around it. Make sure your tongue or teeth are not blocking the opening.
  • Start to breathe in slowly through your mouth. At the same time, press the top of the canister one time to get 1 puff of medicine. Continue to breathe in slowly for 3 to 5 seconds. Count the seconds while breathing in. It is important to press the canister and breathe in slowly at the same time so the medicine gets into your lungs. This step may be difficult at first. If you are using the closed-mouth method and you see a fine mist coming from your mouth or nose, the inhaler is not being used correctly.
  • Hold your breath as long as you can up to 10 seconds. This gives the medicine time to settle into your airways and lungs.
  • Take the mouthpiece away from your mouth and breathe out slowly.
  • If your doctor has told you to inhale more than 1 puff of medicine at each dose, gently shake the inhaler again and take the next puff following exactly the same steps you used for the first puff. Press the canister one time for each puff of medicine.
  • When you are done, wipe off the mouthpiece and replace the cap.

Your doctor, nurse, or pharmacist may want you to use a spacer or holding chamber with the inhaler. A spacer helps get the medicine into the lungs and reduces the amount of medicine that stays in your mouth and throat.

To use a spacer with the inhaler:

• Attach the spacer to the inhaler according to the manufacturer's directions. There are different types of spacers available, but the method of breathing is the same with most spacers.
• Gently shake the inhaler and spacer three or four times.
• Hold the mouthpiece of the spacer away from your mouth and breathe out slowly to the end of a normal breath.
• Place the mouthpiece into your mouth between your teeth and over your tongue with your lips closed around it.
• Press down on the canister top one time to release 1 puff of medicine into the spacer. Within one or two seconds, begin to breathe in slowly through your mouth for three to five seconds. Do not breathe in through your nose. Count the seconds while inhaling.
• Hold your breath as long as you can up to ten seconds (count slowly to ten).
• Breathe out slowly. Do not remove the mouthpiece from your mouth. Breathe in and out slowly two or three times to make sure the spacer is emptied.
• If your doctor has told you to take more than 1 puff of medicine at each dose, gently shake the inhaler and spacer again, and take the next puff, following exactly the same steps you used for the first puff. Do not put more than 1 puff of medicine into the spacer at a time.
• If you rinse your mouth with water after you have finished, be sure to spit out the rinse water. Do not swallow it.
• When you are finished, remove the spacer from the inhaler. Wipe off the mouthpiece and replace the cap.
• Clean the inhaler and mouthpiece at least once a week.
  • To clean the inhaler :
    • Remove the canister from the inhaler and set the canister aside.
    • Wash the mouthpiece and cap with warm, soapy water. Then, rinse well with warm, running water.
    • Shake off the excess water and let the inhaler parts air dry completely before putting the inhaler back together.
• Save your inhaler. Refill units may be available.

For patients using the powder for inhalation dosage form :

• These medicines are used with a special device. If you do not understand the directions that come with the inhaler or if you are not sure how to use the inhaler, ask your health care professional to show you how to use it. Also, ask your health care professional to check regularly how you use the inhaler to make sure you are using it properly.

For patients using the inhalation solution dosage form :

• If you are using this medicine in a nebulizer, make sure you understand exactly how to use it. If you have any questions about this, check with your health care professional.
• Do not use if solution turns pinkish to brownish in color or if it becomes cloudy.
• Do not mix another inhalation medicine with an adrenergic bronchodilator medicine in the nebulizer unless told to do so by your health care professional.

Dosing - The dose of these medicines will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The number of inhalations or the amount of medicine that you use depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking the adrenergic bronchodilator .

For albuterol
• For inhalation aerosol dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 4 years of age and older - 1 to 2 inhalations (puffs) every four to six hours.
    • Children up to 4 years of age - Dose must be determined by your doctor.
  • For preventing bronchospasm caused by exercise:
    • Adults and children 4 years of age and older - 2 inhalations (puffs) taken fifteen minutes before you start to exercise.
    • Children up to 4 years of age - Dose must be determined by your doctor.

For albuterol sulfate
• For inhalation aerosol dosage form:
  • For treating bronchospasm:
    • Adults and children 4 years of age and older - 1 to 2 inhalations (puffs) every four to six hours.
    • Children up to 4 years of age - Dose must be determined by your doctor.
  • For preventing bronchospasm caused by exercise:
    • Adults and children 4 years of age and older - 2 inhalations (puffs) taken fifteen to thirty minutes before you start to exercise.
    • Children up to 4 years of age - Dose must be determined by your doctor.
• For inhalation solution dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 12 years of age and older - This medicine is used in a nebulizer and is taken by inhalation over five to fifteen minutes. The usual dose is 2.5 milligrams (mg) of albuterol taken every four to six hours if needed.
    • Children up to 12 years of age - This medicine is used in a nebulizer and is taken by inhalation over five to fifteen minutes. The usual dose is 1.25 to 2.5 milligrams (mg) of albuterol taken every four to six hours if needed.
• For capsules (powder) for inhalation dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 4 years of age and older - 200 or 400 mcg taken by inhalation every four to six hours.
    • Children up to 4 years of age - Dose must be determined by your doctor.
  • For preventing bronchospasm caused by exercise:
    • Adults and children 4 years of age and older - 200 mcg taken by inhalation fifteen minutes before you start to exercise.
    • Children up to 4 years of age - Dose must be determined by your doctor.

For bitolterol

Note:

Bitolterol was withdrawn from the U.S. market by Elan Pharmaceuticals in November 2001.

• For inhalation aerosol dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 12 years of age and older - 2 inhalations (puffs) every eight hours or 2 inhalations (puffs) at first, allowing one to three minutes between each puff. This dose may be followed by another puff, if needed. However, the dose taken each day should not be more than 2 puffs every four hours or 3 puffs every six hours.
    • Children up to 12 years of age - Dose must be determined by your doctor.
  • For preventing bronchospasm caused by exercise:
    • Adults and teenagers - 2 inhalations (puffs) taken five minutes before you start to exercise.
    • Children - 1 or 2 inhalations (puffs) taken five minutes before you start to exercise.
• For inhalation solution dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 12 years of age and older - This medicine is used in a nebulizer and is taken by inhalation over ten to fifteen minutes. The usual dose is 1 to 2.5 milligrams (mg) of bitolterol taken three or four times a day. Doses should be taken at least four hours apart.
    • Children up to 12 years of age - Dose must be determined by your doctor.

For epinephrine
• For treating bronchospasm:
  • For inhalation aerosol dosage form:
    • Adults and children 4 years of age and older - 1 inhalation (puff). The dose may be repeated after at least one minute, if needed. Doses should be taken at least three hours apart.
    • Children up to 4 years of age - Dose must be determined by your doctor.
  • For inhalation solution dosage form:
    • Adults and children 4 years of age and older - This medicine should be used in a hand-bulb nebulizer. The usual dose is 1 to 3 inhalations (puffs) of a 1% solution. Doses should be taken at least three hours apart.
    • Children up to 4 years of age - Dose must be determined by your doctor.

For fenoterol
• For inhalation aerosol dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 12 years of age and older - 100 or 200 micrograms (mcg) , repeated three or four times a day if needed. This medicine should not be taken more often than every four hours. The total dose should not be more than 8 puffs a day of the 100 mcg per spray product or 6 puffs of the 200 mcg per spray product .
    • Children up to 12 years of age - Dose must be determined by your doctor.
• For inhalation solution dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 12 years of age and older - This medicine is used in a nebulizer and is taken by inhalation over ten to fifteen minutes. The usual dose is 0.5 to 1 milligram (mg) of fenoterol taken every six hours if needed.
    • Children up to 12 years of age - Dose must be determined by your doctor.

For formoterol
• For powder for inhalation dosage form:
  • For preventing bronchospasm:
    • Adults and children 5 years of age and older - 12 mcg taken by oral inhalation twice daily
    • Children under 5 years of age - Use and dose must be determined by your doctor.

Note:

Canadian product information states that formoterol is used in children 6 years of age and older.

For isoetharine
• For inhalation solution dosage form:
  • For treating bronchospasm:
    • Adults - This medicine is used in a nebulizer and is taken by inhalation over fifteen to twenty minutes. The amount of medicine you use and whether it requires dilution depends on the product ordered by your doctor. The usual dose is 2.5 to 10 milligrams (mg). This medicine usually should not be used more often than every four hours.
    • Children - Use is not recommended.
• For inhalation aerosol dosage form:
  • For treating bronchospasm:
    • Adults and teenagers - 1 or 2 inhalations (puffs). This dose may be repeated every four hours as necessary.
    • Children - Use is not recommended.

For isoproterenol
• For inhalation solution dosage form:
  • For treating bronchospasm:
    • Adults and teenagers - This medicine is used in a nebulizer and is taken by inhalation over ten to twenty minutes. The usual dose is 2.5 milligrams (mg). This medicine usually should not be used more often than every four hours.
    • Children - This medicine is used in a nebulizer and is taken by inhalation over ten to twenty minutes. The usual dose is 0.05 to 0.1 milligram (mg) per kilogram (kg) of body weight, up to 1.25 mg, diluted. The dose may be repeated every four hours, if needed.

For isoproterenol hydrochloride
• For inhalation aerosol dosage form:
  • For treating bronchospasm:
    • Adults and children 12 years of age and older - 1 inhalation (puff), repeated after two to five minutes if needed. This dose is taken every three to four hours.
    • Children up to 12 years of age - Use is not recommended.

For isoproterenol sulfate
• For inhalation aerosol dosage form:
  • For treating bronchospasm:
    • Adults and children 12 years of age and older - 1 inhalation (puff), repeated after two to five minutes if needed. This dose is taken every four to six hours.
    • Children up to 12 years of age - Dose must be determined by your doctor.

For metaproterenol
• For inhalation aerosol dosage form:
  • For preventing and treating bronchospasm:
    • Adults and children 12 years of age and older - 2 or 3 inhalations (puffs) every three to four hours. The total dose should not be more than 12 puffs a day.
    • Children up to 12 years of age - 1 to 3 inhalations (puffs) every three to four hours. The total dose should not be more than 12 puffs a day.
• For inhalation solution dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 6 years of age and older - This medicine is used in a nebulizer and is taken by inhalation. The amount of medicine you use and whether it requires dilution depends on the product ordered by your doctor. The usual dose is 10 to 15 milligrams (mg) taken three or four times a day. Doses should be taken at least four hours apart.
    • Children up to 6 years of age - This medicine is used in a nebulizer and is taken by inhalation. The amount of medicine you use and whether it requires dilution depends on the product ordered by your doctor. The usual dose is 5 to 15 milligrams (mg) taken three or four times a day, at least four hours apart.

For pirbuterol
• For inhalation aerosol dosage form:
  • For preventing and treating bronchospasm:
    • Adults and children - 1 or 2 inhalations (puffs) every four to six hours. The total dose should not be more than 12 puffs a day.
  • For preventing bronchospasm caused by exercise:
    • Adults and children - 2 inhalations (puffs) taken five minutes before you start to exercise.

For procaterol
• For inhalation aerosol dosage form:
  • For preventing and treating bronchospasm:
    • Adults and children 12 years of age and older - 1 or 2 inhalations (puffs) three times a day.
    • Children up to 12 years of age - Dose must be determined by your doctor.
  • For preventing bronchospasm caused by exercise:
    • Adults and children 12 years of age and older - 1 or 2 inhalations (puffs) taken at least fifteen minutes before you start to exercise.

For salmeterol
• For the inhalation aerosol dosage form:
  • For preventing bronchospasm:
    • Adults and children 12 years of age and older - 2 inhalations (puffs) two times a day, in the morning and evening. Doses should be taken about twelve hours apart.
    • Children up to 12 years of age - Dose must be determined by your doctor.

  Note:

  Canadian manufacturer states that use in children ages 4 years and older is 2 inhalations twice daily.

  • For preventing bronchospasm caused by exercise:
    • Adults and children 12 years of age and older - 2 inhalations (puffs) taken at least thirty to sixty minutes before you start to exercise. If you are already using salmeterol two times a day to treat your asthma, you do not need to use additional salmeterol before you exercise.
    • Children up to 12 years of age - Dose must be determined by your doctor.
• For the powder for inhalation dosage form:
  • For preventing bronchospasm:
    • Adults and children 4 years of age and older - 1 inhalation (the contents of one blister) two times a day, in the morning and evening. Doses should be taken about twelve hours apart.
    • Children up to 4 years of age - Use and dose must be determined by your doctor.
  • For preventing bronchospasm caused by exercise:
    • Adults and children 4 years of age and older - 1 inhalation (the contents of one blister) at least 30 minutes before exercise
    • Children up to 4 years of age - Use and dose must be determined by your doctor.

For terbutaline
• For inhalation aerosol dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children -
      • For the 200 microgram (mcg) per metered spray product: 2 inhalations (puffs) every four to six hours.
      • For the 500 mcg per metered spray product: 1 inhalation (puff), repeated after five minutes if needed. The total dose should not be more than 6 puffs a day.
  • For preventing bronchospasm caused by exercise:
    • Adults and children -
      • For the 200 microgram (mcg) per metered spray product: 2 inhalations (puffs) taken five to fifteen minutes before you start to exercise.

Missed dose -

• For formoterol : If you miss a regularly scheduled dose of formoterol and it has been less than 6 hours since the scheduled time, take the dose as soon as possible and then go back to your regular dosing schedule. If it has been longer than 6 hours, skip the dose and take the next dose at the regularly scheduled time. Do not double doses.
• For all other adrenergic bronchodilators : If you are using one of these medicines regularly and you miss a dose, use it as soon as possible. Then use any remaining doses for that day at regularly spaced intervals. Do not double doses.

Storage - To store this medicine:

• Keep out of the reach of children.
• Store away from heat.
• Store the solution form of this medicine away from direct light. Store the inhalation aerosol form of this medicine away from direct sunlight.
• Keep the medicine from freezing.
• Store canister with the nozzle end down.
• Do not store the powder for inhalation forms of these medicines in the bathroom, near the kitchen sink, or in other damp places. Moisture may cause the medicine to break down.
• Do not puncture, break, or burn the inhalation aerosol container, even if it is empty.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.