VENTOLIN Ventolin Aerosol, [albuterol sulfate], marketed by Glaxo Wellcome Inc. is a pressurized metered-dose aerosol unit for oral inhalation. The base which is recommended by the World Health Organization is Salbutamol. Ventolin is indicated for the treatment or prevention of bronchospasm in adults and children 4 years of age and older with reversible obstructive airway disease and for the prevention of exercise-induced bronchospasm in patients 4 years of age and older. Ventolin is a short acting sympathomimetic (beta agonist) bronchodilator that relaxes the smooth muscle in the airways allowing effort free airflow in the lungs. It is chemically related to isoprenaline. Ventolin Aerosol, [albuterol sulfate] has poor cardiac [beta 1 receptor] action compared to isoprenaline. Hence it causes less palpitation or a rise of blood pressure in therapeutic doses and hence is safer than adrenaline and isoprenaline. It is resistant to inactivation by COMT and therefore, has a longer duration of action. The action of a single inhalation lasts for about 4-6 hours. Each inhalation may improve the effectiveness of subsequent inhalation Bronchial Asthma: Bronchial asthma is an airway disorder characterized by hyper responsiveness of the tracheo bronchial smooth muscle to a variety of stimuli, resulting in narrowing of air tubes, often accompanied by increased secretion and mucosal edema. Extrinsic asthma: it is mostly episodic, less prone to status asthmaticus. In others, a variety of trigger factors [infections, irritants, pollution, exercise, exposure to cold air, psychogenic] may be involved. Intrinsic asthma: it tends to be perennial, status asthmaticus is more common. Most cells present in the lungs release mediators [histamine, SRS-A] leading to constriction of the bronchial smooth muscle, cause mucosal edema and viscid secretion resulting in reversible airway obstruction. INDICATIONS: • Acute asthma • Symptom relief during maintenance therapy of asthma and other conditions with reversible airways obstruction (including COPD) • Protection against exercise-induced asthma • Can be aerosolized with a nebulizer for patients with cystic fibrosis, along with ipratropium bromide and pulmozyme. DOSAGE and ADMINISTRATION: Bronchospasm For treatment of acute episodes of bronchospasm or prevention of symptoms associated with bronchospasm, the usual dosage for adults and children is 2 inhalations repeated every 4 to 6 hours; in some patients, 1 inhalation every 4 hours may be sufficient. More frequent administration or a larger number of inhalations is not recommended. Exercise-Induced Bronchospasm The usual dosage for adults and children 4 years of age and older is 2 inhalations 15 to 30 minutes before exercise. Administration Information Each metered inhalation of VENTOLIN provides Salbutamol 100 mcg in inert aerosol propellant Priming: Priming VENTOLIN is essential to ensure appropriate albuterol content in each actuation. Prime VENTOLIN before using for the first time, when the inhaler has not been used for more than 2 weeks, or when the inhaler has been dropped. To prime VENTOLIN, release 4 sprays into the air away from the face, shaking well before each spray. Cleaning: To ensure proper dosing and to prevent actuator orifice blockage, wash the actuator with warm water and let it air-dry completely at least once a week. Dose Counter: VENTOLIN has a dose counter attached to the canister that starts at 204 and counts down each time a spray is released. When the counter reads 020, the patient should contact the pharmacist for a refill of medication or consult the physician to determine whether a prescription refill is needed. VENTOLIN comes in a moisture-protective foil pouch, which should be removed prior to use. Discard VENTOLIN when the counter reads 000 (after 200 sprays have been used) or 6 months after removal from the moisture-protective foil pouch, whichever comes first. SIDE EFFECTS: • bronchospasm (wheezing, chest tightness, trouble breathing), especially after starting a new canister of this medicine; • chest pain and fast, pounding, or uneven heart beats; • tremor, nervousness; or • High blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure). DRUG INTERACTIONS: Other short-acting sympathomimetic aerosol bronchodilators should not be used concomitantly with albuterol. If additional adrenergic drugs are to be administered by any route, they should be used with caution to avoid deleterious cardiovascular effects. Beta Blockers: they not only reverse the effect of Ventolin but at the same time also induce severe bronchospasm resulting in an acute attack of asthma. Diuretics: caution is advised in the co administration of beta-agonists with non potassium-sparing diuretics. Serum potassium levels should be monitored regularly Digoxin: it would be prudent to carefully evaluate the serum digoxin levels in patients who are currently receiving digoxin and albuterol since concurrent administration of both the drugs leads to decrease in the serum concentration of digoxin. Monoamine Oxidase Inhibitors or Tricyclic Antidepressants: MAO inhibitors and TCAs can severely potentiate the action of VENTOLIN and hence VENTOLIN should be administered with extreme caution if the patient is on the above stated drugs. It would be wise enough to choose another group of drug. CONTRAINDICATIONS: VENTOLIN is contraindicated in patients with a history of hypersensitivity to albuterol or any other components of VENTOLIN. Rare cases of hypersensitivity reactions, including uritacaria, angioedema, and rash have been reported after the use of albuterol sulfate. Samir is the author of Ventolin Aerosol, Salbutamol Inhaler information located at site REFERENCES: - Pharmacology and Pharmacotherapeutics, R.S.Satoskar, S.D.Bhandarkar, S.S.Ainapure, Revised 17th Edition, pg 341 - Drug Today, July-September 2005 Edition, page 554, 570. - - - - -

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