Is salbutamol possible with alcohol. Salbutamol - instructions for use and release form, indications, composition, dosage and price. Powder for inhalation

It is no secret that any, the most perfect medicine has a "bouquet" of undesirable features that appear depending on the dose, the rate of administration, the state of the human body and a great many other subtleties.

The division into drugs and poisons is conditional, since the same substance can be both a medicine (in a lower dose) and a poison (in a higher dose), compounds with a wide range of therapeutic action are allowed for practical use, i.e. the difference between toxic and therapeutic (therapeutic) doses.

REFERENCE TABLE OF ADVERSE COMBINATIONS OF MEDICINAL PREPARATIONS WITH ALCOHOL

Drink (capacity)

Number of glasses / shot glasses / mugs

5

4

3

2

1

Wine (200 ml)

14 h

36 h

11 h

29 h

8 h

21 h

6 h

14 h

3 h

7 h

Cognac (50 ml)

10 h

26 h

8 h

21 h

6 h

13 h

4 h

10 h

2 h

5 h

Champagne (200 ml)

8 h

22 h

7 h

17 h

5 h

13 h

3 h

8 h

2 h

4 h

Vodka (100 ml)

19 h

38 h

15 h

29 h

11 h

29 h

7 h

19 h

4 h

10 h

Beer (0.5 l)

12 h

30 h

9 h

24 h

7 h

18 h

5 h

12 h

2 h

6 h

The most curious thing about intoxication is that the influence of alcohol is manifested in some people in different ways, although the general outward manifestations of intoxication in most cases are similar. The following is a blood alcohol table.

The state and behavior of a drunk person depending on the blood alcohol content

The blood alcohol table demonstrates how harmful and dangerous drinking alcohol can be. The components of intoxicating drinks harm the body, regardless of their dose. And if you also plan to drive during the day, do not risk your health, do not play with fate! It is better to give up alcoholic temptation, but save the life of yourself and those around you!

Drug name	Main action	Synonyms
ALPRAZOLAM (Alprazolam)	A tranquilizer with a pronounced hypnotic effect. Strengthens the effect of narcotic, neuroleptic and analgesic drugs. Prescribed for the short-term relief of feelings of anxiety, anxiety or fear, the treatment of depression	Alprance, Zotran, Kassadan, Xanax, Xanor, Neyrol, Prinax, Restyl, Solanax, Tafil, Trankimazin, Tricka, Frontal
AMITRIPTILIN (Amitriptilinum)	Sedative antidepressant	Adepril, Adepress, Aniprin, Atriptal, Danilen, Daprimen, Lantron, Laroxal, Laroxil, Lentizol, Novotriptin, Proheptadiene, Redonex, Saroten, Sarotex, Teperin, Tryptisol, Triptopol, Triptil, Tryptanol, Elatral
BUPRENORFIN (Buprenorphine)	Synthetic narcotic analgesic. Prescribed for the treatment of pain	Anfin, Buprenal, Buprenex, Buprex, Lepetan, Nonan, Norfin, Tendzhezik, Unifin
BUTORPHANOL-tartrate (Butorphanol-tartrate)	Synthetic narcotic analgesic. A drug for the treatment of pain syndrome of moderate and severe intensity of various etiologies.	Beforal, Verstadol, Moradol, Stadol, Torat, Torbujezik, Torbutrol. The drug also exists in the form of an aerosol for introduction into the body through the nasal mucosa (Stadol NS).
CARBAMAZEPIN (Carbamazepinum)	Antidepressant. It is used in the complex treatment of headaches.	Karbasan retard, Mazepin, Mazetol, Neurotol, Simonil, Stazepin, Storilat, Tegretal, Tegretol, Temporarad, Finlepsin.
LIDOCAINE HYDROCHLORIDE (Lidocaini Hydrochloridum)	Local anesthetic used to provide local anesthetic	Alokain, Anestacon, Anestekain, Dolikain, Dulcicain, Xycain, Xylocaine, Lidestine, Lignocaine, Maricaine, Octocaine, Remicaine, Solcaine, Stericaine, Xilesin, Xyloton, Xylotox
MIDAZOLAM (Midazolam Hydrochloride)	Soporific (hypnotic), sedative, benzodiazepine derivative	Versed, Dormicum, Dormonides, Flormidal
NALBUFIN (Nalbuphine Hydrochloride)	Synthetic narcotic analgesic for the relief of moderate to severe pain syndrome	Nubain
NITRAZEPAM (Nitrazepam)	A hypnotic, sedative, benzodiazepine derivative.	Apodorm, Benzalin, Hypnax, Gipsal, Dumolid, Insomin, Levetan, Magadon, Mogadon, Nelbon, Neozepam, Nitrenpax, Nitrodiazepam, Pacidrim, Pacisin, Radedorm, Serenex, Somitran, Sonipam, Sonalinolin, Epibinokelin
PENTALGIN (Pentalgin) Complex analgesic drug containing codeine		There are no synonyms
SEDALGIN (Sedalgin) Complex analgesic drug containing codeine	Prescribed for the treatment of pain syndrome	There are no synonyms
SIBAZON (Sibazonum)	Tranquilizer (benzodiazepine derivative), potentiating the effect of hypnotics, narcotic, neuroleptic and analgesic drugs	Anziolin, Apaurin, Apozepam, Atilen, Bensedin, Valitran, Valium, Vatran, Vival, Diazepam, Diapam, Quetinil, Lembrol, Pacitrian, Relanium, Saromet, Seduxen, Serenamil, Serensin, Sonacon, Stesrolin, Eanshami
SPASMOVERALGIN Combined, complex spasm-analgesic drug containing: propyphenazone, papaverine, atropine, phenobarbital, codeine phosphate and ephedrine	Prescribed for the treatment of pain syndrome of spastic genesis	There are no synonyms
SPASMOVERALGINT NEO (Spasmoeveralgin neo) Combined analgesic, sedative, antispasmodic drug containing: propiphenazole, papaverine, atropine, phenobarbital, codeine phosphate and ephedrine	Prescribed for the treatment of pain syndrome of spastic genesis in the gastrointestinal tract, bladder. Biliary, hepatic, renal colic. Migraine, spastic dysmenorrhea	There are no synonyms
TERA FLU (Thera Flu) Combined preparation of analgesic, antipyretic and desensitizing action	It is prescribed for the treatment of headache, sore throat, nasal congestion. Treatments for myalgia (lumbago) and febrile conditions	There are no synonyms
Tiapridal	An antipsychotic agent with anxiolytic and analgesic effects	Delpral, Doparid, Tiapridex, Tiaprizal, Triadal
TRAMADOL (Tramadolum)	Synthetic narcotic analgesic. Prescribed for relief of moderate or severe pain syndrome	Crispin, Melanat, Protradon, Tramal.
TRAMAL RETARD (Tramal Retard)	Analgesic, antitussive agent	There are no synonyms
Cinnarizine (Cinnarizine)	A drug that improves cerebral circulation. Used for the treatment of cerebral vascular insufficiency, headache with vasomotor disorders, migraines and conditions after traumatic brain injury (concussion)	Glamil, Dimitronal, Labyrinus, Marisan, Midronal, Mitronal, Stugeron, Stutgeron, Tsinniprin etc.

P.V. Smolnikov, Cand. honey. Sci., Leading Researcher, State Research Center for Laser Medicine, Ministry of Health of the Russian Federation

• Latin name:Salbutamol
• ATX code:R03AC02
• Active substance:Salbutamol (Salbutamol)
• Manufacturer:OJSC “Moskhimpharmpreparaty them. ON. Semashko ”, CJSC“ Binnopharm ”, CJSC“ Altayvitamins ”( Russian Federation), TEVA (Israel)

Composition

One dose of metered aerosol for inhalation contains 124 mg of salbutamol sulfate, which corresponds to 100 μg of pure substance. Ethanol and hydrofluoroalkane are used as auxiliary substances.

One tablet may contain 2 or 4 mg of the active substance, in prolonged-release tablets (retard) - 4 mg (for children) and 8 mg (for adults).

One dose of powder for inhalation contains 200 or 400 μg of salbutamol, in a syrup for oral administration - 0.4 mg / ml, in a solution for inhalation use - 1.25 mg / ml (the solution comes to pharmacies in ampoules with a volume of 2 ml, according to 20 ampoules in one package), in an injection solution - 0.1 mg / ml.

Release form

Salbutamol (INN - Salbutamol) has the following dosage forms:

• metered aerosol for inhalation 100 mg / dose (produced in aluminum cans under pressure, 200 doses in each inhaler; when sprayed onto a glass surface, the contents of the can leaves a white stain);
• dosed powder for inhalation 200 or 400 mgc / dose;
• film-coated tablets of 2 and 4 mg.

Other brand name salbutamol preparations may also take the form:

• retard tablets;
• solution for inhalation;
• injection solution;
• syrup;
• concentrate for preparation of infusion solution;
• capsules filled with powder for inhalation use.

pharmachologic effect

Salbutamol is bronchodilator , selective β2-adrenergic agonist (selective β2-adrenergic receptor antagonist). pharmachologic effect drug: tocolytic and bronchodilator.

Pharmacodynamics and pharmacokinetics

When used in a therapeutic dose, it has a pronounced bronchodilator effect , warns and stops bronchospastic syndrome , increases the vital capacity of the lungs, makes it difficult to release into the extracellular space histamine , factors chemotaxis , a slowly reacting substance and a number of other highly active substances.

Against the background of the use of salbutamol, there are slight positive foreign and chronotropic effects on heart muscle .

The drug promotes expansion coronary arteries of the heart , suppression of early and late reactivity bronchi , decrease in resistance in respiratory tract , as well as tone and contractile activity myometrium , improving the function atrial fibrillation , stimulates sputum discharge and mucus production.

At the same time, the agent has practically no effect on β1-adrenergic receptors, does not provoke a decrease and, in comparison with other drugs with a similar mechanism of action, has a much lesser effect on a heart .

Salbutamol also has metabolic effects: it helps to reduce the concentration of potassium in, has an effect on the breakdown process glycogen before glucose (glycogenolysis) and secretion.

In individual patients (especially in patients with) it is able to provide hyperglycemic and lipolytic effects , thereby increasing the risk of developing lactic acidotic coma .

After the introduction of inhaled forms of the drug, the effect begins to develop after 5 minutes and reaches a maximum within 30-90 minutes (about 75% of the maximum effect is achieved within 5 minutes).

10 to 20% of the dose received by the patient falls into respiratory tract , the remaining 80-90% remain in the device and settle in oropharynx and then swallowed. The substance remaining in the respiratory tract is partially absorbed into lungs and, without biotransformation in them, enters the bloodstream.

Part of the hit Digestive tract substances are absorbed and actively metabolized on the first pass through liver with the formation of phenolic sulfate.

Both the conjugate and the unchanged substance are excreted mainly in the urine.

Most of the salbutamol injected into a vein, taken orally or by inhalation, is eliminated from the body within 72 hours. The half-life is from 3.7 to 5 hours.

Indications for use

Indications for the use of Salbutamol are:

• celebrated in all forms bronchospasm (the tool can be used for cupping bronchospastic syndrome , and to prevent it);
• pulmonary emphysema ;
• chronic ;
• asthmatic bronchitis ;
• preterm labor without complications.

In pediatrics, Salbutamol is also used to treat broncho-obstructive syndrome .

Contraindications

The use of Salbutamol is contraindicated in:

• increased sensitivity to the components of the drug;
• heart rhythm disorders (for example, for polymorphic ventricular premature beats or paroxysmal );
• heart defects ;
• myocarditis ;
• tachyarrhythmias ;
• aortic stenosis ;
• thyrotoxicosis ;
• decompensated ;
• epileptic seizures ;
• pyloroduodenal narrowing ;
• insufficiency of liver and / or kidney function;

The drug is not prescribed in combination with non-selective β-blockers, as well as for the treatment of children under 2 years of age.

It should be used with caution when pheochromocytoma , severe form chronic heart failure , arterial hypertension .

Intravenous use of Salbutamol is contraindicated in:

• intrauterine fetal death;
• infections of the birth canal;
• bleeding associated with placenta previa;
• premature placental abruption;
• threatening spontaneous in 1 or 2 trimesters of pregnancy;
• late (toxicosis of the 3rd trimester of pregnancy).

Side effects

Salbutamol, produced in the form of an aerosol, does not cause side effects when used in therapeutic doses.

Oral administration, subject to the dosage regimen described in the instructions, is rarely accompanied by unwanted side effects.

When a single or daily dose of Salbutamol is exceeded, as well as in patients with hypersensitivity to stimulants of β2-adrenergic receptors, the most significant side effects may be fingers or hands, internal tremors, and increased tension.

In case of a significant excess of the therapeutic dose or the patient's special sensitivity, transient expansion of peripheral vessels, moderate tachycardia, nausea, muscle cramps, and vomiting may occur.

It is extremely rare, manifested in the form of a skin rash, collapse , hypotension , bronchospasm .

Instructions for the use of Salbutamol

For patients over 12 years old, the daily dose of Salbutamol in oral dosage forms ranges from 6 to 16 mg. It is recommended to divide it into 3-4 doses. In cases where there is a need for this, it is allowed to increase the daily dose to 32 mg with a frequency of applications 4 times a day.

Children from 6 to 12 years old are shown Salbutamol 2 mg 3 or 4 times a day, for patients from 2 to 6 years old the optimal dose is 1-2 mg with a frequency of applications 3 times a day.

When the drug is administered by inhalation, the dose depends on the prescribed dosage form. In accordance with the instructions for use, Salbutamol aerosol is prescribed for relief bronchospastic syndrome or bronchial asthma attack ... For adults, the spray is usually recommended to be administered at 0.1-0.2 mg, for children - at 0.1 mg.

The frequency of procedures depends on the characteristics of the clinical situation and indications.

For the purpose of preventing physical stress bronchial asthma attack before physical activity, Salbutamol aerosol is administered to children in a dose equal to 0.1 mg, to adults - 0.2 mg. The highest daily dose is 0.8 mg (corresponds to 8 inhalations).

The medicine, produced in the form of a powder, should be used in a similar manner, but with a corresponding twofold increase in the dose.

The solution for inhalation is used in a dose equal to 2.5 mg 3 or 4 times a day. If appropriate, it is allowed to increase the dose to 5 mg with the same frequency of applications.

Instructions for use of the Salbutamol inhaler

Before using the inhaler, you should check it for performance. This procedure is also recommended if the patient has not used it for some time.

• It is necessary to remove the cap from the inhaler and make sure that the outlet tube is not clogged with dust or dirt.
• While holding the can in an upright position, place thumb under the bottom, and the index one - on its upper part, after which it is necessary to vigorously shake the can up and down several times.
• After a deep breath (it is recommended to inhale without tension), you should tilt your head up and tightly press the outlet tube of the inhaler with your lips.
• Holding the tube with your lips, you should take a slow deep breath, while simultaneously pressing your index finger (in the first third of inhalation) on the valve of the inhaler cartridge and releasing the dose of medication. The air continues to be inhaled slowly.
• After removing the tube from the mouth, you need to hold your breath for 10 seconds (or as long as it is possible to do it without tension), then slowly exhale through your nose.
• If it is necessary to take more than one dose of Salbutamol, after the first inhalation, hold for about a minute and then repeat all the steps described above (starting from the second point). After completing the procedure, the can should be closed with a cap.

At the time of the release of the dose of the drug, one should not rush; to achieve the maximum effect, inhale the air as slowly as possible. It is optimal to practice a little in front of the mirror before the procedure.

If, during inhalation, steam comes out from the top of the inhaler or from the corners of the mouth, you must start inhalation again from the second point.

How to clean the inhaler?

The inhaler must be cleaned at least once a week. The can is removed from the plastic case, after which the case and cap are rinsed with warm water (not hot!).

The washed parts should be thoroughly dried without using heating devices. After that, the can is placed back in the case and closed with a cap.

Do not immerse a metal can in water.

Overdose

Symptoms of a Salbutamol overdose are:

• expansion of peripheral vessels;
• nausea and vomiting;
• increased excitability;
• flutter of the ventricles;
• decline in performance blood pressure ;
• muscular tremor ;
• hypokalemia ;
• hypoxemia ;
• headache ;
• general malaise;
• hypoglycemia replacing hyperglycemia .

Treatment involves discontinuing the drug, prescribing cardioselective β-blockers to the patient, and symptomatic therapy.

If there is a suspicion of an overdose of Salbutamol, it is necessary to keep the serum potassium concentration under constant control.

Interaction

When using Salbutamol in combination with noncardioselective β-blockers, mutual inhibition of therapeutic effects is possible. In combination with, the risk of developing and tachycardias (in particular, supraventricular extrasystole ).

Combined with diuretics , glucocorticosteroid drugs and xanthine derivatives the risk of developing hypokalemia .

Terms of sale

A prescription is required to purchase the drug.

Salbutamol recipe in Latin:
Rp: Eros. Salbutamoli 12ml
D.t.d:
S: With an attack of suffocation, 1-2 breaths

Storage conditions

The aerosol can must be protected from knocks and falls.

Shelf life

36 months from the date of issue.

special instructions

Increasing the dose or increasing the frequency of applications should be under the supervision of a physician. Reducing the interval is allowed only in extreme cases, while it must be strictly justified.

Against the background of the use of the drug, there is a risk of developing hypokalemia , therefore, in patients with severe forms bronchial asthma it is recommended to constantly monitor serum potassium levels. Risk hypokalemia increases with hypoxia.

The World Anti-Doping Agency (WADA) bans the use of Salbutamol in sports, as this drug has the ability to artificially increase endurance and physical activity during sports competitions.

It is usually recommended to use tablet forms of the drug if it is impossible to administer the drug by inhalation (for example, in small children), since exceeding the dosage in this dosage form can provoke cardiac stimulating effect .

Salbutamol's analogs

Structural analogues of Salbutamol are drugs Ventacol , Salgim , , Salbutabs , Salbumol , Salbupart , Salamol (Salbutamol-Teva), Bronchovaleas , Ekovent , Proventil , Albuterol , Aerolin , Volmax , Ventilan , Aloprol .

A similar mechanism of action is characterized by drugs Atimos , Oxis Turbuhaler , Serevent , Formoterol , Infortispir Respimat , Striverdi Respimat .

Which is better - Salbutamol or Ventolin?

Ventolin is a generic (or structural analogue) of Salbutamol. The preparations contain the same active ingredient, thus they have the same indications and contraindications and are interchangeable.

Some patients have the question “ Ventolin (Salbutamol) - hormonal or not? ”. Experts answer that the drug does not belong to the hormonal group and is bronchodilator to relieve bronchospasm .

This kind of drugs are chemical derivatives (adrenaline ).

Where did Salbutamol Semashko go?

In recent months, special thematic forums have been actively discussing the issue of where the Moscow salbutamol manufacturer Semashko disappeared. In this regard, on the official website of JSC Moskhimfarmpreparaty, an explanation of the management appeared as to why the drug produced by the company disappeared and where did it go.

The thing is that the composition of this product contains chlorofluorocarbons, which pose a danger to the ozone layer. Therefore, in accordance with the Montreal Protocol on Substances that Deplete the Ozone Layer, the Russian Federation had to decide to stop its release.

Salbutamol Semashko was taken out of production, which was announced at a conference on the regulation of the circulation of substances that deplete the ozone layer, initiated and organized by the United Nations, held in Moscow in mid-August 2014.

All those interested in the question of where Salbutamol-Moskhimpharmaceuticals disappeared, the management asks to wait out the situation. By 2015, the company plans to release a new drug called "Salbutamol sulfate", in which the prohibited components will be replaced by harmless ones.

In particular, the freon-11 solvent and the freon-12 sprayer will be replaced by hydrofluorocarbon 134a, and alcohol will be used as a solvent.

Salbutamol during pregnancy

During pregnancy, the use of Salbutamol is contraindicated. During the period, the drug can be prescribed if the benefits to the mother outweigh any possible risks to the child. This is due to its ability to pass into breast milk.

Reviews about Salbutamol

Salbutamol is described as strong and effective remedy... In particular, a lot of positive reviews were left about the drugs produced by the Russian companies Moskhimpharmpreparaty them. ON. Semashko and Altayvitamins.

For many people who suffer from bronchial asthma , these funds are a real salvation, since they quickly improve the patient's condition even with a strong bronchospasm .

Another plus of domestic drugs is their low price in comparison with foreign counterparts, which is a very important selection criterion for a person who is forced to use the product for a long time.

Reviews of Salbutamol-Teva look somewhat less optimistic. Almost all patients who have tried this drug note the aesthetic appearance and inconvenience of the inhaler. The main disadvantage of the device is indicated by the short mouthpiece, which makes the use of the medicine not very comfortable.

Salbutamol price

The price of Salbutamol aerosol depends on which company produced the drug, and varies from 95 to 220 rubles. In Ukraine, the average price of the Salbutamol inhaler is 35 UAH.

Noting the high efficiency of the drug of the company Moskhimfarmpreparaty, and the fact that the drug has disappeared from pharmacies, many people with bronchial asthma are wondering where to buy Salbutamol Semashko in Moscow. Pharmacy staff advise looking for a medicine on special forums and in online pharmacies.

Sharing personal experience, many people say that you can try to buy Salbutamol Moscow in the regions. So, for example, one of the users wrote that he could not find a medicine in pharmacies in Moscow, but in one of the pharmacies in the suburbs it was sold in sufficient quantities.

• Online pharmacies in RussiaRussia
• Online pharmacies of UkraineUkraine
• Internet pharmacies in KazakhstanKazakhstan

ZdravCity

Salbutamol aerosol. d / inhalation doses. 0.1mg / dose 200 doses 12ml n1Binnopharm JSC

Salbutamol-teva aeros. d / inhalation doses. 100 μg / dose 200 doses n1Norton Waterford / Iwax Pharmaceuticals

When administered by inhalation, it acts mainly on β 2 -adrenergic receptors of the bronchi, having little effect on β 2 -adrenergic receptors of other localization. It has a pronounced bronchodilator effect.

By causing the expansion of the bronchi, it stops and prevents bronchospasm. Virtually no effect on β 1 -adrenergic receptors of the heart. Prevents the release of allergy and inflammatory mediators (histamine, SRSA) from mast cells. Improves mucociliary clearance.

The effect of the drug develops quickly and lasts 3-4 hours. After inhalation, approximately 10-20% of the active substance reaches the small bronchi, the rest settles in the upper respiratory tract... Plasma protein binding is 10%. Salbutamol is metabolized in the liver. It is excreted mainly in the urine unchanged and in the form of an inactive metabolite. Most of the dose of salbutamol administered by inhalation or taken by mouth is eliminated within 72 hours.

Indications

BA (prevention and relief of attacks), chronic obstructive bronchitis, pulmonary emphysema and other diseases that occur with bronchospasm. As a tocolytic agent, it is indicated for the threat of premature birth, isthmic-cervical insufficiency, a decrease in the fetal pulse, depending on the contractions of the uterus during the periods of cervical dilatation and expulsion, with a preventive purpose - during operations on the pregnant uterus (application of a circular suture with insufficiency of the internal uterine pharynx) ...

Application

Inhalation - for adults and children over the age of 4 years, to eliminate bronchial obstruction, 0.1 mg of salbutamol is prescribed for inhalation. If the attack does not stop within 5-10 minutes after the first inhalation, inhalation can be repeated. For prophylactic purposes, it is also recommended to inhale 0.1 mg of salbutamol 10-15 minutes before possible contact with the alleged allergen.

With prolonged use of salbutamol, 1-2 inhalations (0.1 mg) are used 3-4 times a day with an interval of at least 3 hours. Long-term use of salbutamol for COPD or BA is carried out only against the background of basic therapy.

Do not use more than 10 doses (1 mg of salbutamol) per day.

Inside, adults are usually prescribed 0.002 g 3-4 times a day.

As a tocolytic agent to eliminate the threat of premature birth, as well as after operations on the pregnant uterus, intravenous drip is injected at a dose of 5 mg in 400-500 ml of isotonic solution or 5% glucose solution at a rate of 15-20 drops (starting with 5 drops) per minute. The infusion rate is regulated taking into account the intensity of uterine contractions and tolerance (heart rate and other indicators of hemodingamics are controlled). Duration of administration is 6-12 hours.

Contraindications

Hypersensitivity to salbutamol, uncorrected hypertension, myocarditis, heart defects, aortic stenosis, decompensated endocrine disorders (thyrotoxicosis, diabetes mellitus), circulatory failure, tachyarrhythmias, glaucoma, pregnancy; in obstetrics - infection of the birth canal, intrauterine fetal death, fetal malformations, bleeding with placenta previa or premature placental abruption.

Side effects

Tachycardia, tremor, headache, sleep disturbance, rarely - allergic reactions (urticaria, angioedema, bronchospasm, arterial hypotension, paradoxical bronchospasm), transient peripheral vasodilation.

special instructions

It is used with extreme caution in case of hypersensitivity to sympathomimetics, severe heart disease (chronic coronary artery disease, acute myocardial infarction, hypertrophic obstructive cardiomyopathy, rhythm disturbances), hyperthyroidism, diabetes mellitus with an unstable course, pheochromocytoma.

During pregnancy, it can be used only for health reasons. Since salbutamol passes into breast milk, its use during breastfeeding is possible only if the expected therapeutic effect for the mother outweighs the potential risk for the child.

The use of salbutamol in high doses can worsen the reaction when driving or operating machinery. This effect is enhanced by the simultaneous use of alcohol, tranquilizers.

Interactions

The combined use of salbutamol with other adrenergic agonists is not recommended, as the risk of developing side effects on the part of the cardiovascular system. The simultaneous use of salbutamol with MAO inhibitors and tricyclic antidepressants is not allowed.

Overdose

It is manifested by tachycardia, arrhythmia, sleep disturbances, pain in the chest, tremors of the hands and the whole body. Treatment is symptomatic. Gastric lavage is performed, β-adrenergic receptor blockers are prescribed.

Doctor Kantuev

Kantuev Oleg Ivanovich - psychiatrist-psychotherapist, narcologist, neurologist.

MEDICINES AND ALCOHOL

increased urine output (urine output), characteristic of alcohol, can shorten the duration of the drug.

quinidine, aymalin, etmozine, ethazizin, lidocaine, diphenin, anaprilin, talinolol, ornid, amiodarone, verapamil, phenigidin, novocainamide

pyrroxan, prazosin, anaprilin, oxprenolol, alprenolol, pindolol, labetolol, octadine, reserpine, raunatin, etc.

azafen, amitriptyline (tryptisol), desipramine petilin), imizine (imipramine), trimipramine, etc.

neodikumarin, omefin, phenylin, fepromarone, etc.

barbital, phenobarbital, barbabital, etaminal, cyclobarbital, hexenal, thiopental, etc.

chlosepid (elenium), sibazone (diazepam, seduxen, relanium), phenazepam, nozepam (tazepam, oxazepam), mezazapam (rudotel)

diphenhydramine, diprazine, suprastin, tavegil

hydrocortisone, cortisone, prednisone, methylprednisolone, dexamethasone, triamcinolone, beclomethasone, etc.

diethyl ether, fluorothane, cyclopropane, nitrous oxide, hexenal, ketamine, sodium oxybutyrate, propanidide, thiopental sodium, trichlorethylene

chlorpromazine, triftazine, thioridazine, chlorprothixene, haloperidol, droperidol, clozepine, etc.

nitroglycerin, sustak, nitrong, trinitrolong, nitrosorbide, erinit, etc.

meprotan, amisil, mebikar, trioxazine and many others.

chlorpromazine, levomepromazine, propazine, thioproperazine (mazheptil), thioridazine, ethaperazine, etc.

The duration of the splitting of various alcoholic beverages by the female and male body

Champagne (200 ml)

The most curious thing about intoxication is that the influence of alcohol is manifested in some people in different ways, although the general outward manifestations of intoxication in most cases are similar. The following is a blood alcohol table.

The state and behavior of a drunk person depending on the blood alcohol content

PPM, g / liter (blood alcohol concentration)

BrAC, mg / liter (alcohol concentration in exhaled air)

External manifestations in behavior

Intoxication tolerance, relatively decent behavior

A slight inadequacy in behavior, which is noticeable only to those who know the person (relatives, colleagues, friends). Excessive sociability, a cheerful mood is manifested by some obsession, the degree of which is determined by the cultural and intellectual level of development of a particular person.

Acceptable blood alcohol level. In order to stop on time and not later pay traffic fines, control yourself with a breathalyzer.

A state of euphoria, impudent behavior

Unjustified self-confidence, violation of social norms and / or morality. It is difficult for a person to concentrate and correctly assess threats. Control over coordination is lost. Exceeding the normal level of alcohol in the blood, as well as intoxication itself, is conceived rejected. Increased likelihood of provoking an accident and / or deprivation of a driver's license.

slightly inappropriate behavior

A clear change in gait, distortion of the perception of the surrounding reality, drowsiness. Depending on mood and temperament, anger, fear or apathy are possible. Slow down reactions. Nausea is possible. It is difficult to drive. The chances of getting into an accident are very high while driving. A meeting with the police will have dire consequences.

Psychotic, totally inappropriate behavior

Complete disorientation sets in. A person cannot get out of a state of anger, fear or grief (individually). Color perception is sometimes impaired. The reaction is very bad. The feeling of pain is dulled. Balance and speech are disturbed. There is a chance of falling into a coma.

Lying state, stupor, and severe apathy

If the body is strong, then lethargy, loss of strength is felt, vomiting is possible. With a weak body, even paralysis can occur. A person no longer responds to pathogens, and also poorly controls urination and defecation. Death is possible.

Near-death condition, clinical coma

Reflexes are strongly suppressed or absent altogether. The body temperature drops. Disruption of the cardiovascular and respiratory systems. Fatal outcome is possible.

Due to paralysis of the respiratory tract, a person dies.

The blood alcohol table demonstrates how harmful and dangerous drinking can be. The components of intoxicating drinks harm the body, regardless of their dose. And if you also plan to drive during the day, do not risk your health, do not play with fate! It is better to give up alcoholic temptation, but save the life of yourself and those around you!

Complex analgesic drug containing codeine

Complex analgesic drug containing codeine

Combined, complex spasm-analgesic drug containing: propyphenazone, papaverine, atropine, phenobarbital, codeine phosphate and ephedrine

Combined analgesic, sedative, antispasmodic drug containing: propiphenazole, papaverine, atropine, phenobarbital, codeine phosphate and ephedrine

Combined preparation of analgesic, antipyretic and desensitizing action

P.V. Smolnikov, Cand. honey. Sci., Leading Researcher, State Research Center for Laser Medicine, Ministry of Health of the Russian Federation

Deadly combination: is it possible to take medications with alcohol

There is not a single medicine that doctors would advise to use along with alcohol. But the world is full of temptations, there are many holidays in our country, and the disease can coincide with any of them. Cold or flu, allergy or headache, injury or exacerbation chronic illness - there are many options. And the question arises: should I take the medicine if a colleague's birthday, a meeting with friends, a family celebration is ahead? Is it necessary to give up alcohol if the medicine has already been drunk? MedNews has found answers to these burning questions.

Anti-inflammatory, analgesic and antipyretic

All paracetamol-based drugs in combination with ethyl alcohol have a hepatotoxic effect - in the process of their metabolism, substances that are dangerous to the liver are formed. This combination can be toxic even with a single use of alcohol, and for those who drink regularly, alcohol with paracetamol is a direct path to liver damage. And here you need to be more careful, because paracetamol-based drugs are produced under a variety of trade names. In addition, paracetamol is part of many popular combination drugs that are taken to relieve symptoms of influenza and SARS.

Non-steroidal anti-inflammatory drugs are also not friendly with alcohol. Acetylsalicylic acid (aka aspirin) and ibuprofen in combination with ethyl alcohol become even more dangerous for the gastric mucosa (blood clotting decreases, the risk of ulcers and gastrointestinal bleeding increases). Sometimes you can hear the following recommendation from "experts": take a pill acetylsalicylic acid before or during a feast, to reduce the degree of intoxication and protect yourself from morning hangovers. But this is a myth: before and during - definitely not worth it, there will be much more harm than good. But in the morning, if you have a very headache, then one tablet of acetylsalicylic acid can be taken. The main thing is that after the last glass or shot, at least an hour has passed. And yet, doctors advise not to get carried away with painkillers to relieve hangover symptoms; it is better to drink enterosorbent - the same activated carbon.

Antibacterial drugs

Some antibacterial drugs (not only antibiotics) affect alcohol metabolism. The processing of ethyl alcohol occurs in two stages: first, the enzyme alcohol dehydrogenase breaks it down to acetaldehyde (acetaldehyde). In the second step, another enzyme, aldehyde dehydrogenase, converts acetaldehyde to acetic acid. Acetic aldehyde causes us the most trouble: it is he who is responsible for the symptoms of a hangover. Some groups of antibiotics interfere with the work of a second enzyme, aldehyde dehydrogenase, which increases the level of toxic acetaldehyde in the body. As a result, the drinker receives in the most vivid form all the painful symptoms of a hangover (they are also symptoms of acetaldehyde poisoning): headache, nausea and vomiting, increased heart rate, respiratory problems, convulsions - and not the next day after drinking alcohol, but immediately.

This effect is called "disulfiram-like reaction" after the name of the drug disulfiram, which has the same effect and is used to treat alcoholism ("binder"). Disulfiram-like reactions are caused by several groups of antibiotics: metronidazole and tinidazole (these drugs are record holders: they provide such an unforgettable experience almost guaranteed!). Sometimes an unforgettable effect is given by cephalosporins, sulfonamides (including biseptol), nitrofurans (furazolidone), chloramphenicol, antifungal drugs - griseofulvin and ketoconazole.

Another bad news: You need to continue to abstain from alcohol 2-4 days after the last intake of these drugs. In addition, many do not realize that a disulfiram-like reaction can occur not only when taking medications inside. Injections, eye drops, nose drops, solutions for inhalation, vaginal suppositories and creams - these antibacterial drugs can affect the metabolism of alcohol in all forms.

Vasoconstrictor drops

Another popular winter medicine that is used to relieve ARVI symptoms, with an innocent rhinitis, is vasoconstrictor drops (many drugs based on xylometazoline and naphazoline). And, again, not everyone thinks that drops dripped into the nose and a glass of wine (or a glass of vodka) drunk can "meet" in the vastness of our body. But they can, and how - it just happens not in the stomach, but in the blood. All vasoconstrictor drops are adrenomimetics, that is, adrenaline-like substances. Ethyl alcohol, in turn, causes our adrenal glands to release more adrenaline into the bloodstream. Your own increased adrenaline plus an adrenergic agonist (albeit in a small dose) is not the most favorable combination for the heart. In sum, all this can give sharp rise blood pressure and severe tachycardia (heart palpitations).

Antidepressants

Alcohol itself is a depressant, that is, it inhibits the activity of the central nervous system (CNS). Therefore, drinking it along with antidepressants is pointless. Yes, immediately after taking alcohol, due to the release of additional adrenaline into the blood, which we have already mentioned, activity increases, the mood rises. But this happens only for a short time, and then, on the contrary, the oppressed state sets in for a long time.

Antidepressants from the group of monoamine oxidase inhibitors (MAOIs) are especially poorly combined with alcohol. As with adrenergic agonists, there is too much adrenaline in the body. Blood pressure rises, heart rate increases, up to the risk of stroke and other disorders in the work of the heart.

And one more fly in the ointment: in some sorts of beer and wine there is a substance tyramine, which in its properties and structure is similar to adrenaline. Usually, the enzyme monoamine oxidase processes tyramine without problems, but MAO inhibitors interfere with this process. Then tyramine enters the bloodstream, the effect is the same as with adrenaline: high blood pressure and tachycardia.

Tranquilizers and sleeping pills

Tranquilizers (anxiolytics) and alcohol are an extremely unfortunate and dangerous combination. Ethanol and drugs from the benzodiazepine group (bromodihydrochlorophenylbenzodiazepine, diazepam, oxazepam, medazepam) - these include, for example, the famous phenazepam - inhibit the activity of the central nervous system. When they work together, this effect can be amplified many times over. As a result, the degree of intoxication and drowsiness increase, coordination of movements is impaired, and breathing may stop. Falling into a deep sleep, a person risks choking on vomit. And I don't even want to talk about how the good old barbiturates are combined with ethanol - let it remain legends from the rock and roll 1960s. Fortunately, drugs in this group are no longer prescribed as sleeping pills and sedatives and are not sold without a prescription.

Antihistamines

Alcohol and allergies are a separate topic: many alcoholic beverages (including quite "noble" ones - for example, wine) themselves can cause and intensify allergies. First generation antihistamines (diphenhydramine, clemastine, chloropyramine) have a sedative effect, and together with alcohol, they, like tranquilizers, can enhance each other's effect. Second- and third-generation antihistamines no longer cause drowsiness. But all three generations of antihistamines disrupt the work of the enzyme aldehyde dehydrogenase, so the toxic effect of alcohol on the liver increases. Ethanol, for its part, reduces the antihistamine effect.

Low blood sugar and insulin

Another property of ethyl alcohol is to lower blood sugar levels. Therefore, it is very dangerous to combine alcohol with drugs that are taken by patients with diabetes - insulin and other hypoglycemic drugs. Alcohol enhances their effects and can cause hypoglycemia - a life-threatening drop in glucose levels (this can happen to a healthy person if you drink too much, especially on an empty stomach). Symptoms of mild initial hypoglycemia - fever, tremors, weakness, increased sweating, heart palpitations; if this condition is not recognized in time, hypoglycemic coma may develop, which may end in death.

In general, the verdict is not very comforting: for some reason, no medicine is recommended to be taken with alcohol. We have considered the most common and dangerous combinations, and forewarned means forearmed. But do not forget that the same medicine can be produced under many different trade names. Therefore, use our table and check which active ingredient is in the pill you are about to take.

How medications combine with alcohol

* Compiled on the basis of materials from A. Borovsky's book "Peculiarities of a National Hangover" (Moscow: Eksmo, 1998) with changes and additions.

Drug class or drug name

Compatibility table of drugs and alcohol

ANAPRILIN, OBZIDAN, INDERAL, OXPRENOPOL (TRASICOR), PINPOLOL (VIXEN), TALINOLOL (CORDAN), TIMOLOL, ALPRENLOL, ATENOLOL (BETACARD, TENORMIN, etc.)

ADRENALINE, NORADRENALINE, MESATONE, CLOFELINE, GALAZOLINE, NAFTHISINE, METHYLDOPA.

ADRENALINE, ISADRIN, DOBUTAMINE, ORCIPRENALINE (ALUPENT, ASTHMOPENT), SALBUTAMOL (ALBUTEROL, VENTOLIN), PHENOTEROL (BEROTEC, TERBUTALIN).

OMNOPONE, MORPHINE, BUPRENORFINE, VALORON, FENTANYL, etc.

TESTOSTERONE, PROPIONATE, METHYLTESTOSTERONE, TESTENATE, SUSTANONE.

QUINIDINE, AYMALINE, ETHMOSINE, ETHACISINE, LIDOCAINE, DIPHENINE, ANAPRILIN, TALINOLOL, ORNID, AMIODARON, VERAPAMIL, PHENIGIDINE, NOVOCAINAMIDE

PIRROXCAN, PRAZOSIN, ANAPRILIN, OXPRENOLOL, ALPRENOLOL, PINDOLOL, LABETOLOL, OCTADINE, RESERPIN, RAUNATIN, etc.

AZAPHENE, AMITRIPTILINE (TRIPTISOL), DESIPRAMINE (PETILINE), IMIZINE (IMIPRAMINE), TRIMIPRAMINE, etc.

BROMCAMPHORA, POTASSIUM BROMIDE, SODIUM BROMIDE, SODIUM OXIBUTIRATE, NITRAZEPAM, RELADORM, etc.

How to use the drug Salbutamol correctly

Salbutamol, the instructions for use of which gives detailed instructions for the use of the drug, is a remedy prescribed for the relief of spasm in the bronchi in the event of the onset and development of suffocation. The peculiarity of the drug is that it is allowed to use Salbutamol during pregnancy and lactation. Treatment of bronchial asthma is a long and even permanent process. This is due to the fact that bronchial asthma is classified as an incurable disease caused by many negative factors.

Features of the composition and action

He will tell you how to use Salbutamol correctly, instructions for using this drug. It describes all its advantages and features of the drug. You should know when purchasing Salbutamol that the release form of this drug provides for the use of an aerosol. A substance that has an active effect is salbutamol at a dosage of 0.0725 mg per 100 mg of the drug. Salbutamol is one of the drugs that make up a group of synthetic drugs created to fight asthmatic attacks, provide emergency medical care and prevention of the development of suffocation.

As an additional component, cetyl oleate is introduced into the composition, the dosage of which is 0.1449 mg for every 100 mg of the drug. When creating an aerosol Salbutamol intended for inhalation in the treatment of asthma, fluorotrichloromethane and difluorodichloromethane were used.

The instructions for use written to Salbutamol say that this drug is used to provide emergency medical care in case of complication of an attack of bronchial asthma.

Its action is aimed at:

• relief of suffocation;
• getting rid of spasm of smooth muscles of the trunk and branches of the bronchial tree;
• prevention of asthmatic attacks.

There are other forms of release medicinal product, which are in high demand in the elimination of asthmatic suffocation and the prevention of the development of a second asthma attack.

• oral administration of Salbutamol tablets;
• the use of Salbutamol inhalation aerosol during asthma;
• spray;
• syrup;
• capsules containing a powder intended for inhalation using a nebulizer;
• concentrate in vials, from which a solution for injection is prepared;
• the use of Salbutamol for inhalation using special equipment or devices to stop or prevent the development of an asthma attack. You can use a regular inhaler or nebulizer at home.

In the course of carrying out therapeutic measures in a hospital setting, it is possible to use the drug Salbutamol, produced in the form of a solution for intravenous invasions. Salbutamol is a drug with a mucolytic effect, and the pharmacology and composition of this drug indicate the possibility of using the drug as a drug with an anti-inflammatory effect.

Pharmacodynamics

For bronchial asthma, manufacturers recommend using an aerosol for inhalation, since this bronchodilating agent has a tocolytic effect and promotes the expansion of the bronchi, increasing the airway lumen and making it easier for the patient to breathe. The composition of the drug, its group affiliation and pharmacodynamics confirm that Salbutamol quickly and effectively relieves an asthma attack, helps to fight inflammatory processdeveloping in the respiratory tract due to abundant secretion and accumulation of mucus.

The action of the drug is aimed at:

• an increase in the vital capacity of the lungs;
• expansion of the coronary arteries without changing blood pressure;
• preventing the release of histamine.

The mechanism of action is associated with the peculiarities of the effect on the beta2-adrenergic receptors of the smooth muscles of the bronchi, as a result of which the muscles of the respiratory organs relax and the lumen of the trunk and branches of the bronchial tree expands. Part of the dose of the drug taken by the patient during inhalation in the event of an asthma attack remains directly in the respiratory tract and lungs of the patient, exerting a local effect depending on where the inflammation is located and the place of narrowing of the bronchial lumen.

In addition, under the influence of Salbutamol, the secretion and excretion of mucus from the respiratory system is activated, the work of the ciliated epithelium improves, which prevents the development of an asthma attack due to contact with an allergen.

How to apply and what is the indication

The use of Salbutamol solution for inhalation is especially effective in the fight against asthmatic suffocation. The inhaler is a balloon made of aluminum, equipped with a special valve and dispenser, when pressed, the drug composition is sprayed. Manufacturers produce analogs developed and created for Salbutamol in the form of capsules with powder for inhalation, tablets, syrup or spray.

When deciding what to replace Salbutamol with, you should definitely consult with your doctor. Otherwise, there may not be a proper result, but side effects will instantly make themselves felt.

The use of Salbutamol is possible strictly according to the doctor's prescription. The substances included in its composition are not always useful for patients in need of urgent relief from an asthma attack. The annotation says that this hormonal drug is often addictive if taken incorrectly.

Indications for use include:

1. Diagnosed obstructive bronchitis in young children.
2. Prevention of the development and relief of spasm in the bronchi in all forms of bronchial asthma.
3. Narrowing of the lumen of the bronchi or blockage.
4. Chronic obstructive bronchitis in adults.
5. Emphysema of the lungs.
6. Bronchitis caused by asthma.

Listing the indications for the use of Salbutamol, one can name the sudden onset of suffocation against the background of premature birth.

There are certain rules for taking the drug in the form of tablets, syrup or spray, use for inhalation with a nebulizer or intravenous administration.

Contraindications that exist for the use of Salbutamol indicate that this medication should be used with extreme caution in patients with hyperglycemia, but the absolute indications for taking the drug are:

• violations of the functionality of the organs of the cardiovascular system;
• hypersensitivity or individual intolerance to the constituent components of the drug;
• congenital or acquired heart disease;
• ischemic disease;
• renal and hepatic impairment;
• aortic stenosis;
• strokes;
• myocardial infarction;
• dysfunction of the thyroid gland;
• glaucoma;
• epilepsy;
• pregnancy.

The use of Salbutamol is possible only on the urgent recommendation of the attending physician, but with great care and under his control, it is possible if:

• hypertension;
• arrhythmias;
• tachycardia;
• heart failure;
• Basedow's disease.

It is forbidden to inject the drug intravenously even during an attack of severe suffocation with:

1. Intrauterine fetal death or diagnosed frozen pregnancy.
2. Developmental disorders or placenta previa.
3. Suspicion of a possible placental abruption.
4. Late toxicosis (edema, impaired renal function).
5. Uterine bleeding.

Side effect

The appearance of side effects after using the drug may be a consequence of an overdose of Salbutamol or improper intake of the drug. It is necessary to use such a device as an inhaler in strict accordance with the attached instructions. Only inhalation aerosol does not cause side effects. In other cases, exceeding the dosage indicated in the annotation leads to a violation of the heart rhythm and other serious consequences.

The most dangerous side effects are:

1. With the introduction of the drug by inhalation, a burn or an irritation reaction of the pharyngeal mucosa is possible. The reason is the exceeded maximum dose of the drug. Correctly dosed intake does not disrupt the normal state of the mucous membrane.
2. An overdose of Salbutamol causes an irregular heartbeat (arrhythmia) or causes a rapid heart rate (tachycardia). Against the background of improper administration of the drug, expansion of peripheral blood vessels is possible.
3. Often a large daily dose can cause tremors of the extremities, the appearance of a feeling of anxiety and unjustified fear, overexcitement, and severe headaches.
4. If devices such as an inhaler or nebulizer are used improperly, the permissible dosage may be exceeded, and the drug composition causes cramps in the limbs.
5. If the expiration date of the medicine has expired, the instructions according to which the substance should be used has been violated, or the composition is applied uncontrollably, the level of potassium in the blood sharply decreases and a pronounced metabolism develops.

Their manifestation is associated with hives, skin rashes, itching, slight burning sensation. Any manifestation of a negative reaction to taking the drug is an indication for discontinuing therapy with it.

Before starting treatment with Salbutamol, you must make sure that there are no contraindications and that this medication is compatible with other substances used. The interaction of Salbutamol with drugs that have a diuretic effect leads to the development of hypokalemia, and when taken simultaneously with drugs that stimulate breathing, tachycardia and heart rhythm disturbances may occur.

In such cases, Salbutamol should be stopped immediately, but only a qualified doctor can select a substitute. Bad habits, such as smoking and alcohol, are completely incompatible with Salbutamol. A contraindication is also 1 trimester of pregnancy, when there is no placental barrier and the components of the drug can harm the developing fetus.

Rules of application and reception

Method of application Salbutamol 100 mcg - aerosol prescribed to children before the upcoming physical activity.

Often, parents use an inhaler as a preventive measure, but this can be done only as directed by the attending physician:

1. For children, there is a syrup, the intake of which is strictly dosed several times a day and is carried out under the strict supervision of doctors. How many times a day you can take Salbutamol syrup and what dosage a small patient uses depends on his age, weight and the severity of the disease. If choking develops during an asthma attack, children are allowed to use an aerosol. Turning the inhaler upside down, holding it strictly vertically, insert the mouthpiece into the oral cavity and cover it with your lips, without biting so as not to damage. To stop the attack, it is enough to make two clicks with simultaneous breaths. Whether the procedure helped or not, it will be possible to understand when the action of the drug will begin, which means, no later than after 5 minutes. If there is no effect, the procedure can be repeated. Correct performance of the procedure is essential. Before spraying the aerosol, the child needs to exhale completely, freeing the lungs from air, and then take a deep slow breath while pressing the dispenser valve.
2. On early dates Pregnancy cannot be treated with Salbutamol, but if a woman used this drug composition after the placental barrier was formed, using the inhaler several times a day, the fetus is not in danger. Often, doctors do not recommend using the spray because of its antispasmodic effect, fearing a negative effect on the uterine muscle, but if there is no risk to the health of the fetus and its full development, then treatment with this drug is not contraindicated for a pregnant woman.
3. The number of inhalations per day is determined by the severity of the patient's condition and the level of upcoming physical activity or possible contact with an allergen. If the patient has to make significant efforts to perform certain actions, he is shown taking two doses (200 μg). These are two inhalations or two clicks on the dispenser.
4. Supportive therapy for chronic bronchitis consists in regular inhalations. This is 400 mcg throughout the day, divided into 4 inhalations. After the procedure, you should refuse to take fluids and food for a while.

At high levels of risk of contact with an allergen, a prophylactic dose of Salbutamol is required, but in cases where the drug is used as a prophylactic agent with the possibility of an asthma attack, the patient takes 2 doses (2 inhalations) at the same time. This means that he needs to shake the inhaler, turn it upside down with the dispenser and insert the mouthpiece into the oral cavity.

The procedure cannot be performed with filled lungs, since the drug composition must penetrate into the most distant corners of the lungs. To do this, you need to exhale completely, then, slowly inhaling air, press the dispenser cap and hold your breath for 30 seconds. You can repeat the inhalation with a strong attack or in the absence therapeutic effect... You need to wait at least 5 minutes. It is important to remember that premature repetition of inhalation can cause side effects.