INFORMATION FOR HEALTH PROFESSIONALS
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Salamol CFC-Free Inhaler is a metered dose aerosol inhaler which delivers 100 micrograms of salbutamol (as sulphate) per actuation (or metered dose, or "puff"). The inhaler also contains the non-CFC propellant norflurane (or HFA134a), and Ethanol anhydrous. Each canister contains 200 metered actuations.
Pressurised inhalation, suspension.
Salamol CFC-Free Inhaler is a metered dose aerosol inhaler consisting of a pressurised aluminium canister fitted with a metered dispensing valve, and fitted into a blue colour plastic actuator/mouthpiece with a dark blue colour cap.
Salbutamol is a selective β-2 adrenoceptor agonist. At therapeutic doses it acts on the β-2 adrenoceptors of bronchial muscle, with little or no action on the β-1 adrenoceptors of the heart. With its fast onset of action, it is particularly suitable for the management and prevention of attack in mild asthma and for the treatment of acute exacerbations in moderate and severe asthma.
Bronchodilators should not be the only or main treatment in patients with severe or unstable asthma. Severe asthma requires regular medical assessment as death may occur. Patients with severe asthma have constant symptoms and frequent exacerbations, with limited physical capacity, and PEF values below 60% predicted at baseline with greater than 30% variability, usually not returning entirely to normal after a bronchodilator. These patients will require high dose inhaled (e.g. >1mg/day beclomethasone dipropionate) or oral corticosteroid therapy.
With this primary background corticosteroid treatment, Salamol CFC-Free Inhaler provides essential rescue medication for a severe asthmatic in treating acute exacerbations. Failure to respond promptly or fully to such rescue medication signals a need for urgent medical advice and treatment.
Salbutamol provides short-acting (4 hour) bronchodilation with fast onset (within 5 minutes) in reversible airways obstruction due to asthma, chronic bronchitis and emphysema. It is suitable for long-term use in the relief and prevention of asthmatic symptoms.
Salamol CFC-Free Inhaler should be used to relieve symptoms when they occur and to prevent them in those circumstances recognised by the patient to precipitate an asthmatic attack (e.g. before exercise or unavoidable allergen exposure).
Salamol CFC-Free Inhaler is particularly valuable as rescue medication in mild, moderate or severe asthma, provided that reliance on it does not delay the introduction and use of regular inhaled corticosteroid therapy.
Salamol CFC-Free Inhaler is administered by the oral inhaled route only.
Salbutamol has a duration of action of 4 to 6 hours in most patients.
Increasing use of β-2 agonists may be a sign of worsening asthma. Under these conditions a reassessment of the patient's therapy plan may be required and concomitant glucocorticosteroid therapy should be considered.
In patients who find co-ordination of a pressurised metered-dose inhaler difficult a spacer device may be used with the Salamol CFC-Free Inhaler.
Babies and young children may benefit from use of a spacer device with the Salamol CFC-Free Inhaler.
As there may be adverse effects associated with excessive dosing, the dosage or frequency of administration should only be increased on medical advice.
Adults: 100 or 200 mcg.
Children: 100 mcg, the dose may be increased to 200 mcg if required.
Adults: 200 mcg before challenge
Children: 100 mcg before challenge, the dose may be increased to 200 mcg if required.
Adults: Up to 200 mcg four times daily
Children: Up to 200 mcg four times daily
On demand use of Salamol CFC-Free Inhaler should not exceed four times daily. Reliance on such supplementary use or a sudden increase in dose indicates deteriorating asthma (see Special Warnings and Special Precautions for Use).
Salamol CFC-Free Inhaler is contra-indicated in patients with a history of hypersensitivity to any of its components.
Although intravenous salbutamol and occasionally salbutamol tablets are used in the management of premature labour uncomplicated by conditions such as placenta praevia, ante-partum haemorrhage or toxaemia of pregnancy, inhaled salbutamol presentations are not appropriate for managing premature labour. Salbutamol preparations should not be used for threatened abortion.
The management of asthma should normally follow a stepwise programme, and patient response should be monitored clinically and by lung function tests.
Increasing use of short-acting inhaled β-2 agonists to control symptoms indicates deterioration of asthma control. Under these conditions, the patient's therapy plan should be reassessed. Sudden and progressive deterioration in asthma control is potentially life-threatening and consideration should be given to starting or increasing corticosteroid therapy. In patients considered at risk, daily peak flow monitoring may be instituted.
In the event of a previously effective dose of inhaled salbutamol failing to give relief for at least three hours, the patient should be advised to seek medical advice in order that any necessary additional steps may be taken.
Patients' inhaler technique should be checked to make sure that aerosol actuation is synchronised with inspiration of breath for optimum delivery of the drug to the lungs.
Salbutamol should be administered cautiously to patients with thyrotoxicosis.
Potentially serious hypokalaemia may result from β-2 agonist therapy mainly from parenteral and nebulised administration.
Particular caution is advised in acute severe asthma as this effect may be potentiated by concomitant treatment with xanthine derivatives, steroids, diuretics and by hypoxia. It is recommended that serum potassium levels are monitored in such situations.
Salbutamol and non-selective β-blocking agents, such as propranolol, should not usually be prescribed together.
Salbutamol is not contra-indicated in patients under treatment with monoamine oxidase inhibitors (MAOIs).
Administration of medicines during pregnancy should only be considered if the expected benefit to the mother is greater than any possible risk to the foetus.
During worldwide marketing experience, rare cases of various congenital anomalies, including cleft palate and limb defects have been reported in the offspring of patients being treated with salbutamol. Some of the mothers were taking multiple medications during their pregnancies.
Because no consistent pattern of defects can be discerned, and baseline rate for congenital anomalies is 2-3%, a relationship with salbutamol use cannot be established.
As salbutamol is probably secreted in breast milk its use in nursing mothers is not recommended unless the expected benefits outweigh any potential risk. It is not known whether salbutamol in breast milk has a harmful effect on the neonate.
None reported.
Adverse events are listed below by system organ class and frequency. Frequencies are defined as: very common (<1/10), common (>1/100 and <1/10), uncommon (>1/1000 and <1/100), rare (>1/10,000 and <1/1000) and very rare (<1/10,000) including isolated reports. Very common and common events were generally determined from clinical trial data. Rare and very rare events were generally determined from spontaneous data.
Very rare: Hypersensitivity reactions including angioedema, urticaria, bronchospasm, hypotension and collapse.
Rare: Hypokalaemia.
Potentially serious hypokalaemia may result from β-2 agonist therapy.
Common: Tremor, headache.
Very rare: Hyperactivity.
Common: Tachycardia.
Very rare: Cardiac arrhythmias including atrial fibrillation, supraventricular tachycardia and extrasystoles.
Rare: Peripheral vasodilatation.
Very rare: Paradoxical bronchospasm.
As with other inhalation therapy, *paradoxical bronchospasm may occur with an immediate increase in wheezing after dosing. This should be treated immediately with an alternative presentation or a different fast-acting inhaled bronchodilator. Salamol CFC-Free Inhaler should be discontinued immediately, the patient assessed, and, if necessary, alternative therapy instituted.
Uncommon: Mouth and throat irritation.
Uncommon: Muscle cramps.
*Tachycardia may occur in some patients
The preferred antidote for overdosage with salbutamol is a cardioselective β-blocking agent. Beta-blocking agents should be used with caution in patients with a history of bronchospasm.
Hypokalaemia may occur following overdose with salbutamol. Serum potassium levels should be monitored.
Salbutamol is a selective β-2 adrenoceptor agonist. At therapeutic doses it acts on the β-2 adrenoceptors of bronchial muscle, with little or no action on the β-1 adrenoceptors of cardiac muscle.
Salbutamol administered intravenously has a half-life of 4 to 6 hours and is cleared partly renally and partly by metabolism to the inactive 4'-O- sulphate (phenolic sulphate) which is also excreted primarily in the urine. The faeces are a minor route of excretion. The majority of a dose of salbutamol given intravenously, orally or by inhalation is excreted within 72 hours. Salbutamol is bound to plasma proteins to the extent of 10%.
After administration by the inhaled route between 10 and 20% of the dose reaches the lower airways. The remainder is retained in the delivery system or is deposited in the oropharynx from where it is swallowed. The fraction deposited in the airways is absorbed into the pulmonary tissues and circulation but is not metabolised by the lung.
On reaching the systemic circulation it becomes accessible to hepatic metabolism and is excreted, primarily in the urine, as unchanged salbutamol and as the phenolic sulphate.
The swallowed portion of an inhaled dose is absorbed from the gastrointestinal tract and undergoes considerable first-pass metabolism to the phenolic sulphate. Both unchanged salbutamol and conjugate are excreted primarily in the urine.
In common with other potent selective β-2 receptor agonists, salbutamol has been shown to be teratogenic in mice when given subcutaneously. In a reproductive study, 9.3% of foetuses were found to have cleft palate, at 2.5 mg/kg, 4 times the maximum human oral dose. In rats, treatment at the levels of 0.5, 2.32, 10.75 and 50mg/kg/day orally throughout pregnancy resulted in no significant foetal abnormalities. The only toxic effect was an increase in neonatal mortality at the highest dose level as the result of lack of maternal care. A reproductive study in rabbits revealed cranial malformations in 37% of foetuses at 50mg/kg/day, 78 times the maximum human oral dose.
Norflurane (or HFA 134a) has been shown to be non-toxic at very high vapour concentrations, far in excess of those likely to be experienced by patients, in a wide range of animal species exposed daily for periods of two years.
1,1,1,2-tetrafluoroethane (also known as HFA 134a or norflurane). Also contains Ethanol anhydrous (Alcohol).
None reported.
36 months
Salamol CFC-Free Inhaler should be stored below 25°C.
Do not refrigerate or freeze. Protect from frost, direct sunlight, and heat.
As with most inhaled medications in aerosol canisters, the therapeutic effect of this medication may decrease when the canister is cold.
The canister should not be broken, punctured or burnt, even when apparently empty.
Salamol CFC-Free Inhaler comprises a suspension of salbutamol sulphate in the non-CFC propellant norflurane (or HFA 134a). Also contains Ethanol anhydrous. The suspension is contained in an aluminium alloy can, sealed with a metering valve. Each canister is fitted with a blue colour plastic actuator incorporating an atomising nozzle and fitted with a dark blue colour dustcap. Salamol CFC-Free Inhaler delivers 100mcg of salbutamol (as sulphate) per actuation.
Each canister contains at least 200 actuations.
Before using for the first time remove the mouthpiece cover by gently squeezing the sides of the cover, shake the inhaler well, and release two puffs into the air to make sure that it works. If it has not been used for several days shake it well and release one puff into the air to make sure that it works.
IMPORTANT:-
Do not rush Stages 4, 5 and 6. It is important that you start to breathe in as slowly as possible just before operating your Inhaler.
Practise in front of a mirror for the first few times. If you see 'mist' coming from the top of the inhaler or the sides of your mouth you should start again from stage 2.
If your doctor has given you different instructions for using your inhaler, please follow them carefully. Tell your doctor if you have any difficulties.
Your inhaler must be cleaned at least once a week.
If you need to use your inhaler before it is dry, shake off any excess water from the plastic actuator and put the metal canister back in. Test the inhaler by releasing two puffs into the air to make sure that it works, before taking your usual dose. Wash and dry the inhaler again as described above.
Prescription Only Medicine
Air Flow Products Ltd
Level 3, The Thorndon Centre
191 Thorndon Quay
PO Box 1485
WELLINGTON
Telephone: 0800 AIRFLOW (0800 247 3569)
Fax: 0800 323 270
Email: afp@air-flow.co.nz
www.air-flow.co.nz
Sponsor:
Norton Healthcare Limited (New Zealand Branch Office)
Makino Road
PO Box 115
FEILDING
SALAMOL is a trade-mark.
Air Flow Products Ltd is a wholly owned subsidiary of the Asthma and Respiratory Foundation of New Zealand (Inc.). Funds raised will support the work of the Asthma and Respiratory Foundation of New Zealand (Inc.).
21 February 2005
Version 1.4