In this article, we will discuss Bronchodilators-Dosage (Part-I). So, let’s get started.
Adrenaline (epinephrine) 0.01 ml/kg per dose (maximum 0.5 ml per dose) of 1:1000 solution IM. Repeat the dose after 15-20 minutes. For cardiac arrest, intravenous 0.1 ml/kg per dose of 1:10,000 solution, and endotracheal: 0.1 ml/kg per dose of 1: 1000 solution. Don’t use 1:1000 solution IV unless ten times diluted. For laryngeal edema due to anaphylaxis and croup, give 0.1 ml/kg (maximum 5 ml) of 1:10,000 solution by nebuliser.
Adult dose: 0.5-1.0 ml of 1:1000 solution IM.
(Inj adrenaline 1 mg per ml; ampoule 1:1000 solution).
Aminophylline 15 to 20 mg/kg/day q 8 hr oral. For status asthmaticus: 5 mg/kg loading dose IV followed by continuous infusion at the following rate: 6 mon – 1 year: 0.6-0.7 mg/kg/hr; 1-9 years: 1.0-1.2 mg/kg/hr; 9-12 years: 0.9 mg/kg/hr; >12 years: 0.7 mg/kg/hr.
The loading dose should be diluted and given slowly. If patient is already receiving oral aminophylline derivatives, do not use the loading dose. For apneic attacks in preterm infants: 5 mg/kg loading dose IV slowly followed by 2 mg/kg q 8 hr orally or IV as maintenance.
Side Effects: Nausea, vomiting, irritability, restlessness, palpitations and convulsions.
(Aminophylline tab 100 mg; inj aminophylline 250 mg/2ml in 10 ml ampoule).
Bambuterol hydrochloride It is an oral prodrug of terbutaline. Children between 2 and 5 yr: 5 mg, 6 and 12 yr: 10 mg single dose at night. Presently recommended for use in children above 2 years of age.
Adult dose: 10-20 mg/day single dose.
(Bambudil, bemlo, roburol, betaday, asthafree, abel tabs 10 mg, 20 mg; syrup 5 mg and 10 mg per ml).
Beclomethasone dipropionate Inhalation of 50–1000 ug per day in 2 or 4 divided doses. (Low dose – 6-11 years: 50-100 μg/d, 12 years and older: 100-200 μg/d; medium dose – 6-11 years: >100-200 μg/d, 12 years and older: >200-400 μg/d; high dose – 6-11 years: >200 μg/d, 12 years and older: >400 μg/d). Chronic asthma patients require regular and prolonged treatment.
Beclomethasone nasal spray 50 μg metered dose aerosol once or twice a day for allergic rhinitis, vasomotor rhinitis, symptomatic relief of nasal polyposis.
Side Effects: Hoarseness, candidiasis of mouth and throat. Rinse mouth after using inhaled steroid preparations.
(Beclate metered dose inhaler (MDI) provides 50 ug, 100 μg, 200 μg per puff/actuation; becoride MDI 100 μg; becoride forte 250 μg per puff, aerocort inhaler provides 100 μg salbutamol and 50 μg beclomethasone, aerocort rotacap provides 200 μg salbutamol and 100 μg beclomethasone; beclate rotacaps 100 μg, 200 μg, and 400 μg beclomethasone).
Budesonide Inhalation steroid for long-term asthma control at dose 100-800 μg per day q 12 hr. (Low dose: 6-11 years: 100-200 μg/d, 12 years and older: 200-400 μg/d; medium dose: 6-11 years: >200-400 μg/d, 12 years and older: >400–800 μg/d;
high dose: 6-11 years: >400 μg/d, 12 years and older: >800 μg/d).
Once daily dosing may be considered in patients where asthma is controlled with 100-200 μg. For croup nebulize: 2 mg in 2.5 ml of normal saline single dose, if there is poor response may be repeated q 12 hr for 48 hr.
(Pulmicort MDI provides 100 μg per dose/actuation; budecort, derinide, budez 100 μg and 200 μg per dose/actuation; budecort 100 μg, 200 μg and 400 μg rotacaps; budecort, pulmicort respules 0.5 mg and 1.0 mg in 2 ml ampoules for nebulization).
Budesonide plus formoterol fumarate Starting dose 400 μg for moderate and 800 ug for severe asthma per day q 12 hr as per budesonide component. Doses need to be increased or decreased on follow-up as per quality of asthma control. At present, not recommended for children below 4 years of age.
(Foracort inhaler and rotacaps contain 6 μg formoterol fumarate and 100 μg, 200 μg and 400 μg budesonide per dose).