Lv Ke Dosage
Tablet: Adults: Usual Dose: 4 mg or 10 mL (2 tsp) of syrup. If adequate bronchodilation is not obtained, each single dose may be gradually increased to as much as 8 mg or 20 mL (4 tsp) of syrup.
To be taken every 6 or 8 hrs.
In some patients known to be unusually sensitive to β-adrenergic stimulant drugs who obtain adequate relief with 5 mL of syrup, it is advisable to initiate treatment with 5 mL (1 tsp) of syrup 3 or 4 times a day.
Children >12 years: 2-4 mg or 5-10 mL (1-2 tsp) of syrup; 6-12 years: 2 mg or 5 mL (1 tsp) of syrup; 2-6 years: 1-2 mg or 2.5-5 mL (½-1 tsp) of syrup.
Nebulizing Solution: Adults and Adolescents: Usual Dose: The usual initial dose of Lv Ke by wet inhalation is 2.5-5 mg. Treatment may be repeated up to 4 times daily. In adults, higher dosing up to 40 mg/day can be given under strict medical supervision in hospital for the treatment of severe airway obstruction.
Children up to 12 years: Dosage has not been established. Note: As there may be adverse effects associated with excessive dosing, the dosage or frequency of administration should only be increased on medical advice.
Administration: Lv Ke 1 mg/mL nebulizing solution for inhalation is given undiluted using a nebulizer, under the direction of a physician. However, if prolonged administration is desired (>10 min), the solution can be diluted with 0.9% sodium chloride solution.
Direction for Dilution/Prolonged Inhalation: Pipette 2.5-5 mL (equivalent to 2.5-5 mg Lv Ke, as sulfate) of Lv Ke nebulizing solution from the bottle by using a calibrated medicine dropper provided in the pack. Drop the solution into an electric nebulizer and dilute it with 2-4 mL normal saline solution and start inhalation. Any unused solution in the chamber of the nebulizer must be discarded. Repeat the same procedure every 8 hrs in a 24-hr period.
The concomitant use of Lv Ke (albuterol sulfate syrup) and other oral sympathomimetic agents is not recommended since such combined use may lead to deleterious cardiovascular effects. This recommendation does not preclude the judicious use of an aerosol bronchodilator of the adrenergic stimulant type in patients receiving Lv Ke (albuterol sulfate syrup). Such concomitant use, however, should be individualized and not given on a routine basis. If regular coadministration is required, then alternative therapy should be considered.
Beta-adrenergic receptor blocking agents not only block the pulmonary effect of beta-agonists, such as Lv Ke (albuterol sulfate syrup), but may produce severe bronchospasm in asthmatic patients. Therefore, patients with asthma should not normally be treated with beta-blockers. However, under certain circumstances, eg, as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-adrenergic blocking agents in patients with asthma. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.
The ECG changes and/or hypokalemia that may result from the administration of nonpotassium-sparing diuretics (such as loop or thiazide diuretics) can be acutely worsened by beta-agonists, especially when the recommended dose of the beta-agonist is exceeded. Although the clinical significance of these effects is not known, caution is advised in the coadministration of beta-agonists with nonpotassium-sparing diuretics.
Mean decreases of 16% to 22% in serum digoxin levels were demonstrated after single dose intravenous and oral administration of albuterol, respectively, to normal volunteers who had received digoxin for 10 days. The clinical significance of these findings for patients with obstructive airway disease who are receiving albuterol and digoxin on a chronic basis is unclear. Nevertheless, it would be prudent to carefully evaluate the serum digoxin levels in patients who are currently receiving digoxin and albuterol.
Monoamine Oxidase Inhibitors or Tricyclic Antidepressants
Albuterol should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents, because the action of albuterol on the vascular system may be potentiated.
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Information checked by Dr. Sachin Kumar, MD Pharmacology