How to Use

These medication come with patient directions. Read them carefully before using the drug . If you do not understand the directions or if you are not sure how to use the drug, ask your health care professional to show you what to do. Always ask your health care professional to check regularly how you use the drug to make sure you are using it properly.

Use this drug only as directed. Do not use more of it and do not use it more often than recommended on the label, unless otherwise directed by your family doctor . Using the drug more often may increase the risk of serious unwanted effects. Deaths have occurred when too much inhalation bronchodilator drug was using.

Keep the spray away from your eyes because it may cause irritation.

Salmeterol and formoterol are using to prevent asthma attacks. They are not using to relieve an attack that has already started . For relief of an asthma attack that has already started, you must use another drug - not formoterol that starts working faster than salmeterol does. If you do not have another drug to use for an attack or if you have any questions about this, check with your family doctor . Because the effects of salmeterol and formoterol usually last about 12 hours, doses must never be taken more than two times a day or less than 12 hours apart.

Some epinephrine preparations are available without a family doctor's prescription. However, do not use this drug unless you are seeing a family doctor about asthma. Do not use this drug if you have been hospitalized for asthma treat or if you are taking a description medication for asthma, unless you have been told to do so by a family doctor.

When you use the inhaler for the first time, or if you have not using it in a while, the inhaler may not deliver the right amount of drug with the first puff. Therefore, before using the inhaler, you may have to test or prime it.

• To test or prime most inhalers :
  • Insert the drug container - canister firmly into the clean mouthpiece according to the manufacturer's directions. Check to make sure it is placed properly into the mouthpiece.
  • Take the cap off the mouthpiece and shake the inhaler three or four times.
  • Hold the inhaler well away from you at arm's length and press the top of the canister, spraying the drug into the air two times. The inhaler will now be ready to provide the right amount of drug when you use it.
• To use most inhalers :
  • Using your thumb and one or two fingers, hold the inhaler upright, with the mouthpiece end down and pointing toward you.
  • Take the cap off the mouthpiece. Check the mouthpiece to make sure it is clear. Then, gently shake the inhaler three or four times.
  • Breathe out slowly to the end of a normal breath.
  • Use the inhalation method recommended by your family doctor:
    • Open-mouth method Place the mouthpiece about 1 to 2 inches - 2 finger widths in front of your widely opened mouth. Make sure the inhaler is aimed into your mouth so the spray does not hit the roof of your mouth or your tongue.
    • Closed-mouth method Place the mouthpiece in your mouth between your teeth and over your tongue with your lips closed tightly around it. Make sure your tongue or teeth are not blocking the opening.
  • Start to breathe in slowly through your mouth. At the same time, press the top of the canister one time to get 1 puff of drug. Continue to breathe in slowly for 3 to 5 seconds. Count the seconds while breathing in. It is important to press the canister and breathe in slowly at the same time so the drug gets into your lungs. This step may be difficult at first. If you are using the closed-mouth method and you see a fine mist coming from your mouth or nose, the inhaler is not being using correctly.
  • Hold your breath as long as you can up to 10 seconds. This gives the drug time to settle into your airways and lungs.
  • Take the mouthpiece away from your mouth and breathe out slowly.
  • If your family doctor has told you to inhale more than 1 puff of drug at each dose, gently shake the inhaler again and take the next puff following exactly the same steps you using for the first puff. Press the canister one time for each puff of drug.
  • When you are done, wipe off the mouthpiece and replace the cap.

Your family doctor, nurse, or pharmacist may want you to use a spacer or holding chamber with the inhaler. A spacer helps get the drug into the lungs and reduces the amount of drug that stays in your mouth and throat.

To use a spacer with the inhaler:

• Attach the spacer to the inhaler according to the manufacturer's directions. There are various types of spacers available, but the method of breathing is the same with most spacers.
• Gently shake the inhaler and spacer three or four times.
• Hold the mouthpiece of the spacer away from your mouth and breathe out slowly to the end of a normal breath.
• Place the mouthpiece into your mouth between your teeth and over your tongue with your lips closed around it.
• Press down on the canister top one time to release 1 puff of drug into the spacer. Within one or two seconds, begin to breathe in slowly through your mouth for three to five seconds. Do not breathe in through your nose. Count the seconds while inhaling.
• Hold your breath as long as you can up to ten seconds - count slowly to ten.
• Breathe out slowly. Do not remove the mouthpiece from your mouth. Breathe in and out slowly two or three times to make sure the spacer is emptied.
• If your family doctor has told you to take more than 1 puff of drug at each dose, gently shake the inhaler and spacer again and take the next puff, following exactly the same steps you using for the first puff. Do not put more than 1 puff of drug into the spacer at a time.
• If you rinse your mouth with water after you have finished, be sure to spit out the rinse water. Do not swallow it.
• When you are finished, remove the spacer from the inhaler. Wipe off the mouthpiece and replace the cap.
• Clean the inhaler and mouthpiece at least once a week.
  • To clean the inhaler :
    • Remove the canister from the inhaler and set the canister aside.
    • Wash the mouthpiece and cap with warm, soapy water. Then, rinse well with warm, running water.
    • Shake off the excess water and let the inhaler parts air dry completely before putting the inhaler back together.
• Save your inhaler. Refill units may be available.

For diseaseds using the powder for inhalation dosage form :

• These medication are using with a special device. If you do not understand the directions that come with the inhaler or if you are not sure how to use the inhaler, ask your health care professional to show you how to use it. Always ask your health care professional to check regularly how you use the inhaler to make sure you are using it properly.

For diseaseds using the inhalation solution dosage form :

• If you are using this drug in a nebulizer, make sure you understand exactly how to use it. If you have any questions about this, check with your health care professional.
• Do not use if solution turns pinkish to brownish in color or if it becomes cloudy.
• Do not mix another inhalation drug with an adrenergic bronchodilator drug in the nebulizer unless told to do so by your health care professional.

Dosage

The number of inhalations or the amount of drug that you use depends on the strength of the drug. Always the number of doses you take each day, the time allowed between doses and the length of time you take the drug depend on the medical problem for which you are taking the adrenergic bronchodilator .

For albuterol
• For inhalation aerosol dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 4 years of age and older 1 to 2 inhalations - puffs every four to six hours.
    • Children up to 4 years of age Dose must be determined by your family doctor.
  • For preventing bronchospasm causing by exercise:
    • Adults and children 4 years of age and older 2 inhalations - puffs taken fifteen minutes before you start to exercise.
    • Children up to 4 years of age Dose must be determined by your family doctor.

For albuterol sulfate
• For inhalation aerosol dosage form:
  • For treating bronchospasm:
    • Adults and children 4 years of age and older 1 to 2 inhalations - puffs every four to six hours.
    • Children up to 4 years of age Dose must be determined by your family doctor.
  • For preventing bronchospasm causing by exercise:
    • Adults and children 4 years of age and older 2 inhalations - puffs taken fifteen to thirty minutes before you start to exercise.
    • Children up to 4 years of age Dose must be determined by your family doctor.
• For inhalation solution dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 12 years of age and older This drug is using in a nebulizer and is taken by inhalation over five to fifteen minutes. The usual dose is 2.5 milligrams - mg of albuterol taken every four to six hours if needed.
    • Children up to 12 years of age This drug is using in a nebulizer and is taken by inhalation over five to fifteen minutes. The usual dose is 1.25 to 2.5 milligrams - mg of albuterol taken every four to six hours if needed.
• For capsules - powder for inhalation dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 4 years of age and older 200 or 400 mcg taken by inhalation every four to six hours.
    • Children up to 4 years of age Dose must be determined by your family doctor.
  • For preventing bronchospasm causing by exercise:
    • Adults and children 4 years of age and older 200 mcg taken by inhalation fifteen minutes before you start to exercise.
    • Children up to 4 years of age Dose must be determined by your family doctor.

For bitolterol Note:

Bitolterol was withdrawn from the USA market by Elan Pharmaceuticals in November 2001.

• For inhalation aerosol dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 12 years of age and older 2 inhalations - puffs every eight hours or 2 inhalations - puffs at first, allowing one to three minutes between each puff. This dose may be followed by another puff, if needed. However, the dose taken each day must not be more than 2 puffs every four hours or 3 puffs every six hours.
    • Children up to 12 years of age Dose must be determined by your family doctor.
  • For preventing bronchospasm causing by exercise:
    • Adults and teenagers 2 inhalations - puffs taken five minutes before you start to exercise.
    • Children 1 or 2 inhalations - puffs taken five minutes before you start to exercise.
• For inhalation solution dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 12 years of age and older This drug is using in a nebulizer and is taken by inhalation over ten to fifteen minutes. The usual dose is 1 to 2.5 milligrams - mg of bitolterol taken three or four times a day. Doses must be taken at least four hours apart.
    • Children up to 12 years of age Dose must be determined by your family doctor.

For epinephrine
• For treating bronchospasm:
  • For inhalation aerosol dosage form:
    • Adults and children 4 years of age and older 1 inhalation - puff. The dose may be repeated after at least one minute, if needed. Doses must be taken at least three hours apart.
    • Children up to 4 years of age Dose must be determined by your family doctor.
  • For inhalation solution dosage form:
    • Adults and children 4 years of age and older This drug must be using in a hand-bulb nebulizer. The usual dose is 1 to 3 inhalations - puffs of a 1% solution. Doses must be taken at least three hours apart.
    • Children up to 4 years of age Dose must be determined by your family doctor.

For fenoterol
• For inhalation aerosol dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 12 years of age and older 100 or 200 micrograms - mcg , repeated three or four times a day if needed. This drug must not be taken more often than every four hours. The total dose must not be more than 8 puffs a day of the 100 mcg per spray product or 6 puffs of the 200 mcg per spray product .
    • Children up to 12 years of age Dose must be determined by your family doctor.
• For inhalation solution dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 12 years of age and older This drug is using in a nebulizer and is taken by inhalation over ten to fifteen minutes. The usual dose is 0.5 to 1 milligram - mg of fenoterol taken every six hours if needed.
    • Children up to 12 years of age Dose must be determined by your family doctor.

For formoterol
• For powder for inhalation dosage form:
  • For preventing bronchospasm:
    • Adults and children 5 years of age and older 12 mcg taken by oral inhalation twice daily
    • Children under 5 years of age Use and dose must be determined by your family doctor.
Note:

Canadian product information states that formoterol is using in child 6 years of age and older.

For isoetharine
• For inhalation solution dosage form:
  • For treating bronchospasm:
    • Adults This drug is using in a nebulizer and is taken by inhalation over fifteen to twenty minutes. The amount of drug you use and whether it requires dilution depends on the product ordered by your family doctor. The usual dose is 2.5 to 10 milligrams - mg. This drug usually must not be using more often than every four hours.
    • Children Use is not recommended.
• For inhalation aerosol dosage form:
  • For treating bronchospasm:
    • Adults and teenagers 1 or 2 inhalations - puffs. This dose may be repeated every four hours as necessary.
    • Children Use is not recommended.

For isoproterenol
• For inhalation solution dosage form:
  • For treating bronchospasm:
    • Adults and teenagers This drug is using in a nebulizer and is taken by inhalation over ten to twenty minutes. The usual dose is 2.5 milligrams - mg. This drug usually must not be using more often than every four hours.
    • Children This drug is using in a nebulizer and is taken by inhalation over ten to twenty minutes. The usual dose is 0.05 to 0.1 milligram - mg per kilogram - kg of body weight, up to 1.25 mg, diluted. The dose may be repeated every four hours, if needed.

For isoproterenol hydrochloride
• For inhalation aerosol dosage form:
  • For treating bronchospasm:
    • Adults and children 12 years of age and older 1 inhalation - puff, repeated after two to five minutes if needed. This dose is taken every three to four hours.
    • Children up to 12 years of age Use is not recommended.

For isoproterenol sulfate
• For inhalation aerosol dosage form:
  • For treating bronchospasm:
    • Adults and children 12 years of age and older 1 inhalation - puff, repeated after two to five minutes if needed. This dose is taken every four to six hours.
    • Children up to 12 years of age Dose must be determined by your family doctor.

For metaproterenol
• For inhalation aerosol dosage form:
  • For preventing and treating bronchospasm:
    • Adults and children 12 years of age and older 2 or 3 inhalations - puffs every three to four hours. The total dose must not be more than 12 puffs a day.
    • Children up to 12 years of age 1 to 3 inhalations - puffs every three to four hours. The total dose must not be more than 12 puffs a day.
• For inhalation solution dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 6 years of age and older This drug is using in a nebulizer and is taken by inhalation. The amount of drug you use and whether it requires dilution depends on the product ordered by your family doctor. The usual dose is 10 to 15 milligrams - mg taken three or four times a day. Doses must be taken at least four hours apart.
    • Children up to 6 years of age This drug is using in a nebulizer and is taken by inhalation. The amount of drug you use and whether it requires dilution depends on the product ordered by your family doctor. The usual dose is 5 to 15 milligrams - mg taken three or four times a day, at least four hours apart.

For pirbuterol
• For inhalation aerosol dosage form:
  • For preventing and treating bronchospasm:
    • Adults and children 1 or 2 inhalations - puffs every four to six hours. The total dose must not be more than 12 puffs a day.
  • For preventing bronchospasm causing by exercise:
    • Adults and children 2 inhalations - puffs taken five minutes before you start to exercise.

For procaterol
• For inhalation aerosol dosage form:
  • For preventing and treating bronchospasm:
    • Adults and children 12 years of age and older 1 or 2 inhalations - puffs three times a day.
    • Children up to 12 years of age Dose must be determined by your family doctor.
  • For preventing bronchospasm causing by exercise:
    • Adults and children 12 years of age and older 1 or 2 inhalations - puffs taken at least fifteen minutes before you start to exercise.

For salmeterol
• For the inhalation aerosol dosage form:
  • For preventing bronchospasm:
    • Adults and children 12 years of age and older 2 inhalations - puffs two times a day, in the morning and evening. Doses must be taken about twelve hours apart.
    • Children up to 12 years of age Dose must be determined by your family doctor.
  Note:

  Canadian manufacturer states that use in child ages 4 years and older is 2 inhalations twice daily.

  • For preventing bronchospasm causing by exercise:
    • Adults and children 12 years of age and older 2 inhalations - puffs taken at least thirty to sixty minutes before you start to exercise. If you are already using salmeterol two times a day to treat your asthma, you don't needed to use additional salmeterol before you exercise.
    • Children up to 12 years of age Dose must be determined by your family doctor.
• For the powder for inhalation dosage form:
  • For preventing bronchospasm:
    • Adults and children 4 years of age and older 1 inhalation - the contents of one blister two times a day, in the morning and evening. Doses must be taken about twelve hours apart.
    • Children up to 4 years of age Use and dose must be determined by your family doctor.
  • For preventing bronchospasm causing by exercise:
    • Adults and children 4 years of age and older 1 inhalation - the contents of one blister at least 30 minutes before exercise
    • Children up to 4 years of age Use and dose must be determined by your family doctor.

For terbutaline
• For inhalation aerosol dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children
      • For the 200 microgram - mcg per metered spray product: 2 inhalations - puffs every four to six hours.
      • For the 500 mcg per metered spray product: 1 inhalation - puff, repeated after five minutes if needed. The total dose must not be more than 6 puffs a day.
  • For preventing bronchospasm causing by exercise:
    • Adults and children
      • For the 200 microgram - mcg per metered spray product: 2 inhalations - puffs taken five to fifteen minutes before you start to exercise.

Missed dose

• For formoterol : If you miss a regularly scheduled dose of formoterol and it has been less than 6 hours since the scheduled time, take the dose as soon as possible and then go back to your regular dosing schedule. If it has been longer than 6 hours, skip the dose and take the next dose at the regularly scheduled time. Do not double doses.
• For all other adrenergic bronchodilators : If you are using one of these medication regularly and you miss a dose, use it as soon as possible. Then use any remaining doses for that day at regularly spaced intervals. Do not double doses.

Storage To store this drug:

• Keep out of the reach of children.
• Store away from heat.
• Store the solution form of this drug away from direct light. Store the inhalation aerosol form of this drug away from direct sunlight.
• Keep the drug from freezing.
• Store canister with the nozzle end down.
• Do not store the powder for inhalation forms of these medication in the bathroom, near the kitchen sink, or in other damp places. Moisture may cause the drug to break down.
• Do not puncture, break, or burn the inhalation aerosol container, even if it is empty.
• Do not keep outdated drug or drug no longer needed. Be sure that any discarded drug is out of the reach of children.