C H A P T E R 5 5
Drugs acting on the lower respiratory tract
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TABLE 55.1
DRUGS IN FOCUS Bronchodilators/antiasthmatics
Drug name
Dosage/route
Usual indications
Xanthines
aminophylline
(generic)
Loading dose: Adult, paediatric (>6 months):
6 mg/kg over 20–30 minutes
Maintenance: Adult 0.7 mg/kg for next
12 hours then 0.5 mg/kg thereafter
Young adult smokers and paediatrics
(9–16 years): 1 mg/kg for next 12 hours then
0.8 mg/kg
Relief of symptoms or prevention of
bronchial asthma and reversal of
bronchospasm associated with COPD
caffeine (Cafnea)
Paediatric: 20 mg/kg IV followed by 5 mg/kg
per day for neonatal apnoea
Short-term management of neonatal
apnoea
theophylline (Nuelin)
Adult 200–300 mg q 12 hours
Paediatric (2–12 years) 10 mg/kg q 12 hours
Relief of symptoms or prevention of
bronchial asthma and reversal of
bronchospasm associated with COPD
Sympathomimetics
adrenaline (EpiPen)
Adult: 12.5–25 mg IM, SC or IV 3 mg/kg/day IV
or SC in 4 to 6 divided doses
Drug of choice for treatment of acute
bronchospasm
eformoterol (Foradile,
Oxis)
Adult: 1–2 caps inhaled b.d.
Paediatric: (>5 years) 1 cap b.d.
Maintenance treatment of asthma
and prevention of bronchospasm in
people ≥5 years of age with reversible
obstructive airway disease; prevention
of exercise-induced bronchospasm in
people ≥12 years of age
Special considerations:
people taking
the drug for asthma maintenance should
not use additional doses of the drug for
exercise-induced asthma
ephedrine (generic)
Adult: 12.5–25 mg IM, SC or IV
Paediatric: 3 mg/kg/day IV or SC in 4 to 6
divided doses
Treatment of acute bronchospasm in adults
and children, although adrenaline is the
drug of choice
indacaterol (Onbrez)
Adult: 150 mcg once daily by inhalation
Long-term maintenance of COPD
salbutamol (Ventolin)
Adult: 5 mg q 4–6 hours by inhalation
Paediatric (4–12 years): 2.5 mg q 4–6 hours by
inhalation
Treatment and prophylaxis of
bronchospasm and acute asthma attacks
salmeterol (Seretide,
Serevent)
Adult and paediatric >12 years: 1–2 puffs q
12 hours
Paediatric (4–12 years): one inhalation b.d. at
least 12 hours apart
Prevention of exercise-induced asthma;
prophylaxis of bronchospasm in selected
people >4 years of age
terbutaline (Bricanyl)
Adult and paediatric >12 years: 3–4.5 mg up
to b.d
Paediatric <12 years: 0.075 mg/kg/dose up to
q 6 hours
Treatment and prophylaxis of
bronchospasm
Anticholinergics
ipratropium (Atrovent)
Adult: 250–500 mcg
Nasal spray: two sprays per nostril t.d.s. to
q.i.d
Paediatric: 250 mcg
Maintenance and treatment of
bronchospasm for adults with COPD;
nasal spray for rhinorrhoea associated
with seasonal and perennial rhinitis or the
common cold
tiotropium (Spiriva)
18 mcg/day (one capsule) using the HandiHaler
inhalation device
Long-term, once-daily maintenance and
treatment of bronchospasm associated
with COPD in adults
