Berodual solution for inhalation instructions for use. Berodual - solution, aerosol for inhalation

Catad_pgroup Antiasthmatic drugs

Berodual - instructions for use

Registration number:

Trade name of the drug:

International nonproprietary name:

Dosage form:

Compound:

1 ml of solution for inhalation contains:
active substance: 261 mcg ipratropium bromide monohydrate, based on anhydrous ipratropium bromide (250 mcg) and 500 mcg fenoterol hydrobromide.
Excipients: benzalkonium chloride, disodium edetate dihydrate, sodium chloride, hydrochloric acid 1H, purified water

Description:

Transparent, colorless or almost colorless liquid, free of suspended particles. The smell is almost imperceptible.

Pharmacotherapeutic group:

Combined bronchodilator (ß 2 -selective adrenergic agonist + m-anticholinergic blocker)

ATX code:

Pharmacological properties

Pharmacodynamics
Berodual contains two components with bronchodilator activity: ipratropium bromide - an m-anticholinergic blocker, and fenoterol - a ß 2 -adrenergic agonist. Bronchodilation following inhaled ipratropium bromide is due primarily to local rather than systemic anticholinergic effects.
Ipratropium bromide is a quaternary ammonium derivative with anticholinergic (parasympatholytic) properties. The drug inhibits reflexes caused by the vagus nerve, counteracting the effects of acetylcholine, a neurotransmitter released from the endings of the vagus nerve. Anticholinergics prevent the increase in intracellular Ca ++ concentration, which occurs due to the interaction of acetylcholine with the muscarinic receptor located on the smooth muscles of the bronchi. The release of Ca++ is mediated by a system of secondary mediators, which include ITP (inositol triphosphate) and DAG (diacylglycerol).
In patients with bronchospasm associated with chronic obstructive pulmonary diseases (chronic bronchitis and emphysema), a significant improvement in lung function (an increase in forced expiratory volume in 1 second (FEV1) and peak expiratory flow by 15% or more) was noted within 15 minutes, the maximum effect was achieved within 1-2 hours and lasted in most patients up to 6 hours after administration.
Ipratropium bromide does not have a negative effect on mucus secretion in the respiratory tract, mucociliary clearance and gas exchange.
Fenoterol selectively stimulates ß 2 -adrenergic receptors in a therapeutic dose. Stimulation of ß 1 -adrenergic receptors occurs when using high doses. Fenoterol relaxes the smooth muscles of the bronchi and blood vessels and counteracts the development of bronchospastic reactions caused by the influence of histamine, methacholine, cold air and allergens (immediate hypersensitivity reactions). Immediately after administration, fenoterol blocks the release of mediators of inflammation and bronchial obstruction from mast cells. In addition, when using fenoterol in doses of 0.6 mg, an increase in mucociliary clearance was noted.
The ß-adrenergic effect of the drug on cardiac activity, such as an increase in the frequency and strength of heart contractions, is due to the vascular effect of fenoterol, stimulation of ß 2 -adrenergic receptors of the heart, and when using doses exceeding therapeutic doses, stimulation of ß 1 -adrenergic receptors. As with the use of other ß-adrenergic drugs, prolongation of the QTc interval was observed when using high doses. When fenoterol was used via metered-dose aerosol inhalers (MDIs), the effect was inconsistent and occurred at doses higher than recommended. However, following administration of fenoterol via nebulizers (inhalation solution in unit dose vials), systemic exposure may be higher than when using the drug via a MDI at recommended doses. The clinical significance of these observations has not been established. The most commonly observed effect of ß-adrenergic agonists is tremor. In contrast to the effects on bronchial smooth muscle, tolerance may develop to the systemic effects of ß-adrenergic receptor agonists. The clinical significance of this manifestation is not clear. Tremor is the most common adverse effect with beta-adrenergic agonists. When these two active substances are used together, the bronchodilator effect is achieved by acting on various pharmacological targets. These substances complement each other, as a result, the antispasmodic effect on the bronchial muscles is enhanced and a greater breadth of therapeutic action is provided for bronchopulmonary diseases accompanied by constriction of the airways. The complementary effect is such that to achieve the desired effect, a lower dose of the ß-adrenergic component is required, which allows you to individually select an effective dose with the virtual absence of side effects of Berodual. In acute bronchoconstriction, the effect of Berodual develops quickly, which makes it possible to use it during acute attacks of bronchospasm.

Indications for use

Prevention and symptomatic treatment of chronic obstructive airway diseases with reversible airway obstruction, such as bronchial asthma and, especially, chronic obstructive pulmonary disease, chronic obstructive bronchitis with or without emphysema.

Contraindications

Hypertrophic obstructive cardiomyopathy, tachyarrhythmia, I and III trimesters of pregnancy. Hypersensitivity to fenoterol or atropine-like drugs or other components of this drug.
Carefully
closed-angle glaucoma, arterial hypertension, diabetes mellitus, recent myocardial infarction (within the last 3 months), heart and vascular diseases, such as chronic heart failure, coronary heart disease, heart disease, aortic stenosis, severe lesions of the cerebral and peripheral arteries . Hyperthyroidism, pheochromocytoma, prostatic hyperplasia, bladder neck obstruction, cystic fibrosis, second trimester of pregnancy, breastfeeding.

Use during pregnancy and breastfeeding

Data from preclinical studies and human experience indicate that fenoterol or ipratropium bromide do not have a negative effect during pregnancy.
The possibility of an inhibitory effect of fenoterol on uterine contractility should be taken into account.
The drug is contraindicated in the 1st and 3rd trimesters (possibility of weakening labor by fenoterol).
The drug should be used with caution in the second trimester of pregnancy. Fenoterol passes into breast milk. There is no data confirming that ipratropium bromide passes into breast milk. However, Berodual should be prescribed to nursing mothers with caution.
Clinical data on the effect of the combination of ipratropium bromide and fenoterol hydrobromide on fertility are not known.

Directions for use and doses

Treatment should be carried out under medical supervision (for example, in a hospital setting). Treatment at home is possible only after consultation with a doctor in cases where a fast-acting ß-agonist in a low dose is not effective enough. An inhalation solution can also be recommended to patients in cases where an inhalation aerosol cannot be used or when higher doses are required.
The dose should be selected individually, depending on the severity of the attack. Treatment should usually begin at the lowest recommended dose and stop once sufficient relief of symptoms has been achieved. The following doses are recommended:
In adults (including older adults) and adolescents over 12 years of age
Acute bronchospasm attacks
Depending on the severity of the attack, doses can vary from 1 ml (1 ml = 20 drops) to 2.5 ml (2.5 ml = 50 drops). In especially severe cases, it is possible to use doses reaching 4 ml (4 ml = 80 drops).
In children aged 6-12 years
Acute attacks of bronchial asthma
Depending on the severity of the attack, doses can vary from 0.5 ml (0.5 ml = 10 drops) to 2 ml (2 ml = 40 drops).
In children under 6 years of age (who weigh less than 22 kg):
Due to the fact that information on the use of the drug in this age group is limited, the following dose is recommended (only under medical supervision): 0.1 ml (2 drops) per kg of body weight, but not more than 0.5 ml (10 drops)
The inhalation solution should only be used for inhalation (with a suitable nebulizer) and should not be administered orally.
Treatment should usually begin with the lowest recommended dose. The recommended dose should be diluted with 0.9% sodium chloride solution to a final volume of 3 - 4 ml and administered (entirely) using a nebulizer.
Berodual solution for inhalation should not be diluted with distilled water.
Dilution of the solution must be carried out each time before use; Remains of the diluted solution should be destroyed.
The diluted solution should be used immediately after preparation.
The duration of inhalation can be controlled by the consumption of the diluted solution.
Berodual solution for inhalation can be used using various commercial models of nebulizers. The dose reaching the lungs and the systemic dose depend on the type of nebulizer used and may be higher than the corresponding doses when using Berodual HFA and CFC metered aerosol (which depends on the type of inhaler). In cases where wall oxygen is available, the solution is best used at a flow rate of 6 - 8 liters per minute.
The instructions for use, maintenance and cleaning of the nebulizer must be followed.

Side effect

Many of the listed undesirable effects may be a consequence of the anticholinergic and beta-adrenergic properties of Berodual. Berodual, like any inhalation therapy, may cause local irritation.
Adverse reactions to the drug were determined based on data obtained in clinical trials and during pharmacological surveillance of the use of the drug after its registration.
The most common side effects reported in clinical studies were cough, dry mouth, headache, tremor, pharyngitis, nausea, dizziness, dysphonia, tachycardia, palpitations, vomiting, increased systolic blood pressure and nervousness.
Immune system disorders
anaphylactic reaction
hypersensitivity
Metabolic and nutritional disorders
hypokalemia
Mental disorders
nervousness
excitation
mental disorders
Nervous system disorders
headache
tremor
dizziness
Visual disorders glaucoma
increased intraocular pressure, accommodation disturbances, mydriasis
blurred vision
Pain in the eyes
corneal edema
conjunctival hyperemia
the appearance of a halo around objects
Heart disorders
tachycardia
heartbeat
arrhythmias
atrial fibrillation supraventricular tachycardia myocardial ischemia
Respiratory, thoracic and mediastinal disorders
cough
pharyngitis
dysphonia
bronchospasm
throat irritation
swelling of the pharynx
laryngospasm
paradoxical bronchospasm dry pharynx

vomit
nausea
dry mouth
stomatitis
glossitis
Gastrointestinal motility disorders
diarrhea
constipation
swelling of the mouth
Changes in the skin and subcutaneous tissues
hives
itching
angioedema hyperhidrosis
Musculoskeletal and connective tissue disorders
muscle weakness
muscle spasm myalgia
Renal and urinary tract disorders
urinary retention
Laboratory and instrumental data
increased systolic blood pressure
increased diastolic blood pressure

Overdose

Symptoms of overdose are usually associated primarily with the effects of fenoterol. Symptoms associated with excessive stimulation of ß-adrenergic receptors may occur. The most likely occurrence is tachycardia, palpitations, tremor, increased blood pressure, decreased blood pressure, an increase in the difference between systolic and diastolic blood pressure, angina pectoris, arrhythmia and a feeling of “flushing” of blood to the face, a feeling of heaviness in the chest, increased bronchial obstruction. Metabolic acidosis and hypokalemia were also observed.
Possible symptoms of overdose caused by ipratropium bromide (such as dry mouth, accommodation disturbances) are mild and transient, which is explained by its topical use.
Treatment
It is necessary to stop taking the drug.
Data from monitoring the acid-base balance of the blood should be taken into account.
It is recommended to prescribe sedatives, anxiolytic drugs (tranquilizers), and in severe cases, intensive therapy.
As a specific antidote, it is possible to use ß-blockers, preferably selective ß 1 -blockers. However, in patients with bronchial asthma or chronic obstructive pulmonary disease, the possibility of increased bronchial obstruction, which can be fatal, under the influence of beta-blockers should be taken into account and their dose should be carefully selected.

Interaction with other drugs

Long-term simultaneous use of Berodual with other anticholinergic drugs is not recommended due to the lack of data.
The simultaneous use of other beta-adrenomimetic drugs, systemic anticholinergic drugs and xanthine derivatives (for example, theophylline) may increase the bronchodilator effect of Berodual and lead to increased side effects.
Hypokalemia associated with the use of beta-agonists can be exacerbated by the simultaneous administration of xanthine derivatives, corticosteroids and diuretics. This fact should be given special attention when treating patients with severe forms of obstructive airway diseases.
Hypokalemia may lead to an increased risk of arrhythmias in patients receiving digoxin. In addition, hypoxia may enhance the negative effects of hypokalemia on heart rate. In such cases, it is recommended to monitor serum potassium levels.
Beta 2-adrenergic drugs should be prescribed with caution to patients receiving monoamine oxidase inhibitors and tricyclic antidepressants, as these drugs can enhance the effect of ß-adrenergic drugs.
Inhalation of general anesthetic agents with halogenated hydrocarbon anesthetics, such as halothane, trichloroethylene or enflurane, may enhance the cardiovascular effects of beta-adrenergic agents.
The combined use of Berodual with cromoglycic acid and/or glucocorticosteroids increases the effectiveness of therapy.

special instructions

If shortness of breath (difficulty breathing) suddenly increases rapidly, you should consult a doctor immediately.
Hypersensitivity:
After using Berodual, immediate hypersensitivity reactions may occur, signs of which, in rare cases, may include: urticaria, angioedema, rash, bronchospasm, oropharyngeal edema, anaphylactic shock.
Paradoxical bronchospasm:
Berodual, like other inhaled drugs, can cause paradoxical bronchospasm, which can be life-threatening. In case of development of paradoxical bronchospasm, the use of Berodual should be stopped immediately and switch to alternative therapy
Long-term use:

• In patients suffering from bronchial asthma, Berodual should be used only as needed. In patients with mild chronic obstructive pulmonary disease, symptomatic treatment may be preferable to regular use.
• in patients with bronchial asthma, one should remember the need to carry out or intensify anti-inflammatory therapy to control the inflammatory process of the respiratory tract and the course of the disease.

Regular use of increasing doses of drugs containing ß 2 -adrenergic agonists, such as Berodual, to relieve bronchial obstruction can cause uncontrolled worsening of the disease. In case of increased bronchial obstruction, increasing the dose of ß 2 -agonists, including Berodual, more than recommended for a long time is not only not justified, but also dangerous. To prevent life-threatening worsening of the disease, consideration should be given to reviewing the patient's treatment plan and adequate anti-inflammatory therapy with inhaled corticosteroids.
Other sympathomimetic bronchodilators should be prescribed concomitantly with Berodual only under medical supervision.
Gastrointestinal disorders
In patients with a history of cystic fibrosis, gastrointestinal motility disorders are possible.
Berodual should be used with caution in patients predisposed to acute-angle glaucoma. There are isolated reports of complications from the organ of vision (for example, increased intraocular pressure, mydriasis, angle-closure glaucoma, eye pain) that developed when inhaled ipratropium bromide (or ipratropium bromide in combination with ß 2 -adrenergic receptor agonists) entered the eyes. Symptoms of acute angle-closure glaucoma may include pain or discomfort in the eyes, blurred vision, the appearance of a halo on objects and colored spots in front of the eyes in combination with corneal edema and redness of the eyes due to conjunctival vascular injection. If any combination of these symptoms develops, the use of eye drops that reduce intraocular pressure and immediate consultation with a specialist are indicated. Patients should be instructed on the correct use of Berodual inhalation solution. To prevent the solution from getting into the eyes, it is recommended that the solution used with a nebulizer be inhaled through the mouthpiece. If there is no mouthpiece, a mask that fits tightly to the face should be used. Patients predisposed to developing glaucoma should take special care to protect their eyes.
Systemic effects:
In the following diseases: recent myocardial infarction, diabetes mellitus with inadequate glycemic control, severe organic heart and vascular diseases, hyperthyroidism, pheochromocytoma or urinary tract obstruction (for example, prostatic hyperplasia or bladder neck obstruction), Berodual should be used only after careful evaluation risk/benefit, especially when using doses higher than recommended.
Effect on the cardiovascular system
In post-marketing studies, rare cases of myocardial ischemia have been reported when taking beta-agonists. Patients with concomitant serious heart disease (for example, coronary heart disease, arrhythmias, or severe heart failure) receiving Berodual should be warned to seek medical attention if they experience heart pain or other symptoms indicating worsening of heart disease. It is necessary to pay attention to symptoms such as shortness of breath and chest pain, as they can be of both cardiac and pulmonary etiology.
Hypokalemia:
When using ß 2 -agonists, hypokalemia may occur (see section "Overdose")
In athletes, the use of Berodual due to the presence of fenoterol in its composition can lead to positive results of doping tests.
The drug contains a preservative, benzalkonium chloride, and a stabilizer, disodium edetate dihydrate. During inhalation, these components may cause bronchospasm in sensitive patients with airway hyperresponsiveness.

Impact on the ability to drive vehicles and machinery

No studies have been conducted on the effects of the drug on the ability to drive vehicles and use machinery.
However, patients should be advised that during treatment with Berodual they may experience undesirable sensations such as dizziness, tremor, disturbances in eye accommodation, mydriasis and blurred vision. Therefore, caution should be recommended when driving vehicles or using machinery. If patients experience the above unwanted sensations, they should refrain from potentially dangerous activities such as driving a car or operating machinery.

Release form

Solution for inhalation 0.25 mg + 0.5 mg/ml. 20 ml in an amber glass bottle with a polyethylene dropper and a polypropylene screw cap with tamper evident. The bottle with instructions for use is placed in a cardboard box.

Storage conditions

List B.
At a temperature not exceeding 30°C, do not freeze. Keep out of the reach of children!

Best before date

5 years.
Do not use the drug after the expiration date.

Vacation conditions

By doctor's prescription.

Manufacturer

Boehringer Ingelheim International GmbH, Germany,
produced by Instituto de Angeli S.R.L., Italy
50066 Reggello, Prulli, 103/C, Florence, Italy

You can obtain additional information about the drug, as well as send your complaints and information about adverse events to the following address in Russia
Boehringer Ingelheim LLC
125171, Moscow, Leningradskoe shosse, 16A, building 3

For the treatment of certain diseases of the respiratory system with symptoms of obstruction of the bronchi and lungs, today all pulmonologists and pediatricians recommend a modern drug - Berodual.

For inhalation through a nebulizer or other inhalers, it is available in the form of a solution, and for people suffering from bronchial asthma, it is produced in the form of pocket aerosol inhalers, which is also very convenient. Among other bronchodilators, it is the leader in terms of sales and popularity.

In this article we will look at when doctors prescribe the drug Berodual, including instructions for use, analogues and prices for this drug in pharmacies. If you have already used Berodual, leave your feedback in the comments.

Composition and release form

Clinical and pharmacological group: bronchodilators.

1 ml of solution for inhalation contains the active ingredients: 260 mcg of ipratropium bromide monohydrate, calculated as anhydrous ipratropium bromide (250 mcg) and 500 mcg of fenoterol hydrobromide. Auxiliary components: benzalkonium chloride, disodium edetate dihydrate, sodium chloride, 1N hydrochloric acid, purified water.

Berodual contains two components with bronchodilator activity: ipratropium bromide, an m-anticholinergic blocker, and fenoterol hydrobromide, a beta2-adrenergic agonist.

What is Berodual used for?

Prevention and symptomatic treatment of chronic obstructive airway diseases with reversible airway obstruction, such as bronchial asthma and, especially, chronic obstructive pulmonary disease, chronic obstructive bronchitis with or without emphysema.

pharmachologic effect

Combined bronchodilator drug. Fenoterol hydrobromide is a selective beta2-adrenergic agonist.

By binding to 2-adrenergic receptors, it activates adenylate cyclase through the stimulatory Gs protein with a subsequent increase in the formation of cAMP, which in turn activates protein kinase A. The latter phosphorylates target proteins in smooth muscle cells, which in turn leads to phosphorylation of myosin light chain kinase, inhibition hydrolysis of phosphoinosine and opening of calcium-activated fast potassium channels.

Thus, fenoterol relaxes the smooth muscles of the bronchi and blood vessels, and also prevents the development of bronchospasm caused by the influence of bronchoconstrictor factors such as histamine, methacholine, cold air and allergens (immediate reaction). After taking the drug, the release of inflammatory mediators from mast cells is inhibited. In addition, after taking fenoterol in high doses, an increase in mucociliary transport is observed.

Instructions for use

The dose should be selected individually. Medical supervision is required during therapy (treatment should usually begin with the lowest recommended dose). The following doses are recommended:

• In adults (including the elderly) and adolescents over 12 years of age during acute attacks of bronchospasm, depending on the severity of the attack, doses can vary from 1 ml (1 ml = 20 drops) to 2.5 ml (2.5 ml = 50 drops). In especially severe cases, it is possible to use doses reaching 4 ml (4 ml = 80 drops).
• In children aged 6-12 years during acute attacks of bronchial asthma, depending on the severity of the attack, doses can vary from 0.5 ml (0.5 ml = 10 drops) to 2 ml (2 ml = 40 drops).
• In children under 6 years of age (body weight<22 кг) в связи с тем, что информация о применении препарата в этой возрастной группе ограничена, рекомендуется использование следующей дозы (только при условии медицинского наблюдения): около 25 мкг ипратропия бромида и 50 мкг фенотерола гидробромида = 0.1 мл (2 капли) на кг массы тела (на одну дозу), но не более 0.5 мл (10 капель) (на одну дозу). Максимальная суточная доза – 1.5 мл.

Before the procedure, Berodual solution must be diluted with physiological solution (distilled water is contraindicated) to three to four milliliters. Then, using a nebulizer, this remedy is inhaled until completely used up (within 6-7 minutes). This procedure can be repeated if necessary (but not earlier than four hours later). The Berodual solution is diluted immediately before use.

Side effects

The most common adverse effects are fine skeletal muscle tremors, nervousness, dry mouth, and changes in taste; Headache, dizziness, tachycardia and palpitations are less common, especially in patients with aggravating factors.

1. From the cardiovascular system: tachycardia, palpitations (especially in patients with aggravating factors); rarely (when used in high doses) - decreased blood pressure, increased blood pressure, arrhythmia.
2. From the side of the central nervous system: slight tremor, nervousness; rarely - headache, dizziness, disturbance of accommodation; in isolated cases - a change in the psyche.
3. From the gastrointestinal tract: nausea, vomiting.
4. Allergic reactions: rarely - rash, angioedema of the tongue, lips and face, urticaria.
5. From the respiratory system: in rare cases - cough, local irritation; very rarely - paradoxical bronchospasm.

Other: hypokalemia, increased sweating, weakness, myalgia, convulsions, urinary retention.

Overdose

Symptoms: symptoms of overdose are usually associated primarily with the action of fenoterol (the appearance of symptoms associated with excessive stimulation of beta-adrenergic receptors).

The most likely occurrences are tachycardia, palpitations, tremor, increased or decreased blood pressure, increased differences between systolic and diastolic blood pressure, angina pectoris, arrhythmia, a feeling of flushing of the face, a feeling of heaviness in the chest, increased bronchial obstruction, metabolic acidosis.

Treatment: the use of sedatives and tranquilizers is recommended; in severe cases - intensive therapy. As a specific antidote, it is possible to use beta-adrenergic receptor blockers, preferably selective beta1-adrenergic blockers.

Contraindications

Hypertrophic obstructive cardiomyopathy, tachyarrhythmia. Hypersensitivity to fenoterol hydrobromide or atropine-like drugs or other components of this drug.

With caution: closed-angle glaucoma, coronary insufficiency, arterial hypertension, diabetes mellitus, recent myocardial infarction, severe organic diseases of the heart and blood vessels, hyperthyroidism, pheochromocytoma, prostatic hypertrophy, bladder neck obstruction, cystic fibrosis, pregnancy, breastfeeding, children under 6 years.

Use during pregnancy

The possibility of an inhibitory effect of fenoterol on uterine contractility should be taken into account.

• The drug is contraindicated in the 1st and 3rd trimesters (possibility of weakening labor by fenoterol). The drug should be used with caution in the second trimester of pregnancy.
• Fenoterol passes into breast milk. There is no data confirming that ipratropium bromide passes into breast milk. However, Berodual should be prescribed to nursing mothers with caution.

Clinical data on the effect of the combination of ipratropium bromide and fenoterol hydrobromide on fertility are not known.

Prices

The average price for BERODUAL solution in pharmacies (Moscow) is 250 rubles.

Analogues

The drug Berodual has no structural analogues for the active substance. However, there are analogues in the pharmacological group (beta-agonists in combinations):

• Biasten;
• Ditek;
• Intal plus;
• Ipramol Steri-Neb;
• Cashnol;
• Combivent;
• Combipack;
• Seretide;
• Seretide Multidisc;
• Symbicort Turbuhaler;
• Tevacombe;
• Foradil Combi

Storage conditions

Store at a temperature not exceeding 25°C. Keep out of the reach of children! Shelf life is three years. Do not use the drug after the expiration date.

Conditions for dispensing from pharmacies

The drug is available with a prescription.

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Berodual is one of the most effective inhalation agents for severe diseases of the lower respiratory tract and bronchial asthma. Instructions for use describe in detail the action, methods of preparation and side effects of the medicine.

Berodual belongs to complex drugs that are used to treat obstructive diseases of the bronchi and lungs.

The medicine is available in two forms:

Berodual is a liquid that is colorless. In some cases, the presence of a slight tint can be observed. There are no undissolved particles in the liquid. Berodual has a scent that is non-irritating and practically unnoticeable.

One bottle contains 20 ml of the product and has a special dispenser cap for easy preparation of the solution.

The composition of the aerosol and solution for inhalation includes the following components:

1. Fenoterol— the chemical compound is a representative of beta-adrenergic agonists. Its action is to stimulate adrenergic receptors in the lower respiratory tract. Fenoterol reduces inflammation and swelling. This effect can be achieved due to the antihistamine effect of the substance. Inflammatory mediators are practically not released, and the ciliated epithelium of the bronchi works more intensely and accelerates mucociliary transport.
2. Ipratropium bromide. The substance is one of the derivatives of atropine and has a similar anticholinergic effect. Ipratropium bromide reduces the functioning of m-cholinergic receptors, they cease to perceive the influence of acetylcholine. This helps reduce the amount of mucus produced. But at the same time, a person’s pulse increases and the tone of the vagus nerve increases, and dry mouth and throat appear.

Fenoterol and ipratropium bromite enhance each other's pharmacological effects several times.

pharmachologic effect

The drug begins to act within the first minutes after the start of inhalation. In this case, at least 60% of the drug enters the bronchial cavity, the rest settles on the bronchi, larynx, and oral cavity. The drug begins its full therapeutic effect after 15 minutes, and its maximum effect occurs after an hour. Under favorable conditions and following the rules of inhalation, it lasts up to 6-8 hours.

During inhalation, Berodual has the following effects on the lower respiratory tract:

• reduces inflammation in the mucous membrane of the bronchi and other areas;
• relieves tissue spasm;
• optimizes the functioning of the secretory glands;
• stimulates the bronchial drainage system.

The use of inhalation leads to the fact that the swelling of the mucous membrane decreases, and the amount of sputum produced gradually decreases, it becomes less dense and is easily coughed up. This allows air to move more freely into and out of the lower respiratory tract.

After just a few inhalation sessions with Berodual, patients note improved breathing, good sputum discharge and a change from a dry, painful cough to a wet one. Stimulating the discharge of sputum leads to the fact that wheezing in the lungs and bronchi begins to decrease and gradually disappears.

The positive pharmacological effect of Berodual is possible only with complex treatment. Refusal to treat antibiotics for infection reduces the effect of inhalation to zero.

Unlike other similar drugs, Berodual does not contain hormones, is not addictive and does not affect the body's hormonal levels.

Indications for use

The main indication for the use of Berodual is diseases of the lower respiratory tract that provoke bronchospasm attacks. These are not only infectious lesions, but also allergy attacks.

The drug can be prescribed:

• during laryngitis;
• for endogenous and allergic bronchial asthma;
• with bronchiectasis of the lungs;
• with pneumonia;
• for various types of bronchitis (but the use of the drug is strictly necessary only when obstruction occurs).

In some cases, the use of Berodual may have little effect. Therefore, in some cases of bronchitis and pneumonia, its use is inappropriate.

Another form of use of the drug is the preparation of the lower respiratory tract for drug manipulation. Berodual is used to prepare the bronchi for the injection of sputum thinners, antiallergic drugs and antibiotics.

The use of Berodual to combat cough without complex treatment has no effect.

Contraindications

Berodual for inhalation (the instructions for use indicate that the drug is a medicine that has no age limit) can be used for newborns and the elderly without changing the dose.

There are strict contraindications to the use of the drug for inhalation:

1. Cardiomyopathy.
2. Tachyametry.
3. Allergy to the main components of the inhalation product.

The ban on the use of Berodual is associated with the main component of the drug: fenoterol. Once in the blood, it causes contraction of blood vessels and affects the heart rate.

It is imperative to consult a doctor about the need to use and replace the drug with analogues if:

• high blood pressure;
• coronary heart disease;
• glaucoma;
• diabetes mellitus of both types;
• cystic fibrosis;
• prostatic hyperplasia;
• hypothyroidism.

Children's and adult dosage of inhalation aerosol

Instructions for use of Berodual indicate the dosage of the drug for inhalation and use of aerosol for children and adults. At the same time, it is recommended to consult about the use of the drug, taking into account the disease and the individual characteristics of the body. A can of Berodual aerosol contains 200 doses of equal volume.

For children and adults, the number of doses is the same:

1. During an attack, it is necessary to inject 2 doses of the drug. Breathing should resume after 5 minutes. If this does not happen, the manipulation is repeated.
2. For long-term therapy, 3 procedures of 2 injections of medication are carried out during the day. In severe cases, it is allowed to increase the number of procedures to 8.

If after 4 injections the bronchospasm does not stop and the person has difficulty breathing, urgent hospitalization is necessary.

Dilution of the drug with saline solution

The use of pure beradual for inhalation is unacceptable. This negatively affects well-being and leads to complications. To prepare a solution of the medicine, saline solution is used. It cannot be replaced with distilled or boiled water.

The solution is easy to prepare at home. To do this, it is enough to know the dosage for a given age category. The number of milliliters of the product can be counted using the medication cap. The volume of liquid together with saline solution should be 4 ml.

Dosage Features:

1. For children under one year of age, inhalations are carried out in exceptional cases with a minimum amount of the drug. Manipulations at this age are carried out only in a medical institution. An hour after inhalation, the child should be under the supervision of a doctor or nurse. The duration of the course is no more than 5 days.
2. For children under six years old. The number of drops for preparing the solution is calculated based on the child’s body weight. For children who weigh less than 22 kg, use from 2 to 11 drops (1 drop per 2 kg of body weight). If the child weighs more, the doctor should calculate the dose. When in doubt, use the minimum dose. Exceeding it reduces the effectiveness of the procedure.
3. For children over 12 years of age and adults, the dose is 20 drops or 1 milliliter to prepare a solution for one procedure. It is used for chronic obstructive disease and for the prevention of bronchial asthma attacks.
4. In severe forms of the disease and frequent attacks of bronchial asthma, the dose may be increased to 50 drops for one procedure. The maximum permitted dose for a person without cardiovascular disease in case of bronchospasm is 80 drops.
5. During the second trimester of pregnancy, the drug is used only in exceptional cases when the use of other drugs is strictly prohibited. The dosage in this case is equal to the adult dosage, but may be reduced.

For inhalation, only a fresh solution is used; if there is any liquid left after the procedure, it must be disposed of.

Method of use in a nebulizer

Inhaling Berodual using a nebulizer is convenient and safe. This method can be used even at elevated temperatures, since the steam is not warm.

Rules for using a nebulizer for inhalation with Berodual:

1. You must use a mask to protect your eyes from the medication vapors.
2. The number of inhalations per day is 2 procedures; they can be increased only with the permission of the attending physician.
3. Inhalation time depends on the speed of the nebulizer, but should not exceed 7 minutes.
4. If a person has difficulty breathing during the procedure, it is necessary to reduce the intensity of the steam supply. If the condition worsens, the procedure is interrupted.
5. You cannot go outside for 30 minutes after the procedure.
6. You can drink, eat food and other medications only half an hour after inhalation.

During the procedure, you must take deep, slow breaths, exhaling through your nose.

During the treatment of infectious diseases of the lungs and bronchi, half an hour after using inhalations with Berodual, it is recommended to carry out a similar procedure with a mucolytic. Most often, Lazolvan or Ambrobene are used for this.

Use during pregnancy and lactation

Berodual for inhalation, the instructions for use of which indicate this, can be used both during pregnancy and while breastfeeding, but with restrictions.

In the 2nd trimester, if the expectant mother is feeling normal, the use of Berodual is allowed in combination with other drugs. You can use the medicine for inhalation in the first and third semester only if strictly necessary. Contraindication is increased uterine tone. Elements of Berodual can negatively affect tone, increasing it.

The medicine can pass into the milk of a young mother, so during breastfeeding it must be expressed and fed to the baby only after Berodual has been removed from the body.

Side effects

The drug has many side effects that are associated with the body's reaction to the elements of the drug. Most people, after using Berodual, have a dry mouth and may feel thirsty. Since the drug negatively affects the pulse and heart function, side effects may occur with long-term use.

They are as follows:

• increase and decrease in blood pressure;
• tachycardia;

• fibrillation.

Berodual should be used with extreme caution.

Contact of the drug with the eyes can lead to dangerous consequences:

• blurred vision;
• increased intraocular pressure;
• corneal edema;
• discomfort in the eyes;

Other side effects of Berodual:

• disorder and disturbance of intestinal motility;
• pharyngitis;
• decreased potassium levels;
• swelling of the tissues of the face, throat and mouth;
• weakness;
• muscle pain;
• hyperthyroidism;
• hives;
• urination problems, etc.

If a side effect of Berodual occurs, the patient must take sedatives and stop using the drug. In case of cardiovascular failure or severe pulse disorder, a person is placed in intensive care, where he is given tranquilizers.

Interaction

When prescribing Berodual, you must tell your doctor about chronic diseases, since the drug may negatively affect the functioning of other medications. Berodual weakens the effect of beta blockers.

Berodual enhances the effect:

• xalin derivatives;
• cromoglicic acid;
• MAO inhibitors;
• some antidepressants.

The use of the drug simultaneously with general anesthesia requires additional monitoring by physicians. The combination of medications can negatively affect the functioning of the cardiovascular system.

special instructions

Berodual for inhalation (the instructions for use contain instructions that it is necessary to avoid getting the drug into the eyes) can cause severe burning, pain in the eyes and changes in the visual outlines of objects.

Pregnant women should stop taking the drug at 38-41 weeks. When contractions occur, fenoterol weakens labor and can cause serious complications.

In case of hereditary systemic intestinal diseases, taking the drug can cause constipation.

Athletes should avoid using birodual before competitions. Elements of the drug may negatively affect a doping test. After inhalation, it is better to refrain from driving a car and performing dangerous work for several hours. Berodual affects the clarity of vision and can cause dizziness.

Precautionary measures

Berodual for inhalation (instructions for use are included with the product) requires the mandatory use of a mask.

Children should close their eyes during the procedure. An overdose of the drug and its use without prescription and supervision by the attending physician increases the risk of developing side effects several times.

Terms and conditions of storage

The drug can be destroyed when exposed to direct sunlight. It must be stored in dark, cool rooms where the air temperature does not rise above 25 degrees.

When storing Berodual in the refrigerator, do not freeze the drug or place it in places with the lowest possible temperature. Metered aerosol for inhalation should not be placed near heat sources. Throwing a used cylinder into a fire can be dangerous.

The shelf life of Berodual is 3 years.

Analogues of Berodual

Berodual is considered the most effective and affordable inhalation agent used in the treatment of infectious and inflammatory diseases of the lower respiratory tract. If the drug is intolerant or side effects occur, it can be replaced with analogues.

List of analogues:

The cost of the drug in Moscow, St. Petersburg and the regions

The average cost of Berodual is within 270 Russian rubles. An aerosol can be purchased for 430 rubles. The cost of the drug in Moscow is from 230 to 530 rubles. You can purchase Berodual in more than 490 pharmacies.

The cost of the drug in St. Petersburg varies from 230 to 300 rubles. You can buy medicine for inhalation in 403 pharmacies. Prices in the northern regions of Russia are higher - from 260 rubles, in the southern regions - from 220 rubles. In the Far East, prices start from 265 rubles.

The drug Berodual is a bronchodilator composition that is used for inhalation. It is strictly forbidden to prescribe this drug yourself due to the fact that it has significant limitations in use and can have negative side effects. Despite this, the drug is prescribed for inhalation administration to people of various ages when they are diagnosed with certain diseases of the bronchopulmonary system. In order to get the maximum benefit from Berodual without harming the patient, inhalation should be administered correctly, strictly observing the dosage of the drug. Dispensing Berodual from pharmacies is strictly prescription.

Active ingredients in berodual

The medicine contains two bronchodilators:

• fenoterol – belongs to the group of beta2-adrenergic agonists;
• ipratropium bromide – refers to m-anticholinergic drugs.

Thanks to this, the drug has a positive effect on diseases of various natures.

Berodual does not contain steroids, which are synthetic analogues of hormones produced by the adrenal glands. For this reason, the drug is not a hormonal drug, which is a big plus and allows it to be used quite widely.

What effect does the drug have on the body?

During the process of inhalation, berodual manifests its medicinal qualities directly in the lungs and bronchi, and therefore the therapeutic effect is achieved in an extremely short time. The effect of the medicine is related to its constituent components. Thus, fenoterol stimulates adrenergic receptors located in the bronchi, which causes maximum relaxation of the bronchial muscles. In addition, this substance helps reduce swelling of the mucous lumens of the bronchi and lungs and weaken local inflammation. This reduces bronchial obstruction and significantly improves air flow in the respiratory system.

Ipratropium bromide relieves bronchial spasm and eliminates hypersecretion of the bronchial glands, which stops the production of excess mucus (sputum), which, when thickened excessively, makes breathing difficult and provokes a severe cough.

Thanks to the antispasmodic, anti-inflammatory and normalizing mucus production properties of Berodual, patients using this drug experience the following during treatment:

• eliminating cough;
• easier breathing;
• elimination of wheezing;
• restoration of the drainage function of the bronchi.

For what diseases is Berodual indicated?

The drug is prescribed for diseases of an infectious and non-infectious nature, in which bronchospasm of a reversible nature is observed. The main indications for the use of Berodual inhalations are:

• COPD (chronic obstructive pulmonary disease);
• bronchial asthma;
• pneumonia;
• obstructive bronchitis;
• emphysema;
• bronchospasm of an allergic nature.

This drug cannot be used for any type of cough, and therefore you should strictly adhere to the indications for its use. If the drug is used inappropriately for the disease, it either turns out to be useless to the patient, or, which is much more serious, causes harm to him. Even if Berodual was prescribed previously, you cannot voluntarily repeat a similar course of treatment for the same disease. The medicine should be used with extreme caution in children, as even minor deviations from the doctor’s recommendations can lead to negative side effects.

Video recipe for the occasion:

Contraindications to treatment with Berodual

There are quite a lot of prohibitions for carrying out inhalations with Berodual, and ignoring them is strictly prohibited. You should refuse treatment in the following cases:

• hypertrophic obstructive cardiomyopathy;
• tachyarrhythmia;
• first trimester of pregnancy;
• third trimester of pregnancy;
• intolerance to the components of the drug.

In addition to absolute contraindications to the use of the drug, there are cases when the use of Berodual should be carried out with extreme caution. As a rule, this applies to persons who, due to their underlying disease, are under constant medical supervision. Such conditions that require mandatory medical monitoring during the entire course of inhalation of the drug include:

• angle-closure glaucoma;
• arterial hypertension;
• elevated blood sugar levels;
• diabetes;
• myocardial infarction suffered less than 3 months ago;
• severe heart disease;
• severe vascular diseases;
• hyperthyroidism;
• prostatic hyperplasia;
• pheochromocytoma;
• bladder neck obstruction;
• second trimester of pregnancy;
• breast-feeding.

In all these cases, a medicine is prescribed when the expected benefit from it significantly outweighs the possible harm to health. If side effects of such inhalations appear during treatment, and they do not go away quickly on their own, you should immediately call an ambulance. This is usually required in case of disturbances in the functioning of the heart or respiratory system, which is extremely rare, but can pose a threat to the patient’s life.

Side effects of Berodual

For patients in whom inhalation with Berodual may cause unpleasant side effects, the doctor decides whether it is possible for them to continue such therapy or whether the drug should be replaced. The most common side effects that occur are:

• dry mouth;
• increased cough;
• severe headache;
• severe dizziness;
• pharyngitis;
• tremor;
• nausea;
• vomit;
• cardiopalmus;
• tachycardia;
• dysphonia;
• significant increase in systolic pressure;
• increased nervousness.

If treatment with Berodual is carried out at home, then if a side effect of the medicine occurs, the patient should immediately inform the doctor about this and, until consultation with a doctor, refuse inhalations.

How to breed Berodual

For inhalation, the drug is diluted in saline solution, which is sold in a pharmacy. It is strictly prohibited to use Berodual in its pure form for this procedure. The medicine and saline solution should be at room temperature. You should not prepare a composition for inhalation from cold preparations.

The concentration of the solution for inhalation in children and adults is not the same. The berodual comes with a measuring cap, with which the solution is prepared. For adults, pour 4 ml of saline solution into the cap (using distilled or boiled water instead is unacceptable) and add 20 drops of berodual. After this, the mixture is shaken and poured into the nebulizer container. According to the doctor’s recommendations and in case of severe disease, the dosage of the drug can be increased to 50 drops, and in the most severe cases the dose increases to 80 drops.

However, this happens extremely rarely, and, as a rule, such therapy is carried out in a hospital setting.

For children aged 6 to 12 years, only 10 drops of the drug are diluted in the same volume of saline solution. In very severe cases of the disease and under strict medical supervision, the dose can be increased to 40 drops.

If treatment with Berodual is required for children under the age of 6 years or with a body weight of less than 22 kg, then the amount of the drug in the inhalation solution is reduced even more. In such a situation, only 2 drops of Berodual are added to the same 4 ml of saline solution, but if the disease is very severe, 5 drops of Berodual are diluted. For children in this group, inhalation is carried out only with mandatory and constant medical supervision.

General recommendations for the use of Berodual solution for inhalation

The composition obtained by combining saline solution and berodual must be used immediately after preparation and only through a nebulizer. It should absolutely not be taken orally or topically for irrigating the throat. One portion of the solution is intended for 1 inhalation, the duration of which directly depends on the speed of use of the drug. The fact is that different nebulizers process solutions for inhalation at different speeds, and therefore it is impossible to say exactly the duration of the procedure, but it should never exceed 7 minutes.

If for some reason the solution remains unused, it cannot be stored. It must be destroyed. For patients of any age, only freshly prepared composition is used in treatment.

Features of inhalation in adults

It is more convenient to use a nebulizer with a mask for inhalation. As soon as the delivery of the medicinal composition begins, you should take a deep breath through your mouth - as slowly as possible - and hold your breath for 2 seconds. After this, exhale normally through the nose. Breathing should proceed at an even pace and not cause discomfort. If the patient complains of lack of air, the procedure is either canceled or the breathing rate is allowed to increase; this is done at the discretion of the doctor. A maximum of 3 inhalations are carried out during the day. The duration of therapy is determined solely by the doctor.

Inhalation is carried out before or after a meal - it does not matter, since the drug, when introduced into the body, penetrates the respiratory system and in no way affects the gastrointestinal tract. Immediately after inhalation in the cold season, you should not leave the room for 30 minutes. When the outside temperature is above +15 degrees, you can leave the room immediately. During the treatment period, both active smoking and passive smoking (inhalation of smoke from cigarettes smoked by others) are strictly prohibited.

Inhalation with Berodual in children

Inhalation for children is carried out in the same way as for adults, the only difference being that the concentration of berodual in the nebulizer is lower and constant monitoring by an adult is required. You should not leave your child alone during inhalation. Inhalations are carried out 2 times a day - morning and evening. In the event that the disease is particularly severe and the patient’s age exceeds 6 years, 3 inhalations are possible, but only for medical purposes.

Inhalations for children under one year of age

Treatment of diseases of the respiratory system at such a young age is usually carried out in a hospital setting. Berodual inhalations are used for infants in exceptional cases, since the drug is quite strong. They are carried out with a nebulizer for 7 minutes. Usually, after the procedure, the child is constantly monitored for 1 hour, so that in case of an allergy or negative side effect, there is time to provide the necessary medical assistance. The duration of therapy for infants does not exceed 5 days.

Inhalations during pregnancy

Pregnant women are prescribed Berodual inhalations from the 4th to 6th months of pregnancy and only if therapy with other medications is impossible. Inhalations are done in the same way as for other adult patients. If the drug is used in the later stages, its effect will lead to the fact that the tone of the uterus will be insufficient for childbirth, and natural delivery will become impossible. When used in the first trimester, this drug, on the contrary, increases the likelihood of miscarriage.

Possibility of inhalation at temperature

Since inhalations using a nebulizer do not involve exposure to hot steam, it is allowed to carry them out with a berodual even at very high body temperatures. This procedure is completely safe and will not worsen the patient’s condition. Temperature becomes an obstacle to inhalation only if it causes the patient to faint.

Berodual, when used correctly - without violating the dosage and duration of use - cannot cause harm and quickly eliminates problems of the respiratory system. For patients of any age, it is often the only medicine acceptable for a particular patient.

Berodual is a drug that is used when bronchospastic syndrome occurs to relieve difficulty breathing and acute suffocation.

It is used to treat chronic obstructive bronchitis. The medication has long become the leader in sales among other bronchodilators; it is used to treat patients of any age category, and its popularity is due to its ease of use.

On this page you will find all the information about Berodual: complete instructions for use for this drug, average prices in pharmacies, complete and incomplete analogues of the drug, as well as reviews from people who have already used Berodual for inhalation. Would you like to leave your opinion? Please write in the comments.

Clinical and pharmacological group

Bronchodilator drug.

Conditions for dispensing from pharmacies

Dispensed with a doctor's prescription.

Prices

How much does Berodual cost? The average price in pharmacies is 300 rubles.

Release form and composition

• 1 ml of solution for inhalation contains the active ingredients: 261 mcg of ipratropium bromide monohydrate, calculated as anhydrous ipratropium bromide (250 mcg) and 500 mcg of fenoterol hydrobromide.
• Auxiliary components: benzalkonium chloride, disodium edetate dihydrate, sodium chloride, hydrochloric acid 1H, purified water.

Transparent, colorless or almost colorless liquid, free of suspended particles. The smell is almost imperceptible.

Pharmacological effect

The pharmacological action of Berodual is aimed at combating suffocating cough by relaxing smooth muscles and relieving bronchospasm. The drug has an expectorant effect, dilates the bronchi, thins and removes mucus and phlegm that accumulate in the lungs and respiratory tract.

The therapeutic effect of the drug is provided by two active components: ipratropium bromide and fenoterol. Fenoterol has a blocking effect on inflammatory mediators, eliminates tension in the smooth muscles of the bronchi and prevents the development of spasms that can occur under the influence of histamine, cold air or allergens.

Indications for use

For what cough are Berodual inhalations prescribed? For cough caused by infectious and non-infectious respiratory diseases, accompanied by obstruction (narrowing) of the airways, with reversible bronchospasm. The indication for use in accordance with the instructions is the presence of bronchospastic reactions that occur under the influence of internal mediators (methacholine, histamine), as well as external allergens.

The instructions for use of the Berodual solution indicate the following diseases for which the drug is indicated:

• COPD

Contraindications

It is prohibited to use the drug in the following situations:

• prenatal period of intrauterine gestation;
• hypertrophic obstructive cardiomyopathy;
• first trimester of pregnancy;
• hereditary or acquired intolerance to the constituent components of a pharmaceutical drug;
• disturbance of the rhythm of cardiac activity such as tachyarrhythmia;
• hypersensitivity to the active or auxiliary substances included in the drug.

Prescribing a pharmaceutical drug against the background of the following pathological conditions necessarily requires extreme caution (for example, undergoing a conservative course in a specialized pulmonology hospital):

• diabetes;
• hyperthyroidism;
• angle-closure glaucoma;
• heart failure;
• arterial hypertension;
• cardiac ischemia;
• cystic fibrosis;
• history of myocardial infarction within the last three months;
• obstruction of the bladder neck (of a special organogenic nature);
• pheochromocytoma or other hormone-dependent neoplasms;
• benign prostatic hyperplasia;
• severe damage to the cerebral and peripheral bloodstream.

Use during pregnancy and lactation

Berodual solution for inhalation is not prescribed in the first and third trimesters of pregnancy.

During breastfeeding and the second trimester of pregnancy, the drug should be prescribed with extreme caution.

Instructions for use

The instructions for use indicate that when using Berodual for inhalation, the following dosages are recommended:

1. In adults (including the elderly) and adolescents over 12 years of age during acute attacks of bronchospasm, depending on the severity of the attack, doses can vary from 1 ml (1 ml = 20 drops) to 2.5 ml (2.5 ml = 50 drops). In especially severe cases, it is possible to use the drug in doses reaching 4 ml (4 ml = 80 drops).
2. In children aged 6-12 years during acute attacks of bronchial asthma, depending on the severity of the attack, doses can vary from 0.5 ml (0.5 ml = 10 drops) to 2 ml (2 ml = 40 drops).
3. In children under 6 years of age (body weight<22 кг) в связи с тем, что информация о применении препарата в этой возрастной группе ограничена, рекомендуется использование следующей дозы (только при условии медицинского наблюдения): 0.1 мл (2 капли) на кг массы тела, но не более 0.5 мл (10 капель).

Treatment at home is possible only after consultation with a doctor in cases where a fast-acting beta-adrenergic agonist at a low dose is not effective enough. Also, an inhalation solution may be recommended to patients in cases where an inhalation aerosol cannot be used or when it is necessary to use higher doses.

The dose should be selected individually, depending on the severity of the attack. Treatment is usually started at the lowest recommended dose and stopped once sufficient relief of symptoms has been achieved.

Rules for using the drug:

1. The inhalation solution should only be used for inhalation (with a suitable nebulizer) and should not be administered orally.
2. The recommended dose should be diluted with 0.9% sodium chloride solution to a final volume of 3-4 ml and administered (completely) using a nebulizer.
3. The diluted solution should be used immediately after preparation.
4. Should not be diluted with distilled water.
5. The solution should be diluted each time before use; Remains of the diluted solution should be destroyed.

Berodual inhalation solution can be used using various commercial nebulizer models. The dose reaching the lungs and the systemic dose depend on the type of nebulizer used and may be higher than the corresponding doses when using Berodual HFA and CFC metered aerosol (which depends on the type of inhaler). In cases where wall oxygen is available, the solution is best used at a flow rate of 6-8 l/min.

Side effects

Berodual is usually well tolerated. In some situations, the development of undesirable side effects from various systems is possible.

The most common side effects reported in clinical studies were cough, dry mouth, headache, tremor, pharyngitis, nausea, dizziness, dysphonia, tachycardia, palpitations, vomiting, increased systolic blood pressure and nervousness.

From the nervous system:

• changes in taste and dry mouth;
• nervousness;
• headache;
• dizziness;
• tremor.

From the respiratory system:

• cough;
• irritation of the respiratory mucosa;
• development of paradoxical bronchospasm (rare).

From the digestive system:

• digestive disorders (nausea, vomiting);
• impaired intestinal motility (mainly in patients with cystic fibrosis).

From the cardiovascular system:

• increased heart rate;
• tachycardia;
• increased systolic and decreased diastolic pressure;
• arrhythmia.

Allergic reactions:

• rash;
• hives;
• angioedema.

From other systems:

• myalgia (muscle pain) and muscle cramps;
• violation of visual accommodation;
• hypokalemia;
• increased sweating;
• weakness;
• urinary retention.

When the solution gets into the eye, the pupil dilates, intraocular pressure increases, which is accompanied by pain or discomfort in the eyeball, blurred vision of objects, the appearance of colored spots in front of the eyes and redness of the conjunctiva.

Overdose

The most likely symptoms of an overdose are the following:

• an increase in the difference between systolic and diastolic blood pressure;
• angina pectoris and the symptoms that accompany it (for example, a feeling of heaviness in the chest);
• hyperemia of the skin of the face and accompanying sensation of heat;
• subjective feeling of heartbeat and tachycardia confirmed by hardware methods;
• increase or decrease in blood pressure (depending on individual predisposition);
• strengthening of the broncho-obstructive pathological process;
• metabolic acidosis.

An overdose may also be due to excess intake into the body. ipratropium bromide, however, in this case it is weakly expressed and has a transient (passing) character. This is explained by the breadth of therapeutic use of this component in pharmacy. In this case, it may be observed dry mouth or disturbance of accommodative ability organs of vision.

special instructions

The inhalation solution should be taken with caution in case of diabetes mellitus, arterial hypertension, angle-closure glaucoma, heart and vascular diseases (coronary artery disease, heart failure, aortic stenosis, heart disease, severe lesions of the peripheral and cerebral arteries), recent heart attack (within the last three months ), prostatic hyperplasia, pheochromocytoma, hyperthyroidism, cystic fibrosis and bladder neck obstruction.

Regular use of increasing doses of Berodual and other drugs containing β 2-adrenergic agonists to relieve obstruction leads to an uncontrolled worsening of the disease. Increasing the dose when bronchial obstruction increases beyond the recommended dose is unacceptable, unjustified and dangerous. To prevent the disease from worsening and to prevent the patient’s life-threatening condition, the doctor should promptly review the patient’s treatment plan and replace it with adequate anti-inflammatory therapy with inhaled corticosteroids.

Drug interactions

Since the active component of Berodual is a combination of an m-anticholinergic blocker and a β 2 -adrenergic agonist, the following interactions are possible when used in combination with other substances/drugs:

• β-blockers: a significant reduction in the bronchodilator effect of Berodual is possible.
• Glucocorticosteroids (GCS) and/or cromoglycic acid: increase the effectiveness of treatment.
• Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs): can enhance the effect of β-adrenergic drugs.
• Anticholinergics for systemic use, other β-adrenergic agonists, xanthine derivatives (including theophylline): may enhance side effects and the bronchodilator effect of Berodual.
• Inhalational halogenated anesthetics (eg, halothane, trichlorethylene, or enflurane): may potentiate the cardiovascular effects of beta-adrenergic agents;
• Xanthine derivatives, corticosteroids and diuretics: hypokalemia associated with the use of β-adrenergic agonists may increase (it is especially important to consider this interaction when treating severe forms of obstructive airway diseases).
• Digoxin: there is likely an increased risk of arrhythmias due to hypokalemia associated with the use of β-agonists, in addition, the negative effect of hypokalemia on heart rhythm may be enhanced by hypoxia (if this combination of drugs is necessary, the level of potassium in the blood serum should be regularly checked) /