Rinase 250 mcg/ml

Description

Indications

• Nebuliser Solution: Used for the treatment of reversible bronchospasm associated with chronic obstructive pulmonary disease (COPD). When used alongside inhaled beta-2 agonists, it is also indicated for reversible airway obstruction in acute and chronic asthma.
• Inhaler: Acts as a bronchodilator for chronic reversible airway obstruction, including asthma, chronic bronchitis, and emphysema. Also used for the treatment of acute reversible airway obstruction.

Use this medication only as directed by a registered physician.

Pharmacology
Ipratropium Bromide is a quaternary ammonium compound with anticholinergic properties. It inhibits vagal reflexes by blocking acetylcholine, preventing bronchoconstriction. This mechanism helps relax bronchial smooth muscles, reducing airway resistance.

Dosage & Administration

Nebuliser Solution:

• Adults & Children (Above 12 years): 250-500 mcg (1-2 ml) 3 to 4 times daily.
• Acute Bronchospasm: 500 mcg/2 ml, without exceeding 2 mg daily unless under medical supervision.
• Children (6-12 years): 250 mcg (1 ml), up to 1 mg daily.
• Children (0-5 years, acute asthma only): 125-250 mcg (0.5-1 ml), up to 1 mg daily, with a dosing interval determined by the physician.

Inhaler:

• Adults: 1-2 puffs (20 mcg/spray) three or four times daily. Up to 80 mcg (4 puffs) may be needed initially. Do not exceed 12 inhalations in 24 hours.
• Children (6-12 years): 1-2 puffs two to three times daily.
• Children (Below 6 years): 1 puff (20 mcg) three times daily, supervised by an adult.

Administration Instructions
Using an inhaler correctly ensures maximum medication delivery. Follow these steps:

1. Remove the cap and shake the inhaler at least six times.
2. If unused for over a week, release one test puff into the air.
3. Breathe out completely, then place the inhaler in your mouth.
4. While inhaling deeply, press down firmly on the canister.
5. Remove the inhaler, hold your breath for 10 seconds, then exhale.
6. If prescribed multiple puffs, wait 1 minute between doses.
7. Rinse your mouth with water after use.
8. Clean the inhaler weekly by rinsing the plastic actuator and cap in warm water (avoid soaking the metal canister).

Interaction

• Can be used safely with sympathomimetic bronchodilators, methylxanthines, steroids, and cromolyn sodium.
• No major drug interaction studies are available.

Contraindications

• Hypersensitivity to Ipratropium, Atropine, or their derivatives.
• Patients with a history of allergic reactions to soya lecithin, soybean, or peanuts should avoid the inhaler.

Side Effects

Nebuliser Solution:

• Common: Headache, dizziness, cough, dry mouth, vomiting.
• Uncommon: Skin rash, tachycardia, urticaria, pruritus.
• Rare: Anaphylactic reaction, increased intraocular pressure, atrial fibrillation, nausea.

Inhaler:

• Potentially Serious: Rare idiosyncratic reactions.
• Common: Dry mouth, cough, dizziness, blurred vision, nausea.
• Less Frequent: Nervousness, tremors, coordination issues, mucosal ulceration.
• Rare Cases: Acute eye pain, narrow-angle glaucoma worsening, allergic reactions (angioedema, urticaria, laryngospasm, anaphylaxis).

Pregnancy & Lactation

• Pregnancy: Safety not established; use only if benefits outweigh potential risks.
• Lactation: Unknown if excreted in breast milk; caution advised.

Precautions & Warnings

• Medical supervision is required for initial nebulizer use.
• Caution in narrow-angle glaucoma, prostate hyperplasia, bladder obstruction, cystic fibrosis.
• Avoid eye contact with nebulized solution to prevent ocular complications.
• Inhaler use may cause temporary blurred vision or glaucoma worsening.
• If symptoms persist or worsen, seek immediate medical attention.
• Not recommended as initial therapy for acute bronchospasm where a rapid response is needed.

Overdose Effects

• Acute overdose unlikely due to poor systemic absorption.
• Inhaled doses over 5 mg may cause tachycardia and palpitations.
• Oral doses of 30 mg caused anticholinergic side effects, but none required specific reversal.

Therapeutic Class

• Anticholinergic Bronchodilators

Storage Conditions

• Store below 25°C. Keep ampoules in original packaging.
• Single-use ampoules should be used immediately after opening; discard unused portions.

Use this medication only as directed by a registered physician.