Basic therapy of asthma, providing for the appointment of combination therapy (inhaled corticosteroids and β2-adrenomimetic long-acting). Patients with symptoms that are inadequately controlled with inhaled corticosteroids and β2-agonists short action; Patients on effective maintenance steroid trenbolone doses of inhaled corticosteroids and β2-agonists long-acting.
Contraindications : Hypersensitivity to the drug, children under 12 years.
Precautions Pregnancy, lactation, pulmonary tuberculosis, fungal, viral or bacterial infections of the respiratory system, thyrotoxicosis, pheochromocytoma, diabetes, uncontrolled hypokalemia, idiopa-matic hypertrophic subaortic stenosis, atrioventricular block III degree methyltrienolone, severe hypertension, aneurysm of any location or other severe cardiovascular disease (acute myocardial infarction, ischemic heart disease, tachyarrhythmia,steroid trenbolone for chronic heart failure, the extended interval Q-Tc (receiving formoterol may cause lengthening QTc- interval)).
Pregnancy and lactation No clinical data on the use of Foster during pregnancy. In animal studies embryotoxic or teratogenic effects vyyaleno was not. During pregnancy, Foster should be used only in cases where the benefit of the drug outweighs the potential risk to the fetus. It is recommended to prescribe the lowest dose that provides effective control of asthma symptoms. There is no data on the penetration of Foster in the breast milk of women. Foster can be administered in lactating women only when the expected therapeutic effect for the mother outweighs the potential risk to the child.
Dosing and Administration Foster is not intended for the initial treatment of bronchial asthma. Titration of drugs included in the Foster occurs individually and depending on the severity of the disease. This should be considered not only at the start of combination therapies but also changing in the maintenance doses if the patient requires a separate combination of different doses of active components than in Foster, to assign β2- agonists and / or glucocorticoids in separate inhalers. For adults and adolescents over 12 years: 1-2 inhalations twice daily. Patients steroid trenbolone should be under constant medical supervision for an adequate selection of the dose of Foster. The dose should be reduced to the lowest against which retained optimal control of asthma symptoms. Upon reaching full control of asthma symptoms on a background of the minimum recommended dose, the next step may be to try the appointment of monotherapy trenbolone for sale with inhaled corticosteroids. No need for special dose selection for elderly patients drug. No data on the admission Foster patients with renal or hepatic insufficiency. On the use of the inhaler instructions. The patient must be taught how to use the inhaler, and to periodically check the inhalation technique. Before the first use of the inhaler and after 3 days or more after the break in his use of the first dose should be sprayed in the air to make sure it works.
- Take the inhaler between thumb and forefinger, as shown in the figure.
- Remove the protective cap from the inhaler mouthpiece.
- Take the mouthpiece into your mouth, tightly clasping his lips, and fully exhale through the nose.
- Make a long deep breath and simultaneously performed by pressing on the end of the balloon forefinger.
- After inhalation as long as you can hold your breath. Then remove the mouthpiece from the mouth and continue to breathe normally.
- For the second dose, holding the inhaler in a vertical position, wait 30 seconds and then repeat steps 3 through 5. After use, the mouthpiece is closed tight protective cap. Caution! Follow steps 3 and 4, you can not rush. It should begin to breathe in as slowly as possible just before pressing the inhaler valve. If the gas is partially out of the top of the steroid trenbolone inhaler or from the corners of the patient’s mouth, you should repeat the procedure from step 3. For patients with weak hands easier to hold the inhaler with both hands. Therefore, the upper part of the inhaler should hold two index fingers and its lower part – thumbs. After inhalation, it is recommended to rinse the mouth with water. Recommended to wash it with warm water as contamination In order body building video to maintain the purity of the mouthpiece. No clinical data on the use of Foster with a spacer; therefore recommended dosage formulation given considering that the inhaler is used without a spacer with a standard activator. It will be appreciated that when using Foster a spacer may be necessary to dose adjustment.
Pharmacokinetic indices for the respective drugs were comparable after administration of beclomethasone dipropionate and formoterol as monotherapies and as part of a combined preparation.
For beclomethasone dipropionate when administered as part of a combined of the drug to its active metabolite beclomethasone-17-monopropionata and value of the maximum concentration plasma is slightly lower, while the absorption is faster than the monopreparation beclomethasone dipropionate.
for formoterol when administered as part of a combined plasma drug coincided with that of the single agent, but systemic activity was slightly higher than that of single agent.
No data obtained what is trenbolone regarding pharmacokinetic or pharmacodynamic interactions between and formoterol:
BDP under the action of esterase is converted to the active metabolite beclomethasone-17-monopropionat .
Inhaled rapidly absorbed light; intense absorption precedes its conversion BDP its active metabolite beclomethasone-17-monopropionata . Systemic bioavailability provided by 36% due to light, and also due to the suction organs of the gastrointestinal tract ingested dose inhalation portion. The bioavailability of ingested is negligible, however, presystemic conversion causes that 41% BDP digested . There is almost a linear increase in systemic effects with increasing inhaled dose. The absolute bioavailability following inhalation is approximately 2% and 62% of the nominal dose in relation to the unmodified , respectively.
The connection to plasma proteins is high enough.
Metabolism is characterized by a very high rate of clearance from the systemic circulation through the action of esterase present in most tissues. The main metabolite of BDP – active metabolite what is trenbolone Less active metabolites are beclomethasone monopropionatand beclomethasone (, which are also formed by metabolism, but their role in systemic exposure is very low. Excretion main part excreted in feces as polar metabolites. Renal excretion of the its metabolites is negligible. The respectively. A special population Liver failure does not alter the pharmacokinetics and safety profile BDP due to the fact that the latter is subjected to rapid metabolism The polar metabolites by the action of enzymes present in the gastro-intestinal tract, blood plasma, lung and liver. The pharmacokinetic properties patients with renal failure has not been studied. Considering that both what is trenbolone and its metabolites in the urine almost not allocated, there is no reason to assume increased systemic action of the drug on the body of patients suffering from renal failure.
Formoterol Absorption and distribution of inhaled formoterol is absorbed into the lungs and gastrointestinal tract. Part inhalation dose that is swallowed, depending on the type of inhalation device and inhalation technique. So when using a metered dose inhaler multidose it can be up to 90%. Therefore swallowed fraction must be considered in the inhalation route of administration of the drug. At least 65% of an oral dose of formoterol is absorbed through the digestive tract, with 70% of this volume it undergoes first-pass metabolism. The maximum concentration of unchanged formoterol in plasma observed for 0.5. 1 hour after oral administration. Communication with plasma proteins of formoterol is from 61-64%, with the affinity to albumin – 34%. The range of therapeutic dosages affinity saturation is not observed.When perroralnom reception hours. Inhalation 12-96 mcg of formoterol fumarate absorption of formoterol is linear. Metabolism Metabolism Formoterol is carried out, in particular, due to the direct conjugation fenolgidroksilnoy group. The conjugates of glucuronic acid is not active. The second important pathway formoterol – O-dimetelirovanie by conjugation at two phenolic hydroxyl groups. Cytochrome P450 enzymes, is involved in the O-demetelirovanii formoterol. There is reason to assume that formoterol metabolism is carried out mainly in the liver. Formoterol does not inhibit what is trenbolone enzymes at therapeutically relevant concentrations. Excretion Total formoterol renal excretion following inhalation of a single dose via metered dry powder inhaler increases linearly in the dose range 12-96 mg. Indicators and excretion of unchanged total formoterol, on average, are 8 and 25%, respectively. Based on the measurement of plasma concentrations of formoterol after single inhalation of a dose of 120 mg in 12 healthy volunteers was designated , which was 10 hours. The ratio (R, R) – and (S, S) enantiomers of unchanged drug in renal excretion is respectively 40 and 60%. The relative ratio of these two parameters is not changed within the range of dosages investigated; . no evidence of accumulation of one enantiomer relative to the other after receiving repeated doses in healthy volunteers after oral administration (40-80 mg), 6.10% of the dose was found in the urine as unchanged drug; 8% of the dose was present in the form of glucuronides. Total 67% of the oral dose excreted by the kidneys formoterol (mainly as metabolites), the remainder of the dose – via the intestine. Renal clearance of formoterol is 150 ml / min. personal trainer for bodybuilding laser lipo machine bodybuilding magazine free
If you plan to anesthesia drugs halogenated hydrocarbons, it is necessary to warn the patient not to use before anesthesia.
As with the appointment of other corticosteroids, should review the need for, and dose of Foster in patients with active or inactive hexahydrobenzylcarbonate forms of pulmonary tuberculosis, fungal, viral or bacterial infections of the respiratory system.
due to the risk of developing acute treatment Foster can not abruptly stop, the dose should be reduced gradually and under medical supervision.
When patients are undergoing active treatment (inhaled or oral corticosteroids), it is necessary to continue without any change, even if there is an improvement of symptoms. Saving the symptoms of asthma or the need to increase the dose of Foster may indicate a deterioration of bronchial asthma and the need to review treatment. For the relief of acute episodes of bronchospasm, patients are advised to carry a beta2-agonists of short action.
Foster Treatment should not be used in acute asthma.
As with any other inhalation therapy, paradoxical bronchospasm may occur with an immediate intensification of wheezing after taking the dose. In this connection, Foster discontinue therapy treatment policy review and, if necessary, to assign an alternative therapy.
Any inhaled corticosteroids may cause systemic effects, especially with prolonged use at high doses; it should be hexahydrobenzylcarbonate noted, however, that the likelihood of such symptoms are much lower than in the treatment with oral corticosteroids.
Possible systemic effects include adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density, cataract and glaucoma. Considering the above, the dose of inhaled corticosteroids should be titrated to the minimum, which will ensure the maintenance of effective control.
In chronic receiving excessive doses of beclomethasone dipropionate may manifest its systemic effect: it may be a significant inhibition of adrenal cortex up to adrenal crisis. Adrenal crisis manifested anorexia, abdominal pain, weight loss, fatigue, headache, nausea, vomiting, hypotension, hypoglycemia, accompanied by confusion. and / or convulsions. Situations that can serve as a triggering factor of acute adrenal crisis, include trauma, surgery, infection or rapid dose reduction is part of the Foster beclomethasone. In chronic overdose recommended control reserve of adrenocortical function.
If there is reason to believe that against the background of previous systemic therapy SCS was disturbed adrenal function, should take precautions when transferring patients to treatment Foster. Advantages hexahydrobenzylcarbonate of beclomethasone inhalation therapy, usually minimizes the need for acceptance of oral corticosteroids, but in patients discontinuing therapy with oral corticosteroids for a long time can be maintained insufficient function of the adrenal glands. Patients who are in urgent need of past reception of high doses of corticosteroids or receiving long-term treatment with inhaled corticosteroids at high doses, may also be in this risk. It is necessary to provide for the appointment of additional corticosteroids during times of stress or surgery.
It is recommended to instruct the patient about the need to rinse your mouth with water after maintenance doses of inhaled to prevent the risk of candidiasis of the mucous membranes of the mouth and pharynx. The balloon is under pressure: do not expose to high temperatures Do hexahydrobenzylcarbonate not pierce, do not burn even empty. Use within 3 months of use.