Berodual N, 20 mcg+0.5 mg/dose, dosed aerosol for inhalation, 10 ml, 1 pc.

Compound

1 ml of solution for inhalation contains the following pharmaceutical components:

• ipratropium bromide – 0.261 mg (0.25 mg when converting the dosage form into a dry residue);
• fenoterol hydrobromide – 0.5 mg;
• benzalkonium chloride;
• disodium edetate dihydrate;
• sodium chloride;
• 1-molar hydrochloric acid;
• purified water.

Composition of the 1st injection of metered-dose inhalation aerosol:

• ipratropium bromide – 0.021 mg (corresponds to 0.02 mg in the mass part of the anhydrous active substance);
• fenoterol hydrobromide – 0.05 mg;
• 1,1,1,2-tetrafluoroethane (HFA 134a) as propellant;
• anhydrous citric acid;
• ethanol;
• distilled water.

Release form

• A clear, colorless (or almost colorless) solution for inhalation without suspended particles and practically odorless. The pharmaceutical drug is packaged in dropper bottles of 2 ml (1 ml corresponds to 20 drops). The cardboard box contains a container with a medicinal liquid and an annotation for it.
• Metered-dose aerosol for inhalation in special cylinders with a mouthpiece of 10 ml, designed for 200 injections (1 dose equals 1 injection). The cardboard package contains an annotation and a container with the medicine.
• Berodual N is an enhanced pharmaceutical form of this drug, which does not differ in use, as it is supplied in the form of an aerosol for inhalation and a solution for inhalation. Accordingly, it exerts its therapeutic properties somewhat more effectively.

pharmachologic effect

The group of the drug Berodual (the international name of the drug is identical to the commercial one) are combined bronchodilator drugs of inhalation type of action, that is, the active components provide active expansion of the bronchial lumen when inhaled. The mechanism of its therapeutic effect depends on two biological active substances that form the basis of the pharmaceutical mixture used in pulmonology hospitals.

Ipratropium bromide is an ammonium derivative that has anticholinergic properties. Bronchodilation is due to its local action, since it is administered in the form of fine particles by inhalation of an aspiration aerosol or inhalation solution. The biologically active component prevents the release of acetylcholine, the main mediator of parasympathetic synapses, which manifests itself in the normalization of calcium concentrations inside cellular structures. In this way, the action of the vagus nerve is neutralized and the bronchial lumen expands.

Fenoterol hydrobromide , in turn, is a beta-adrenergic receptor stimulant, the selectivity of the therapeutic effect of which depends on the quantitative factor. Thus, small dosages of the biologically active component selectively act on beta2 receptors, which is what is expected from the use of Berodual in the course of conservative treatment of bronchopulmonary pathology.

The mechanism of biochemical effects of fenoterol is to counteract agents such as histamine , methacholine, cold air and allergens of plant and animal nature (a special case of inhibition of an immediate hypersensitivity reaction). Immediately after administration in a therapeutic dose, the release of inflammatory mediators from mast cells is blocked, which inevitably leads to relaxation of the smooth muscles of the bronchial tree and local vascular bed. In addition, there is an increase in the productivity of mucociliary clearance .

Separately, the cardiac effects of fenoterol should be noted, since when it enters the main bloodstream, the biologically active component becomes able to interact with beta-adrenergic receptors localized in the myocardium; accordingly, the following manifestations can be observed:

• increased heart rate;
• progressive increase in the strength of the muscle organ;
• prolongation of the QT interval on the electrocardiogram.

The combined use of two active bronchodilators allows the desired therapeutic effect to be achieved through different pharmacological mechanisms, since the targets for the action of the active components differ. The complementary influence of fenoterol and ipratropium ensures reliable achievement of the desired clinical result, which manifests itself in enhancing the antispasmodic properties of the muscular apparatus of the bronchi and their sufficient expansion to ensure the normal functioning of a healthy body.

Berodual N aerosol for inhalation dosed 20 µg + 50 µg/dose. Release form: 10 ml. (200 doses)

Home \ Medicines \ Other dosage forms \ Berodual N aerosol for inhalation dosed 20 µg + 50 µg/dose. Release form: 10 ml. (200 doses)

Active ingredient: Ipratropium bromide + Fenoterol (Ipratropium bromide + Fenoterol) ATC R03AL01 Fenoterol + ipratropium bromide Pharmacological group Combined bronchodilator (β2-selective adrenergic agonist + m-anticholinergic blocker) [Beta-adrenergic agonists in combinations] Nosological classification (ICD-10)

• J42 Chronic bronchitis, unspecified
• J43 Emphysema
• J44 Other chronic obstructive pulmonary disease
• J44.9 Chronic obstructive pulmonary disease, unspecified
• J45 Asthma

PRICE: 499.46 rub.

Description of the dosage form Clear, colorless or slightly yellowish or slightly brownish liquid, free of suspended particles. Pharmacological action Pharmacological action - bronchodilator, m-anticholinergic, beta2-adrenomimetic. Pharmacodynamics Berodual® N contains two components with bronchodilator activity: ipratropium bromide - an m-anticholinergic blocker and fenoterol hydrobromide - a β2-adrenergic agonist. Bronchodilation following inhaled ipratropium bromide is due primarily to local rather than systemic anticholinergic effects. Ipratropium bromide is a quaternary ammonium compound with anticholinergic (parasympatholytic) properties. Ipratropium bromide inhibits reflexes caused by the vagus nerve. Anticholinergics prevent the increase in intracellular Ca2+ concentration, which occurs due to the interaction of acetylcholine with the muscarinic receptor located on the smooth muscles of the bronchi. The release of Ca2+ is mediated by a system of secondary mediators, which include inositol triphosphate (ITP) and diacylglycerol (DAG).

In patients with bronchospasm associated with COPD (chronic bronchitis and emphysema), a significant improvement in lung function (increase in FEV1 and peak expiratory flow rate by 15% or more) was noted within 15 minutes, the maximum effect was achieved after 1–2 hours and lasted for most patients within 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 hydrobromide selectively stimulates β2-adrenergic receptors at a therapeutic dose. Stimulation of β2-adrenergic receptors activates adenylate cyclase through stimulation of the Gs protein. Stimulation of β1-adrenergic receptors occurs when high doses are used. Fenoterol hydrobromide 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 observed. The β-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 β2-adrenergic receptors of the heart, and when using doses exceeding therapeutic doses, stimulation of β1-adrenergic receptors. As with the use of other β-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 β-adrenergic agonists is tremor. In contrast to the effects on bronchial smooth muscle, tolerance may develop to the systemic effects of β-adrenergic agonists; the clinical significance of this manifestation is unclear. Tremor is the most common adverse effect with β-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 β-adrenergic component is required, which allows you to individually select an effective dose with virtually no side effects. In acute bronchoconstriction, the effect of the drug Berodual® N develops quickly, which allows its use in acute attacks of bronchospasm.

Pharmacokinetics The therapeutic effect of the combination of ipratropium bromide and fenoterol hydrobromide is a consequence of its local action in the respiratory tract. The development of bronchodilation is not parallel to the pharmacokinetic parameters of the active substances. After inhalation, 10–30% of the administered dose of the drug usually enters the lungs (depending on the dosage form and method of inhalation). The remainder of the dose is deposited on the mouthpiece, in the oral cavity and oropharynx. Part of the dose, deposited in the oropharynx, is swallowed and enters the gastrointestinal tract. Part of the drug dose that enters the lungs quickly reaches the systemic bloodstream (within a few minutes). There is no evidence that the pharmacokinetics of the combination drug differs from that of each of the individual components.

Fenoterol hydrobromide The ingested portion of the dose is metabolized to sulfate conjugates. Absolute bioavailability when taken orally is low (about 1.5%). After intravenous administration, free and conjugated fenoterol account for 15 and 27% of the administered dose, respectively, in a 24-hour urine analysis. After inhalation, approximately 1% of the administered dose is excreted as free fenoterol in a 24-hour urinalysis. On this basis, the total systemic bioavailability of an inhaled dose of fenoterol hydrobromide is estimated to be 7%. Kinetic parameters describing the distribution of fenoterol were calculated from plasma concentrations after intravenous administration. After IV administration, plasma concentration-time profiles can be described by a three-compartment model, according to which T1/2 is approximately 3 hours. In this three-compartment model, the apparent Vss of fenoterol is approximately 189 L (≥2.7 L/kg). About 40% of fenoterol is bound to plasma proteins. Preclinical studies have shown that fenoterol and its metabolites do not cross the BBB. The total clearance of fenoterol is 1.8 l/min, renal clearance is 0.27 l/min. Cumulative renal excretion (over 2 days) of the isotope-labeled dose (including parent compound and all metabolites) after IV administration was 65%. The total isotope-labeled dose excreted through the intestines was 14.8% after intravenous administration and 40.2% after oral administration within 48 hours. The total isotope-labeled dose excreted through the kidneys was about 39% after oral administration.

Ipratropium bromide Cumulative renal excretion (over 24 hours) of the parent compound is approximately 46% of the IV dose, less than 1% of the oral dose, and approximately 3-13% of the inhalation dose. Based on these data, the overall systemic bioavailability of ipratropium bromide administered orally and inhaled is calculated to be 2 and 7–28%, respectively. Thus, the influence of the ingested portion of ipratropium bromide on systemic exposure is negligible. Kinetic parameters describing the distribution of ipratropium bromide were calculated based on its plasma concentrations after intravenous administration. A rapid two-phase decrease in plasma concentration is observed. The apparent Vss is approximately 176 L (>2.4 L/kg). The drug binds to plasma proteins to a minimal extent (less than 20%). Preclinical studies have shown that ipratropium, a quaternary ammonium compound, does not cross the BBB. T1/2 in the final phase is approximately 1.6 hours. The total clearance of ipratropium is 2.3 l/min, and the renal clearance is 0.9 l/min. After IV administration, approximately 60% of the dose is metabolized by oxidation, mainly in the liver. Cumulative renal excretion (over 6 days) of the isotope-labeled dose (including parent compound and all metabolites) was 72.1% after IV administration, 9.3% after oral administration, and 3.2% after inhalation administration. . The total isotope-labeled dose excreted through the intestines was 6.3% after intravenous administration, 88.5% after oral administration, and 69.4% after inhalation administration. Thus, excretion of the isotope-labeled dose after intravenous administration occurs primarily through the kidneys. T1/2 of the parent compound and metabolites is 3.6 hours. The main metabolites excreted in the urine bind weakly to muscarinic receptors and are considered inactive.

Indications of the drug Berodual® N Prevention and symptomatic treatment of obstructive airway diseases with reversible airway obstruction, such as:

• bronchial asthma;
• chronic obstructive pulmonary disease;
• chronic obstructive bronchitis with or without emphysema.

Contraindications

• hypersensitivity to fenoterol hydrobromide, atropine-like substances or any other components of the drug;
• hypertrophic obstructive cardiomyopathy;
• tachyarrhythmia;
• pregnancy (first trimester);
• children under 6 years of age.

With caution: angle-closure glaucoma; coronary insufficiency; arterial hypertension; poorly controlled diabetes mellitus; recent myocardial infarction; severe organic diseases of the heart and blood vessels; hyperthyroidism; pheochromocytoma; prostatic hypertrophy; bladder neck obstruction; cystic fibrosis; childhood.

Hypertrophic obstructive cardiomyopathy, tachyarrhythmia; hypersensitivity to fenoterol hydrobromide, atropine-like substances or any other components of the drug, first trimester of pregnancy, children under 6 years of age. With caution: angle-closure glaucoma, coronary insufficiency, arterial hypertension, poorly controlled diabetes mellitus, recent myocardial infarction, severe organic diseases of the heart and blood vessels, hyperthyroidism, pheochromocytoma, prostatic hypertrophy, bladder neck obstruction, cystic fibrosis, childhood.

Use during pregnancy and lactation Current clinical experience has shown that fenoterol and ipratropium do not have a negative effect on pregnancy. However, normal precautions should be taken when using these drugs during pregnancy, especially during the first trimester. The inhibitory effect of fenoterol on uterine contractility should be taken into account. Preclinical studies have shown that fenoterol hydrobromide can pass into breast milk. No such data have been obtained for ipratropium. Significant exposure of an infant to ipratropium, especially when administered as an aerosol, is unlikely. However, given the ability of many drugs to pass into breast milk, caution should be exercised when prescribing Berodual® N to breastfeeding women.

Fertility. There are no clinical data on the effects of fenoterol hydrobromide, ipratropium bromide, or their combination on fertility. Preclinical studies have not shown the effect of ipratropium bromide and fenoterol hydrobromide on fertility.

Side effects Many of the listed undesirable effects may be a consequence of the anticholinergic and β-adrenergic properties of the drug. Berodual® N, 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.

The frequency of adverse reactions that may occur during therapy is given in the following gradation: very often (≥1/10); often (≥1/100, <1/10); uncommon (≥1/1,000, <1/100); rare (≥1/10000, <1/1000); very rare (<1/10000); unspecified frequency (frequency cannot be estimated from available data).

From the immune system: rarely* - anaphylactic reaction, hypersensitivity. Metabolism and nutrition: rarely* - hypokalemia. Mental disorders: infrequently - nervousness; rarely - agitation, mental disturbances. From the nervous system: infrequently - headache, tremor, dizziness. From the organ of vision: rarely* - glaucoma, increased IOP, accommodation disturbances, mydriasis, blurred vision, eye pain, corneal edema, conjunctival hyperemia, the appearance of a halo around objects. From the cardiovascular system: infrequently - increased heart rate, tachycardia, palpitations; rarely - arrhythmia, atrial fibrillation, supraventricular tachycardia*, myocardial ischemia*. From the respiratory system, chest and mediastinum: often - cough; infrequently - pharyngitis, dysphonia; rarely - bronchospasm, pharyngeal irritation, pharyngeal edema, laryngospasm*, paradoxical bronchospasm*, dry throat*. From the gastrointestinal tract: infrequently - vomiting, nausea, dry mouth; rarely - stomatitis, glossitis, gastrointestinal motility disorders, diarrhea, constipation*, oral edema*. From the skin and subcutaneous tissues: rarely - urticaria, itching, rash, angioedema, hyperhidrosis*. From the musculoskeletal system and connective tissue: rarely - muscle weakness, muscle spasm, myalgia. From the kidneys and urinary tract: rarely - urinary retention. Laboratory and instrumental data: infrequently - increased systolic blood pressure; rarely - increased blood pressure. * These adverse reactions were not identified during clinical trials of the drug Berodual® N. The assessment was made based on the upper limit of the 95% CI calculated for the general patient population.

Interaction

Long-term simultaneous use of Berodual® N with other anticholinergic drugs is not recommended due to the lack of data. β-adrenergic and anticholinergic drugs, xanthine derivatives (for example, theophylline) can enhance the bronchodilator effect of the drug Berodual® N. Simultaneous administration of other β-adrenergic agonists that enter the systemic circulation of anticholinergic drugs or xanthine derivatives (for example, theophylline) may lead to increased side effects effects. A significant weakening of the bronchodilator effect of the drug Berodual® N is possible with the simultaneous administration of β-blockers.

Hypokalemia associated with the use of β-adrenergic agonists can be enhanced by the simultaneous administration of xanthine derivatives, corticosteroids and diuretics. This should be given special attention when treating patients with severe forms of obstructive airway disease. 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 concentrations. Beta2-adrenergic agents should be prescribed with caution to patients receiving MAO inhibitors and tricyclic antidepressants, because these drugs can enhance the effect of β-adrenergic drugs. Inhalation of halogenated hydrocarbon anesthetics, such as halothane, trichlorethylene or enflurane, may increase the adverse effects of beta-adrenergic agents on the cardiovascular system.

Method of administration and dosage The dose should be selected individually. In the absence of other doctor's recommendations, the following doses are recommended.

Adults and children over 6 years old

Treatment of attacks. In most cases, two inhalation doses of the aerosol are sufficient to relieve symptoms. If breathing relief does not occur within 5 minutes, you can use an additional 2 inhalation doses. If there is no effect after four inhalation doses and additional inhalations are required, seek medical attention without delay. Intermittent and long-term therapy. 1–2 inhalations per dose, up to 8 inhalations per day (on average 1–2 inhalations 3 times a day). For bronchial asthma, the drug should be used only as needed. Berodual® N should be used in children only as prescribed by a doctor and under the supervision of adults.

Directions for use: Patients should be instructed on the correct use of the metered dose aerosol. Before using a new inhaler for the first time, take the inhaler upside down, remove the protective cap and make 2 injections into the air by pressing the bottom of the can 2 times. Each time you use a metered dose aerosol, the following rules must be observed: 1 Remove the protective cap. 2 Exhale slowly and completely. 3 Hold the inhaler as shown in Fig. 1, wrap your lips tightly around the mouthpiece. The can should be directed with the bottom and the arrow pointing upward.

4 Start inhaling and at the same time press firmly on the bottom of the can until one inhalation dose is released. Continue to inhale slowly to the maximum and hold your breath for a few seconds. Then remove the mouthpiece from your mouth and exhale slowly. To receive the second inhalation dose, repeat steps from step 2 5 Put on the protective cap. 6. If the aerosol can has not been used for more than 3 days, before use, press the bottom of the can once until a cloud of aerosol appears.

Since the can is opaque, it is impossible to determine visually whether it is empty. The canister is designed for 200 inhalations. After using this number of doses, a small amount of solution may remain. However, the inhaler should be replaced because otherwise, you may not receive the required therapeutic dose. The amount of the drug remaining in the can can be checked as follows: - shake the can, this will show whether there is any liquid left in it; - another way. Remove the plastic mouthpiece from the can and place the can in a container of water. The contents of the can can be determined by its position in the water (see Fig. 2).

Clean your inhaler at least once a week. It is important to keep the inhaler mouthpiece clean so that drug particles do not block the release of the aerosol.

When cleaning, first remove the protective cap and remove the canister from the inhaler. Run a stream of warm water through the inhaler to ensure that the drug and/or visible dirt is removed. After cleaning, shake the inhaler and allow it to air dry without using heating devices. Once the mouthpiece is dry, insert the can into the inhaler and put on the protective cap. Warning: the plastic mouthpiece is designed specifically for Berodual® N metered-dose aerosol and serves for precise dosing of the drug. The mouthpiece should not be used with other metered dose aerosols. Also, you cannot use Berodual® N aerosol with any other adapters other than the mouthpiece supplied with the can. The contents of the can are under pressure. The canister must not be opened or exposed to temperatures above 50 °C.

Overdose

Symptoms: usually associated primarily with the effects of fenoterol. Symptoms associated with excessive stimulation of β-adrenergic receptors may occur. The most likely occurrence is tachycardia, palpitations, tremor, arterial hypertension or hypotension, increased pulse pressure, angina pain, arrhythmias and hot flashes, metabolic acidosis, and hypokalemia.

Symptoms of an overdose of ipratropium bromide (such as dry mouth, impaired eye accommodation), given the wide breadth of the therapeutic effect of the drug and the local method of administration, are usually mild and transient.

Treatment: you must stop taking the drug. Data from monitoring the acid-base balance of the blood should be taken into account. Sedatives and tranquilizers are indicated, and in severe cases, intensive care. As a specific antidote, it is possible to use β-blockers, preferably β1-selective blockers. However, one should be aware of the possible increase in bronchial obstruction under the influence of beta-blockers and carefully select the dose for patients suffering from bronchial asthma or COPD due to the risk of severe bronchospasm, which can be fatal.

special instructions

Dyspnea. If shortness of breath (difficulty breathing) suddenly increases rapidly, you should consult a doctor immediately. Hypersensitivity. After using the drug Berodual® N, immediate hypersensitivity reactions may occur, signs of which in rare cases may include urticaria, angioedema, rash, bronchospasm, oropharyngeal edema, anaphylactic shock.

Paradoxical bronchospasm. Berodual® N, like other inhaled drugs, can cause paradoxical bronchospasm, which can be life-threatening. If paradoxical bronchospasm develops, the use of Berodual® N should be stopped immediately and switched to alternative therapy.

Long-term use. In patients suffering from bronchial asthma, Berodual® N should be used only as needed. In patients with mild COPD, 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 β2-adrenergic agonists, such as Berodual® N, to relieve bronchial obstruction can cause uncontrolled worsening of the disease. In case of increased bronchial obstruction, increase the dose of β2-agonists, incl. Berodual® N, 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 simultaneously with Berodual® N only under medical supervision. Gastrointestinal disorders. In patients with a history of cystic fibrosis, gastrointestinal motility disorders are possible.

Visual disorders. Avoid contact of the drug with the eyes. Berodual® N 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 IOP, mydriasis, angle-closure glaucoma, eye pain) that developed when inhaled ipratropium bromide (or ipratropium bromide in combination with β2-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 lower IOP and immediate consultation with a specialist is indicated.

Systemic effects. For the following diseases: recent myocardial infarction, diabetes mellitus with inadequate glycemic control, severe organic diseases of the heart and blood vessels, hyperthyroidism, pheochromocytoma or urinary tract obstruction (for example, prostatic hyperplasia or bladder neck obstruction), Berodual® N should be used only after careful risk/benefit assessment, especially when using doses higher than recommended.

Impact on cardiovascular system. In post-marketing studies, rare cases of myocardial ischemia have been reported when taking beta-agonists. Patients with concomitant serious heart disease, such as coronary artery disease, arrhythmias or severe heart failure, receiving Berodual® N should consult a doctor if chest pain or other symptoms indicating worsening of heart disease occur. It is necessary to pay attention to symptoms such as shortness of breath and chest pain, because... they can be of both cardiac and pulmonary etiology.

Hypokalemia. When using β2-agonists, hypokalemia may occur (see “Overdose”). In athletes, the use of the drug Berodual® N due to the presence of fenoterol in its composition can lead to positive results of doping tests. Please note that the drug contains a small amount of ethanol (13.313 mg per dose). Impact on the ability to drive vehicles and machinery. Studies have not been conducted to study the effect of the drug on the ability to drive vehicles and operate machinery. Care should be taken when performing these activities as... possible development of dizziness, tremor, impaired eye accommodation, mydriasis and blurred vision. If the above undesirable sensations occur, you should refrain from such potentially dangerous actions as driving vehicles and machinery.

Release form Aerosol for inhalation dosed 20 mcg + 50 mcg/dose. 10 ml (200 doses) in a metal can with a dosing valve and a mouthpiece with a protective cap with the company logo. The can is placed in a cardboard box.

Dispensing conditions from pharmacies are by prescription.

Storage conditions for the drug Berodual® N At a temperature not exceeding 25 °C. Keep out of the reach of children. The shelf life of Berodual® N is 3 years. Do not use after the expiration date stated on the package.

Pharmacodynamics and pharmacokinetics

With active inhalation of a medicinal solution, improvement in the functioning of the bronchopulmonary system occurs in a short time, even if only 10-39% of the total dose is deposited in the tissue of the respiratory tract (the rest of the drug remains on the tip of the inhaler, in the oral cavity and in the upper respiratory tract). paths).

The therapeutic effects of ipratropium bromide develop within 15 minutes and represent an increase in forced expiratory time in 1 second (an important parameter for assessing the normal functioning of the respiratory system) and peak expiratory flow by 15 percent. The maximum effect of this biologically active component is achieved within 1-2 hours from the moment of injection, and the achieved effects persist for 6 hours.

The overall systemic bioavailability of fenoterol hydrobromide slightly lower than that of ipratropium and is about 1.5%, however, Berodual is a pharmaceutical drug of local action, therefore the rate of therapeutic effect through the inhalation route of administration is more clinically significant, which is no less than that of the first active component of the drug.

Effect of the drug Berodual N on the body

The inhaler delivers a dosed dose of medications. The wide spray nozzle directs the stream towards the respiratory organs, reaching the lower respiratory tract. The drug can also be given to children, this is especially true for those who suffer from asthma.

The action of Berodual is as follows: in case of excessive physical exertion, in contact with an allergen or in extreme cold, when an asthmatic’s inhalation process slows down, a dose of an aerosol will relieve this spasm, allowing the lungs to work widely, with a normal frequency of inhalations and exhalations. Berodual produces the first relief effect within 15 minutes.

Then the drug is active for two hours, then the residual effect of the inhaler remains for 6 hours, but repeated use is required. You can use the spray on a regular basis according to your schedule, and you can also use the spray in moments of urgent need at the onset of an asthma attack.

The pulmonologist recommends: “Children and adults who have been diagnosed with chronic inflammation of the respiratory tract should always carry a bottle of the drug “Berodual N” with them.

Why do experts prescribe this inhaler, its advantages over analogues:

• long-lasting effect – up to 6 hours;
• low dose spray;
• elimination of bronchospasm in just 15 minutes;
• In addition to quick results, there are also long-term, therapeutic ones aimed at chronic diseases.

Indications for use

• bronchial asthma of various origins (allergic and endogenous, asthma of physical exertion);
• chronic disease of the lung tissue accompanying bronchospastic syndrome;
• chronic bronchitis with obstruction of the bronchopulmonary tract;
• emphysema;
• other chronic obstructive diseases of the respiratory system with reversible blockage of the airways;
• preventive sanitation of nosological units affecting the respiratory system;
• preparatory measures regarding the lumen of the respiratory tract before aerosol administration of antibiotics , corticosteroids or other mucolytic drugs.

Contraindications

• hereditary or acquired intolerance to the constituent components of a pharmaceutical drug;
• disturbance of the rhythm of cardiac activity such as tachyarrhythmia ;
• hypertrophic obstructive cardiomyopathy ;
• first trimester of pregnancy;
• prenatal period of intrauterine gestation;
• 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):

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

Side effects

The adverse effects of using a pharmaceutical drug are associated with the extremely high biochemical activity of the active components of the inhaled drug, as they have anticholinergic and beta-adrenergic properties . Also, the use of Berodual can cause local irritation, which is typical for any kind of inhalation therapy.

The most commonly observed side effects from the entire wide list of adverse effects are dry mouth, headache and dizziness , intention tremor , cough, pharyngitis , nausea, tachycardia, impaired sound production, subjective feeling of heartbeat, vomiting, nervousness and increased systolic blood pressure. .

Other side effects:

• From the cardiovascular system: arrhythmias, atrial fibrillation, supraventricular tachycardia , ischemia , increased diastolic blood pressure.
• The organs of vision may respond to the administration of a pharmaceutical drug in the following ways: increased intraocular pressure, disruption of the accommodation process , mydriasis , development of glaucoma , pain, corneal edema, blurred vision, conjunctival hyperemia, the appearance of a faint halo around objects.
• Respiratory tract: dysphonia, bronchospastic syndrome , pharyngeal irritation followed by swelling, laryngospasm, paradoxical bronchospasm.
• From the immune system: anaphylactic manifestations, hypersensitivity .
• The nervous system and mental health may also be adversely affected by inhaled mixtures: agitation, mental disturbances, nervousness, trembling of the upper limbs when performing conscious movements (especially pronounced during small coordinated motor acts).
• From the side of metabolic processes: decrease in blood potassium.
• Digestive system: stomatitis , glossitis , disturbances of adequate motility of the gastrointestinal tract, diarrhea or constipation , swelling of the oral cavity.
• From the skin and subcutaneous tissue: itching, urticaria , local angioedema, hyperhidrosis .
• From the urinary system: delay in the physiological duration of the act of urination.

Drug interactions

• Anticholinergic drugs: it is not recommended to use simultaneously with Berodual N for a long time due to the lack of data on interaction;
• β-blockers: can significantly weaken the bronchodilator effect of the aerosol;
• Other β-adrenergic agonists entering the systemic circulation, anticholinergics or xanthine derivatives (including theophylline): likely to increase side effects; it is also possible to enhance the bronchodilator effect of Berodual N;
• Halogenated inhalational anesthetics (including trichlorethylene, halothane, enflurane): may increase the adverse effects of beta-adrenergic agents on the cardiovascular system;
• Glucocorticosteroids, xanthine derivatives and diuretics: hypokalemia associated with the use of β-adrenergic agonists may increase, therefore, when treating severe forms of obstructive airway diseases, it is recommended to monitor the concentration of potassium in the blood;
• Digoxin: hypokalemia associated with the use of beta-agonists may increase the risk of arrhythmias and enhance the negative effect on heart rhythm (monitor serum potassium concentrations);
• Tricyclic antidepressants and monoamine oxidase inhibitors: prescribe with caution, since β-adrenergic agonists can enhance the effect of β-adrenergic drugs.

Instructions for use of Berodual (Method and dosage)

Aerosol Berodual, instructions for use

Before carrying out self-inhalations with a pharmaceutical drug, you should carefully read the recommendations for the correct use of the Berodual aerosol, which are usually presented as follows:

• The spray is in a can with a protective cap, which must be removed before use. If the medicine has not been in use for the last 3 days, then before actively using it, you must press the valve once until the inhalation aerosol appears in the form of a small cloud.
• Exhale deeply and slowly.
• Place your lips around the tip of the inhaler so that the arrow on the medicine bottle is facing up and the mouthpiece is facing down.
• At the same time, press on the bottom of the container, releasing 1 measured dose of the drug, and take a deep breath “full chest” to increase the area of ​​interaction of biologically active components and structures of the respiratory system.
• After use, put the protective cap back on, returning the cylinder to its original position.

Berodual inhaler: dosage of an aerosol form of a pharmaceutical drug

Adults and children over 6 years of age during an acute attack - 2 inhalations. If relief does not occur within 5 minutes, then 2 more inhalation doses are prescribed. If this treatment tactic continues to be ineffective, it is necessary to urgently seek qualified medical help. For long-term conservative rehabilitation - 1-2 inhalations 3 times a day, but so that in total there are no more than 8 manipulations within one day.

Berodual solution for inhalation, instructions for use

A pharmaceutical drug in this form of release requires special medical equipment for proper use, which is called a nebulizer . This is a device through which Berodual (or other medicine) is sprayed into a fine cloud. In this form, the drug almost freely enters even poorly ventilated areas of the bronchopulmonary system, and the dosage for a nebulizer is much lower than for a traditional inhaler, which is why the “miracle of technology” has especially taken root in pulmonology hospitals and is now widely used for the treatment of respiratory diseases.

Before using the drug directly, you should definitely learn how to dilute it correctly for inhalation, since the effectiveness of the effect and the complete implementation of the therapeutic capabilities of the active components of Berodual depend on this stage. As a rule, an isotonic solution of sodium chloride with a concentration of 0.9% is used as a solvent, because it is closest to the composition of the aqueous portion of plasma (in no case should distilled water be used to dilute a pharmaceutical drug, this can lead to adverse consequences). How to dilute with saline - add liquids up to 3-4 ml to the recommended dose.

General schemes of conservative treatment with inhalation solution

For adults and children over 12 years of age, to eliminate acute attacks - 20-80 drops (1-4 ml) 4 times, and for a long-term course - 1-2 ml (20-40 drops) up to 4 times a day. For moderately developing bronchospastic syndrome, to facilitate ventilation of the bronchopulmonary system - 0.5 ml (10 drops).

In pediatric practice, for children from 6 to 12 years old - 0.5-1 ml (10-20) drops to counteract an attack (in severe clinical cases, the dosage can increase to 2-3 ml, which corresponds to 40-60 drops). For long-term therapy, for example, for allergic cough - 0.5-1 ml (10-20 drops) 4 times a day.

In the younger age category of patients under 6 years old and weighing less than 22 kg, the dosage of the pharmaceutical drug is calculated individually, based on the following need for the therapeutic course - 25 mcg of Ipratropium and 50 mcg of Fenoterol per 1 kg of body weight (total amount of drug up to 0.5 ml) up to 3 times a day.

Instructions for use Berodual N

The practical use of this pharmaceutical form of the drug does not differ from the previously invented Berodual. An enhanced variation is also supplied in the form of an aerosol in special cylinders for active inhalation and a solution for inhalation through a nebulizer or other similar medical equipment. As for dosages, you should separately visit a qualified pulmonologist and find out this issue on an individual basis, since at the moment there are no general protocols for conservative treatment with Berodual N.

Berodual

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 is excreted in 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.

Use for renal impairment

The drug should be prescribed with caution for obstruction of the bladder neck.

Use in children

In 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 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): about 25 mcg ipratropium bromide and 50 mcg fenoterol hydrobromide = 0.1 ml (2 drops) per kg of body weight (per dose), but not more than 0.5 ml (10 drops) (per dose). The maximum daily dose is 1.5 ml.

special instructions

The patient should be informed that if shortness of breath (difficulty breathing) suddenly increases rapidly, 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. If paradoxical bronchospasm develops, the use of Berodual should be stopped immediately and switched to alternative therapy.

Long-term use

In patients with bronchial asthma, Berodual® should be used only as needed. In patients with mild COPD, 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 β2-adrenergic agonists, such as Berodual®, to relieve bronchial obstruction can cause uncontrolled worsening of the disease. In case of increased bronchial obstruction, increase the dose of β2-agonists, incl. Beroduala, 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 prescribed with caution to patients predisposed to the development of 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 β2-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 you do not have a mouthpiece, use a mask that fits tightly to your face. Particular care should be taken to protect the eyes of patients predisposed to the development of glaucoma.

Systemic effects

For the following diseases: recent myocardial infarction, diabetes mellitus with inadequate glycemic control, severe organic diseases of the heart and blood vessels, hyperthyroidism, pheochromocytoma or urinary tract obstruction (for example, prostatic hyperplasia or bladder neck obstruction), Berodual® should be prescribed only after careful assessment of the risk/benefit ratio, especially when used in doses higher than recommended.

Effect on the cardiovascular system

In post-marketing studies, rare cases of myocardial ischemia have been reported when taking beta-adrenergic agonists. Patients with concomitant serious heart disease (for example, coronary artery disease, arrhythmias or severe heart failure) receiving Berodual® should be warned to consult a doctor if they develop 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, because... they can be of both cardiac and pulmonary etiology.

Hypokalemia

Hypokalemia may occur when using β2-adrenergic agonists.

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.

Overdose

When using a pharmaceutical drug in clinical practice, a pathological condition such as an overdose of active ingredients may occur, which is usually associated with excessive stimulation of beta-adrenergic receptors. In this case, the most likely symptoms of intoxication are the following:

• 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;
• 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;
• metabolic acidosis .

Also, an overdose may be due to excessive intake of ipratropium bromide , but in this case it is weakly expressed and has a transient (passing) nature. This is explained by the breadth of therapeutic use of this component in pharmacy. In this case, dry mouth or impaired accommodative ability of the visual organs may occur.

beta1-blockers can be used as a specific pharmacological antidote . Having the opposite mechanism of therapeutic action, these drugs will help get rid of a pathological condition that threatens the life and well-being of the patient. But in patients with chronic obstructive pulmonary disease and bronchial asthma, under the influence of biologically active components of this type of pharmacological action, there is a possibility of developing bronchial blockage, which can only be avoided by careful selection of the exact dosage.

The administration of sedatives and tranquilizers is also used as therapeutic measures (when the symptoms are too severe). In case of severe overdose syndrome, intensive conservative treatment should be immediately carried out using all possible medications that can adequately help the patient.

Side effects and contraindications

Possible consequences:

• itching, redness, urticaria - an allergic reaction to the components;
• paradoxical bronchospasm - when the spasm only increases after using the drug;
• problems with gastrointestinal motility;
• possible vision pathologies – recorded in patients with glaucoma and other abnormalities;
• myocardial ischemia and other cardiovascular diseases;
• hypokalemia;
• dizziness;
• tremor of the limbs.

The drug should not be used:

• with personal intolerance to ingredients;
• tachyarrhythmias;
• cardiomyopathy;
• children under 6 years old;
• pregnant women in the first months of gestation.

Prescribe Berodual with caution if the patient:

• glaucoma;
• heart failure;
• diabetes;
• cystic fibrosis;
• arterial hypertension and others.

special instructions

Berodual - hormonal or not?

Bronchial asthma is a polyetiological disease, one of the factors of which is allergic disorders and sensitization of the body, which is why conservative treatment of this respiratory pathology is so complex from a medical point of view. Very often, pharmaceutical preparations based on natural human hormones are used of asthmatic conditions Since bronchial asthma is among the indications for the use of Berodual, ordinary people without medical education have a completely logical question: “Is Berodual a hormonal drug or not?”

The solution to this problem lies in the chemical composition of the drug, which is represented by ipratropium bromide and fenoterol hydrobromide. The first active ingredient is an amine derivative with anticholinergic properties, and the second active component of the drug is a non-selective beta-adrenergic agonist. Based on this, we can confidently state that Berodual is not a hormonal drug and, according to its mechanism of action, cannot affect the hormonal balance in the body.

Composition of the drug

The drug Berodual itself is written in Latin as “Berodual”. The same name is indicated in the instructions for the drug and on the packaging.

The medicine contains 2 active substances with targeted action:

• ipratropium bromide (ipratropium bromide);
• fenoterol (fenoterol).

Both of these drugs relieve bronchospasm and improve bronchial patency. Their combined local effect provides a broad therapeutic effect.

Important! The purpose of the drug, its release form, takes into account the age of the patient and his state of health.

The dosage of Berodual for use in a nebulizer may vary significantly depending on the indications. The use of the inhaler can only be recommended for adults and children over 6 years of age.

Berodual's analogs

Berodual analogues are medicines that have a similar or identical ATC code, which is used to mark absolutely all pharmaceutical products on the official market, or INN Berodual (international nonproprietary name). Analogs for inhalation in pharmacy kiosks are usually cheaper, because the price factor in choosing a drug is sometimes one of the most important, especially in the conservative treatment of chronic, indolent diseases. Bronchodilators of various natures that can replace Berodual are the following list: Berotex , Ventolin , Duolin , Salbroxol , Salbutamol .

Which is better: Berodual or Pulmicort?

Pulmicort is a synthetic hormonal drug, which is a glucocorticosteroid for inhalation use. That is, the active component of the drug is identical in its chemical structure to the structure of biological substances produced by the adrenal glands. The mechanism of therapeutic action is to directly influence cellular elements in order to regulate metabolic processes and cycles of formation of new substances.

The effectiveness of local use of Pulmicort is 15 times higher than that of Prednisolone , since the synthetic active ingredients have a higher chemical affinity for glucocorticosteroid receptors, therefore the drug is the drug of choice in the treatment of bronchial asthma in clinically advanced cases (or when the pathological process cannot be stopped by others , safer conservative means).

Therefore, it is extremely difficult to compare Berodual and Pulmicort. Medical researchers have not reached a consensus on this issue and regularly publish “new” arguments in favor of a particular pharmaceutical drug. More experienced doctors have found the only correct and very acceptable option, which is the use of Pulmicort and Berodual together in the combined treatment of diseases of the respiratory system. Thus, the therapeutic effects of two strong pharmaceutical drugs are combined, which makes it possible to eliminate even the most clinically severe attacks of bronchial asthma or chronic obstructive pulmonary disease.

The dosage of inhalations with Berodual and Pulmicort is selected individually for each patient empirically, starting from the minimum limit of the therapeutic range of pharmaceuticals (for Berodual - 0.5 ml, and for Pulmicort - 0.25 mg for one inhalation).

Which is better: Berodual or Ventolin?

Ventolin is a pharmaceutical drug that belongs to selective beta2-adrenergic agonists , the therapeutic effect of which is to actively expand the bronchial lumen and facilitate ventilation of the pulmonary parenchyma. As a rule, this drug is prescribed for the prevention and conservative relief of spastic contractions that develop upon contact with an allergen in the pathogenesis of bronchial asthma.

Berodual, in turn, contains fenoterol , which, like Ventolin, has a stimulating effect on this type of receptors in the bronchial tree. However, this is not the only biologically active component of Berodual, due to which the indications for its use are much wider than those of Ventolin, therefore this pharmaceutical drug is considered better by most qualified pulmonologists, and its use is more rational.

Berotek or Berodual - which is better?

Like Ventolin, Berotek belongs to the group of pharmaceutical beta2-adrenergic receptor agonists , that is, the active component of the drug, like the previous drug, selectively affects the bronchi, which is manifested in the relaxation of the smooth muscles of the airways and the expansion of their lumen. Thus, the prescription of Berotek as a symptomatic treatment of bronchial asthma is quite justified, but Berodual covers a wider range of action, and the therapeutic effect develops faster, so there is no need to talk about comparing drugs separately.

Salbutamol or Berodual - which is better?

Salbutamol is a drug that has been described since time immemorial in medical literature. According to its chemical structure and therapeutic effect, it is a non-selective stimulator of beta-adrenergic receptors, extending its biochemical effects to both the respiratory system and the heart. The active component of the pharmaceutical drug of the same name is clearly stronger in its effects than fenoterol, which is why Salbutamol is included in the protocol for the treatment of bronchial asthma.

But when comparing it with Berodual, one should not forget about ipratropium, the use of which is associated with fewer side effects and adverse consequences of undergoing a conservative course of sanitation of the respiratory system. It should also be noted that relief occurs more quickly when treating a nosological entity such as, for example, chronic bronchitis , which is also very significant.

Based on the above facts, it can be admitted that Berodual is better in the treatment of indolent diseases of the respiratory tract with possible or already occurring obstructive processes, but for the rehabilitation of bronchial asthma one should choose Salbutamol, because this is not just the recommendations for the management of this nosological unit, but also the official protocols for pulmonologists and pediatricians.

Analogs

It is possible to replace the drug with an analogue only after consultation with the treating specialist.

Pulmicort

Synthetic hormonal medicine, glucocorticoid. The effectiveness is 15 times higher, which makes the drug preferable in severe clinical cases. Pulmicort can be used together with Berodual to achieve the greatest therapeutic effect, but the dosage and frequency of use of the drug is determined by the attending physician.

Ventolin

A selective beta2-adrenergic agonist is prescribed if prevention is necessary or to neutralize spastic contractions resulting from allergic reactions in bronchial asthma, but is characterized by a smaller range of therapeutic effects compared to Berodual.

Berotek

Beta2-adrenergic receptor antagonist, has a relaxing effect on the smooth muscles of the respiratory tract. But, it is characterized by a smaller range of therapeutic actions in comparison with Berodual.

Salbutamol

A non-selective beta-adrenergic receptor stimulator, it affects not only the bronchopulmonary system, but also the heart. The medicinal effect of Salbutamol is stronger than that of Berodual, but there are more side effects when using it.

Berodual for Children

The drug is actively used in pediatric practice from a very young age for several reasons. First of all, of course, the therapeutic effectiveness of the drug should be taken into account when inhalations are administered to a child for chronic obstructive diseases of the respiratory system. The complex of ipratropium bromide and Fenoterol allows not only to expand the bronchial lumen, but also to significantly facilitate ventilation of the lung parenchyma. The dosage of the nebulizer for children can be found in the instructions for use section, which will also be useful for parents who prefer the aerosol form of the pharmaceutical drug.

Separately, it is worth noting that the pharmaceutical drug can be used not only for nosological entities, the pathogenesis of which is inextricably linked with spasmodic narrowing of the bronchi, but also for dry cough, because the active components improve mucociliary clearance, which has a stimulating effect on regulatory and immune processes. This eliminates the problem of sluggish idiopathic dry cough.

The most frightening cough for young parents is definitely the so-called “barking” cough, which develops with laryngitis in children. This disease, which affects the upper respiratory tract, is especially dangerous, because the pathological process in the larynx is associated with the risk of developing an acute form of laryngitis and false croup. Therefore, when this nosological unit is identified, the dosage for inhalation for children is slightly higher than that prescribed for chronic obstructive diseases of the respiratory system.

Berodual during pregnancy and lactation

There have been no reliable studies on the ability of the active ingredients to influence the body of the fetus and mother in one way or another during pregnancy, however, the preclinical practice of using Fenoterol and Ipratropium in past years indicates that biologically active substances do not have a negative effect on the physiological processes occurring in the body women.

It is not recommended to use the pharmaceutical drug only in the 1st and 3rd trimesters, since Fenoterol has an inhibitory effect on the muscular apparatus of the uterus. Accordingly, this component of Berodual can slow down labor or create conditions of artificial hypotension, which can also adversely affect the early stages of ontogenesis.

It has been clinically proven that Fenoterol is able to pass into breast milk during lactation , however, there is no such data on ipratropium, therefore, for young mothers who are breastfeeding, it is recommended to prescribe Berodual only with increased precautions.

Reviews about Berodual

Reviews of Berodual for inhalation are confirmed by clinical and theoretical studies of the biologically active components of the pharmaceutical drug, since the overwhelming majority are colored with positive emotions. The aerosol and nebulizer are convenient for everyday use and do not require additional medical knowledge or special professional skills.

Reviews from doctors about this drug praise the combined approach to expanding the lumen of the bronchial tree, which is carried out through Berodual, because the active ingredients combine two different mechanisms for the development of bronchodilation, which makes it possible to effectively combat pathological conditions in the respiratory tract even in the most complex clinical cases.

Reviews of Berodual for children do not differ from those for adult patients. Of course, the parents of their recovered children more actively recommend the use of the pharmaceutical drug in conservative treatment, since they have personally observed how inhalations with Berodual facilitate pulmonary breathing and significantly improve the quality of life for children even of the youngest age.

Berodual price, where to buy

A solution for a nebulizer can be bought for 250 rubles, and the price of Berodual for inhalation in the form of an aerosol almost doubles and reaches 500 rubles. Separately, it is worth noting that in Russia it is extremely difficult to find such a pharmaceutical form of the drug in a pharmacy kiosk.

The price of Berodual N, as a rule, is in an even higher range, since this pharmaceutical form of the drug is an enhanced analogue, and, accordingly, the therapeutic effect occurs more fully and much faster, therefore, how much Berodual N costs, you should find out at your nearest pharmacy separately.

The price of Berodual aerosol in Ukraine is on average 250 hryvnia; an inhalation solution can be purchased at about the same price.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Berodual N aerosol for injection.
  dosage 20mcg+50mcg/dose 200 doses 10mlBoehringer Ingelheim RUR 535 order
• Berodual solution for ing 0.25mg+0.5mg 20mlIstituto de Angeli Srl

  RUB 302 order

Pharmacy Dialogue

• Berodual (flask 20ml)Boehringer Ingelheim

  RUB 272 order

• Berodual N (aerial 200doses 10ml)Boehringer Ingelheim

  RUR 501 order

show more

Pharmacy24

• Berodual H 10 ml 200 doses aerosol Boehringer Ingelheim Pharma GmbH & Co.
  KG, Nimechchina 244 UAH. order
• Berodual 20 ml solution Istituto de Angeli S.r.l., Italy

  244 UAH order

PaniPharmacy

• Berodual liquid Berodual d/ing solution. 20ml Italy, Instituto de Angeli

  245 UAH order

• Berodual aerosol Berodual-N aer. 10ml 200doses Germany, Boehringer Ingelheim Pharma

  237 UAH order

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Recipe in Latin

The Berodual prescription in Latin for the aerosol form presented at the pharmacy includes the name of the product, bottle capacity and dosage.

Recipe for inhalation

Full recipe for Berodual aerosol in Latin:

• DTD No. I
• Rp.: Aer. "Berodual" 15ml

2 breaths 3 times a day

Writing a recipe in Latin begins with the word “Recipe,” which means “take.” In the recipe this word is abbreviated as Rp.

The abbreviation in the description also applies to the release form of the medicinal product. "Aer." indicates an aerosol form of release. Derived from the Latin word "Aerosol".

After indicating the form of the drug on the prescription, its name (Berodual) is written in Latin. In this case it is "Berodual". The inhalation bottle contains 15 ml of medication. This volume is written immediately after the name.

The required quantity is indicated on the second line: “DtdN”. This generally accepted abbreviation literally stands for “give out in quantity.” This abbreviation is derived from the Latin phrase: “Da tales doses numero.” After this, the number of containers is indicated. Here – 1.

The next line indicates the purpose of “designate”, from the word Signa. In a recipe, the signature describes the process of consumption.

Description of the drug prescription for use in a nebulizer

Please note that the Latin recipe for Beroduala for inhalation using a portable inhaler and a nebulizer are different.

An example recipe for use in a nebulizer is as follows:

• Rp.: Sol. "Berodual" 20 ml
• DS Inhale 3 times a day using a nebulizer,

For each inhalation, dilute 20 drops of solution in 3 ml of 0.9% sodium chloride.

It is according to this prescription that the drug will be dispensed by the pharmacist. The beginning of the prescription is the same as for the inhaler - Rp.

Since the dosage form is a solution, this is reflected in the recipe by the wording “Sol.” This abbreviation is derived from the word Solutions, which in translation means “solution”, and then the name of the drug in Latin is indicated - Berodual and the container.

After this, the second line, starting with “DS”, describes this mandatory condition, the direct purpose - the frequency of doses and the procedure for using the solution form. Since the nebulizer requires dilution of Berodual with sodium chloride, this circumstance is also reflected in the prescription, taking into account the required amount of each product.

Important! For each patient, the doctor makes an individual prescription.

Berodual in Latin is prescribed by a doctor. The method of use of the product depends on the form of release and purpose.