Alupent (Orciprenaline Sulfate)
Orciprenaline powder is a bronchodilating agent. The bronchospasm associated with various pulmonary diseases – chronic bronchitis, pulmonary emphysema, bronchial asthma, silicosis, tuberculosis, sarcoidosis and carcinoma of the lung, has been successfully reversed by therapy with orciprenaline.
Orciprenaline has the following major characteristics: The action of orciprenaline is one of beta stimulation. Receptor sites in the bronchi and bronchioles are more sensitive to the drug than those in the heart and blood vessels, so that the ratio of bronchodilating to cardiovascular effects is favorable. Consequently, it is usually possible clinically to produce good bronchodilation at dosage levels which are unlikely to cause cardiovascular side effects.
The efficacy of the bronchodilator after both oral and inhalation administration has been demonstrated by pulmonary function studies (spirometry, and by measurements of airways resistance by body plethysmography).Rapid onset of action follows administration of orciprenaline inhalants, and the effect is usually noted immediately. Following oral administration, the effect is usually noted within 30 minutes.The peak effect of bronchodilator activity following orciprenaline generally occurs within 60 to 90 minutes, and this activity lasts for 3 to 6 hours.Orciprenaline taken orally potentiates the action of a bronchodilator inhalant administered 90 minutes later, whereas no additive effect occurs when the drugs are given in reverse order.
Patients have not developed tolerance to the drug during prolonged therapy.No toxic effects on the liver, kidneys or hematologic system have been reported in the long-term use of orciprenaline in man.Indications And Clinical Uses: Orciprenaline has been found useful in the following conditions: bronchial asthma, chronic bronchitis, pulmonary emphysema.Orciprenaline is also useful in sarcoidosis, silicosis, carcinoma of the lung and tuberculosis when bronchospasm contributes to the disability.
Patients with chronic airways obstructive disease require long-term therapy with bronchodilators as an essential part of overall management aimed at lowering airways resistance and facilitating bronchial drainage. Orciprenaline has been shown to fulfill the basic requirements of such continued therapy in that it is effective both orally and as an inhalant, has a rapid and prolonged action, and has a low incidence of side effects.
Inhalation Aerosol: The efficacy of orciprenaline administered as an aerosol has been demonstrated by increased flow rates (FEV1, MMFR, MEFR, MBC) decreased airways resistance (body plethysmography), and decreased functional residual capacity (body plethysmography).
In one study the effect of 4.5 mg of orciprenaline has been compared with the effect of 0.45 mg of isoproterenol each drug being given as an aerosol over a period of 8 minutes. Although the improvement in pulmonary function was consistently better with orciprenaline, 1 hour, 3 hours, and 6 hours following inhalation, changes in pulse rate and blood pressure were less pronounced with orciprenaline. This indicated a more favorable ratio of bronchodilating to cardiovascular effects for orciprenaline.
In another study, orciprenaline 2% solution, racemic epinephrine 2.25% and isoproterenol 1% were each administered as aerosols on separate days. The aerosols were administered by hand nebulizer for 30 minutes or until cardiovascular side effects appeared.
The immediate effect of orciprenaline on airways resistance in this study was similar to that produced by isoproterenol and by racemic epinephrine. However, the reduction in airways resistance after orciprenaline was significantly greater than that seen with isoproterenol in 30 minutes after inhalation, and after 90 minutes the effect of orciprenaline was superior to both isoproterenol and racemic epinephrine.
Whereas isoproterenol aerosol and epinephrine aerosol produced only transient reductions in the functional residual capacity of less than 30 minutes duration, the effect of orciprenaline on this parameter remained significant up to 90 minutes after inhalation.
Syrup: The efficacy of orciprenaline has been demonstrated by improvement of flow rates (FEV1, MMFR, MEFR) and airways resistance measurements (body plethysmography). Repeated measurements of pulmonary function made over a 4-hour period show that orciprenaline 20 mg orally gives a generally better result regarding duration of action and magnitude of response than placebo, 100 mg methoxyphenamine, 30 mg ephedrine by mouth, or 10 mg isoproterenol sublingually.
The effect of an inhalant bronchodilator may be potentiated by oral administration of 20 mg of orciprenaline 90 minutes prior to use of the inhalant. No additive effect occurs when the drugs are given in reverse order. The probable reason for this is that a bronchodilator delivered to the lungs via the vascular system (i.v. or oral medication) acts upon bronchioles whether or not they are occluded. Such an effect causes a wider distribution in the lungs of a subsequently given drug, and consequently the bronchodilation is more intense. Knowledge of this interaction is of value when instructing patients in the combined use of oral and inhalant forms of orciprenaline.
Orciprenaline may be given orally in dosages ranging from 60 to 120 mg daily. An effective clinical response in adults and children above 12 years can be achieved by 20 mg orciprenaline 3 times daily, and at this dosage side effects are not significantly different from those following placebo. Orciprenaline at a dosage of 20 mg 4 times daily is well tolerated and side effects are usually mild. Only at dosages of 100 mg daily and above, do palpitations and tremulousness become troublesome. If high doses of orciprenaline are necessary, it may be possible to eliminate the side effects whilst continuing the same total daily dose, by administering 10 mg single doses at more frequent intervals.
General: The low incidence of side effects together with effective bronchodilation make orciprenaline acceptable to patients with chronic bronchial asthma for continuous use either alone or concurrently with corticosteroids. Some of these patients may be controlled with orciprenaline as the sole medication, and it may be possible to avoid the use of steroid therapy. In a proportion of individuals who are already taking corticosteroids, it may be possible to withdraw this medication and continue with orciprenaline alone. However, caution should be observed in this regard as many patients, particularly those with severe bronchial asthma, can be managed satisfactorily only if steroids and bronchodilators are given together.
Prolonged studies have shown that patients with bronchitis and emphysema respond to continuous therapy with orciprenaline. The frequency and severity of acute attacks decrease, and patients experience relief of wheezing, chest congestion and shortness of breath. A close association is apparent between objective measurements of pulmonary function and the subjective response.
Contra-Indications: Known sensitivity to the drug or other sympathomimetic amines. The use of orciprenaline and other beta stimulators is generally considered to be contraindicated in patients with cardiac arrhythmias associated with tachycardia.Beta blocking agents, (e.g. propranolol) effectively antagonize the action of orciprenaline. Their concomitant use, except in the treatment of accidental overdosage, is therefore contraindicated.
The global market size of Tulobuterol hydrochloride is $XX million in 2018 with XX CAGR from 2014 to 2018, and it is expected to reach $XX million by the end of 2024 with a CAGR of XX% from 2019 to 2024.
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Raloxifene Hydrochloride Tablets
Raloxifene Hydrochloride Tablets, USP is indicated for the reduction in risk of invasive breast cancer in postmenopausal women at high risk of invasive breast cancer [see Clinical Studies (14.4)].
The effect in the reduction in the incidence of breast cancer was shown in a study of postmenopausal women at high risk for breast cancer with a 5-year planned duration with a median follow-up of 4.3 years [see Clinical Studies (14.4)]. Twenty-seven percent of the participants received drug for 5 years. The long-term effects and the recommended length of treatment are not known.
High risk of breast cancer is defined as at least one breast biopsy showing lobular carcinoma in situ (LCIS) or atypical hyperplasia, one or more first-degree relatives with breast cancer, or a 5-year predicted risk of breast cancer ≥1.66% (based on the modified Gail model). Among the factors included in the modified Gail model are the following: current age, number of first-degree relatives with breast cancer, number of breast biopsies, age at menarche, nulliparity or age of first live birth. Currently, no single clinical finding or test result can quantify risk of breast cancer with certainty.
After an assessment of the risk of developing breast cancer, the decision regarding therapy with Raloxifene Hydrochloride Tablets, USP should be based upon an individual assessment of the benefits and risks.
Raloxifene Hydrochloride Tablets, USP does not eliminate the risk of
breast cancer. Patients should have breast exams and mammograms before
starting Raloxifene Hydrochloride Tablets, USP and should continue
regular breast exams and mammograms in keeping with good medical
practice after beginning treatment with Raloxifene Hydrochloride
Tablets, USP.
For either osteoporosis treatment or prevention, supplemental calcium
and/or vitamin D should be added to the diet if daily intake is
inadequate. Postmenopausal women require an average of 1500 mg/day of
elemental calcium. Total daily intake of calcium above 1500 mg has not
demonstrated additional bone benefits while daily intake above 2000 mg
has been associated with increased risk of adverse effects, including
hypercalcemia and kidney stones. The recommended intake of vitamin D is
400 to 800 IU daily. Patients at increased risk for vitamin D
insufficiency (e.g., over the age of 70 years, nursing home bound, or
chronically ill) may need additional vitamin D supplements. Patients
with gastrointestinal malabsorption syndromes may require higher doses
of vitamin D supplementation and measurement of 25-hydroxyvitamin D
should be considered.
In clinical trials, raloxifene-treated women had an increased risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism). Other venous thromboembolic events also could occur. A less serious event, superficial thrombophlebitis, also has been reported more frequently with raloxifene than with placebo. The greatest risk for deep vein thrombosis and pulmonary embolism occurs during the first 4 months of treatment, and the magnitude of risk appears to be similar to the reported risk associated with use of hormone therapy. Because immobilization increases the risk for venous thromboembolic events independent of therapy, raloxifene should be discontinued at least 72 hours prior to and during prolonged immobilization (e.g., post-surgical recovery, prolonged bed rest), and raloxifene therapy should be resumed only after the patient is fully ambulatory. In addition, women taking raloxifene should be advised to move about periodically during prolonged travel. The risk-benefit balance should be considered in women at risk of thromboembolic disease for other reasons, such as congestive heart failure, superficial thrombophlebitis, and active malignancy [see Contraindications (4.1) and Adverse Reactions (6.1)].