- July 11, 2022
- Newsletter
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Background
Epidemiology
Anatomy
Pathophysiology
Etiology
Genetics
Prognostic Factors
Clinical History
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Medication
20
mg
inhaled by nebulizer twice a day
or
1 or 2 capsules inhaled every 12 hours (Do not exceed 4 capsules/day)
15
mcg
oral inhalation twice a day
1 capsule (75 mcg) is inhaled once a day
Nebulization solution: 0.63 mg to 1.25mg oral inhalation every 1 hour for 2 to 3 doses or as needed
Metered-dose inhaler: 1 to 2 oral inhalations every 1 hour for 2 to 3 doses or as needed
Inhaler:
2
actuations
every 6 hrs
Do not exceed 12 actuations per day
Nebulizer: 2.5 mL every 6-8hours
MD:
1 - 1
mcg/m²
Capsules
Aerosol
3 times a day
1 - 1
minutes
CM
Dose Adjustments
AD
500
mcg
Tablet
Orally
once a day
4
weeks
Inhalation mouth spray:
Mouth spray
Inhalation
Each actuation=2.5mcg tiotropium(3.124mcg tiotropium bromide monohydrate) and 2.5mcg olodaterol(2.736mcg olodaterol hydrochloride
Chronic obstructive pulmonary disorder
Two inhalations orally every day at the same time
200
mg
Orally
every 12 hrs
10
days
Note: It is indicated for Acute Bronchitis & Acute Exacerbation of Chronic Bronchitis
glycopyrrolate inhaled and formoterol
Mouth spray
Orally inhaled
twice a day
Two inhalations (Formoterol 18mcg/ Glycopyrrolate inhaled 9 mcg for each inhalation)
Do not exceed two inhalations per day
Mild/moderate/severe:
875
mg
every 12 hrs or 500mg every 8hrs
Acute exacerbation:
500 mg oral tablet immediate release every 12 hours for 5 to 7 days
Note: Not recommended for with risk infection of Pseudomonas
chronic exacerbation
:
400mg orally/intravenous every day for five days
320mg orally every day for five days
One inhalation orally twice a day. Do not exceed one inhalation per day
Indicated for Acute Exacerbations of Chronic Bronchitis:
400
mg/day
Orally
Single dose or divided every 12hr
Aerosol Metered dose inhaler
1 to 2 inhalations in 2-3 doses every hour, then every 2 to 4 hours
In the case of mild/moderate infections: 500 mg orally every 12 hours or 400 mg intravenously every 12 hours for 7-14 days
In the case of severe/complicated infections: 750 mg orally every 12 hours or 400 mg intravenously every 8 hours for 7-14 days
Limitations for usage: Reserve the fluoroquinolones for patients who are voided of available treatment options for chronic bronchitis
A dose of 500 mg orally every 12 hours or 250 mg orally every 6 hours is indicated in chronic bronchitis infection
3 days of 500 mg orally every day OR Instead, take 500 mg orally in a single dosage on Day 1, then 250 mg orally every day from Days 2 to 5
Indicated for Cancer, skin sores, asthma, bronchitis :
4 mg of flower tops orally three times a day
Or
4 gm of flower tops in 150 ml of water;1 cup of tea orally three times a day
Or
1.5-3 ml of liquid extract orally three times a day;1:1 in 25% alcohol
1-2 ml of tincture orally three times a day;1:10 in 45% alcohol
Indicated for Cancer, skin sores, asthma, bronchitis :
4 mg of flower tops orally three times a day
Or
4 gm of flower tops in 150 ml of water;1 cup of tea orally three times a day
Or
1.5-3 ml of liquid extract orally three times a day;1:1 in 25% alcohol
1-2 ml of tincture orally three times a day;1:10 in 45% alcohol
Exacerbation of chronic bronchitis by acute bacteria Take 400 mg orally after every 12 hours up to 10 days
inhaling 400 mcg (1 puff) orally two times daily
Using a mouthpiece on a nebulizer, inhale 175 mcg orally every day
Administer every day at the same time
Do not exceed 175mg daily once
Dose Adjustments
Renal impairment
Any level of impairment: No change in dose is necessary.
Patients with COPD with substantial renal impairment should be monitored for systemic antimuscarinic side effects.
Hepatic impairment
Mild-to-severe: Safety has not been determined; individuals with any degree of hepatic impairment are not recommended
It is indicated in the maintenance of bronchospasm that is linked to COPD, helping in COPD exacerbations
Spiriva Handihaler- 2 inhalations from a capsule orally each day through the HandiHaler device
Spiriva Respimat- 2 actuation of 2.5 mcg each, inhaled orally daily
indacaterol, inhaled/glycopyrrolate inhaled
Indicated for long-term maintenance of COPD
Inhale the contents orally through one capsule every 12 hours by a neo haler device
umeclidinium bromide/vilanterol inhaled
Indicated for long-term maintenance of COPD that includes emphysema and chronic bronchitis
62.5 mcg/25mcg as one actuation inhaled orally each day
Do not exceed more than one inhalation each day
budesonide inhaled/formoterol/glycopyrrolate inhaled
2 inhalations orally two times daily
Dosage Modifications
Renal impairment
Study not carried out
Study not carried out
Dosing Considerations
Limitations of use: Not suggested for in acute bronchospasm
Aerosol: Administer 100 mcg/20 mcg (1 metered-dose inhaler actuation) every six hours
Do not exceed more than six actuations daily.
Nebulizer: Administer 3ml inhalation every 6 hours.
Do not exceed 3ml every 4 hours.
(off-label):
By using a dry powder inhaler, The administration of batefenterol at a dose of 300 µg for a duration of 42 days
Note: The dosage of 300 µg of batefenterol could be considered as the most suitable for clinical trials (phase III)
Indicated as mucolytic agent:
Administer 750 mg to 2.25 g daily in three to four divided doses
Take a dose of 20 mcg orally two times a day
Daily dose should not be more than 60 mcg
Inhaled a dose of 20 mcg up to 4 times daily
Indicated for Chronic bronchitis
400 mg to 600 mg orally one time a day for nearly 10 days
Community-acquired pneumonia
600 mg orally one time a day for nearly 10 days
Uncomplicated gonorrhea
400 mg orally one time
Cervicitis or Nongonococcal urethritis
400 mg orally one time a day for nearly 7 days
For one week, take 400 mg two times a day by oral route
Mild/moderate/severe :
45 mg/kg daily divided in doses for every 12hrs or 40 mg/kg per day in divided doses for every 8hrs
Indicated as mucolytic agent:
Children 12 to under 15 years: Administer 100 to 750 mg thrice daily.
Children 6 to 11 years: Administer 100 to 250 mg thrice daily.
Children 2 to 5 years: Administer 100 mg twice or 62.5mg 125mg four times daily.
Future Trends
References
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20
mg
inhaled by nebulizer twice a day
or
1 or 2 capsules inhaled every 12 hours (Do not exceed 4 capsules/day)
15
mcg
oral inhalation twice a day
1 capsule (75 mcg) is inhaled once a day
Nebulization solution: 0.63 mg to 1.25mg oral inhalation every 1 hour for 2 to 3 doses or as needed
Metered-dose inhaler: 1 to 2 oral inhalations every 1 hour for 2 to 3 doses or as needed
Inhaler:
2
actuations
every 6 hrs
Do not exceed 12 actuations per day
Nebulizer: 2.5 mL every 6-8hours
MD:
1 - 1
mcg/m²
Capsules
Aerosol
3 times a day
1 - 1
minutes
CM
Dose Adjustments
AD
500
mcg
Tablet
Orally
once a day
4
weeks
Inhalation mouth spray:
Mouth spray
Inhalation
Each actuation=2.5mcg tiotropium(3.124mcg tiotropium bromide monohydrate) and 2.5mcg olodaterol(2.736mcg olodaterol hydrochloride
Chronic obstructive pulmonary disorder
Two inhalations orally every day at the same time
200
mg
Orally
every 12 hrs
10
days
Note: It is indicated for Acute Bronchitis & Acute Exacerbation of Chronic Bronchitis
glycopyrrolate inhaled and formoterol
Mouth spray
Orally inhaled
twice a day
Two inhalations (Formoterol 18mcg/ Glycopyrrolate inhaled 9 mcg for each inhalation)
Do not exceed two inhalations per day
Mild/moderate/severe:
875
mg
every 12 hrs or 500mg every 8hrs
Acute exacerbation:
500 mg oral tablet immediate release every 12 hours for 5 to 7 days
Note: Not recommended for with risk infection of Pseudomonas
chronic exacerbation
:
400mg orally/intravenous every day for five days
320mg orally every day for five days
One inhalation orally twice a day. Do not exceed one inhalation per day
Indicated for Acute Exacerbations of Chronic Bronchitis:
400
mg/day
Orally
Single dose or divided every 12hr
Aerosol Metered dose inhaler
1 to 2 inhalations in 2-3 doses every hour, then every 2 to 4 hours
In the case of mild/moderate infections: 500 mg orally every 12 hours or 400 mg intravenously every 12 hours for 7-14 days
In the case of severe/complicated infections: 750 mg orally every 12 hours or 400 mg intravenously every 8 hours for 7-14 days
Limitations for usage: Reserve the fluoroquinolones for patients who are voided of available treatment options for chronic bronchitis
A dose of 500 mg orally every 12 hours or 250 mg orally every 6 hours is indicated in chronic bronchitis infection
3 days of 500 mg orally every day OR Instead, take 500 mg orally in a single dosage on Day 1, then 250 mg orally every day from Days 2 to 5
Indicated for Cancer, skin sores, asthma, bronchitis :
4 mg of flower tops orally three times a day
Or
4 gm of flower tops in 150 ml of water;1 cup of tea orally three times a day
Or
1.5-3 ml of liquid extract orally three times a day;1:1 in 25% alcohol
1-2 ml of tincture orally three times a day;1:10 in 45% alcohol
Indicated for Cancer, skin sores, asthma, bronchitis :
4 mg of flower tops orally three times a day
Or
4 gm of flower tops in 150 ml of water;1 cup of tea orally three times a day
Or
1.5-3 ml of liquid extract orally three times a day;1:1 in 25% alcohol
1-2 ml of tincture orally three times a day;1:10 in 45% alcohol
Exacerbation of chronic bronchitis by acute bacteria Take 400 mg orally after every 12 hours up to 10 days
inhaling 400 mcg (1 puff) orally two times daily
Using a mouthpiece on a nebulizer, inhale 175 mcg orally every day
Administer every day at the same time
Do not exceed 175mg daily once
Dose Adjustments
Renal impairment
Any level of impairment: No change in dose is necessary.
Patients with COPD with substantial renal impairment should be monitored for systemic antimuscarinic side effects.
Hepatic impairment
Mild-to-severe: Safety has not been determined; individuals with any degree of hepatic impairment are not recommended
It is indicated in the maintenance of bronchospasm that is linked to COPD, helping in COPD exacerbations
Spiriva Handihaler- 2 inhalations from a capsule orally each day through the HandiHaler device
Spiriva Respimat- 2 actuation of 2.5 mcg each, inhaled orally daily
indacaterol, inhaled/glycopyrrolate inhaled
Indicated for long-term maintenance of COPD
Inhale the contents orally through one capsule every 12 hours by a neo haler device
umeclidinium bromide/vilanterol inhaled
Indicated for long-term maintenance of COPD that includes emphysema and chronic bronchitis
62.5 mcg/25mcg as one actuation inhaled orally each day
Do not exceed more than one inhalation each day
budesonide inhaled/formoterol/glycopyrrolate inhaled
2 inhalations orally two times daily
Dosage Modifications
Renal impairment
Study not carried out
Study not carried out
Dosing Considerations
Limitations of use: Not suggested for in acute bronchospasm
Aerosol: Administer 100 mcg/20 mcg (1 metered-dose inhaler actuation) every six hours
Do not exceed more than six actuations daily.
Nebulizer: Administer 3ml inhalation every 6 hours.
Do not exceed 3ml every 4 hours.
(off-label):
By using a dry powder inhaler, The administration of batefenterol at a dose of 300 µg for a duration of 42 days
Note: The dosage of 300 µg of batefenterol could be considered as the most suitable for clinical trials (phase III)
Indicated as mucolytic agent:
Administer 750 mg to 2.25 g daily in three to four divided doses
Take a dose of 20 mcg orally two times a day
Daily dose should not be more than 60 mcg
Inhaled a dose of 20 mcg up to 4 times daily
Indicated for Chronic bronchitis
400 mg to 600 mg orally one time a day for nearly 10 days
Community-acquired pneumonia
600 mg orally one time a day for nearly 10 days
Uncomplicated gonorrhea
400 mg orally one time
Cervicitis or Nongonococcal urethritis
400 mg orally one time a day for nearly 7 days
For one week, take 400 mg two times a day by oral route
Mild/moderate/severe :
45 mg/kg daily divided in doses for every 12hrs or 40 mg/kg per day in divided doses for every 8hrs
Indicated as mucolytic agent:
Children 12 to under 15 years: Administer 100 to 750 mg thrice daily.
Children 6 to 11 years: Administer 100 to 250 mg thrice daily.
Children 2 to 5 years: Administer 100 mg twice or 62.5mg 125mg four times daily.
Founded in 2014, medtigo is committed to providing high-quality, friendly physicians, transparent pricing, and a focus on building relationships and a lifestyle brand for medical professionals nationwide.
USA – BOSTON
60 Roberts Drive, Suite 313
North Adams, MA 01247
INDIA – PUNE
7, Shree Krishna, 2nd Floor, Opp Kiosk Koffee, Shirole Lane, Off FC Road, Pune 411004, Maharashtra
Founded in 2014, medtigo is committed to providing high-quality, friendly physicians, transparent pricing, and a focus on building relationships and a lifestyle brand for medical professionals nationwide.
MASSACHUSETTS – USA
60 Roberts Drive, Suite 313,
North Adams, MA 01247
MAHARASHTRA – INDIA
7, Shree Krishna, 2nd Floor,
Opp Kiosk Koffee,
Shirole Lane, Off FC Road,
Pune 411004, Maharashtra
