1. Medications for the respiratory system
Domina Petric, MD

2. Nose I.

3. Nasal decongestants for local use: SYMPATHOMIMETICS
xylometasolinum
oxymetasolinum
naphazolinum

4. Indications
acute rhinitis
allergic rhinitis
rhinosinusitis
otitis media
during endoscopic nasal procedures

5. Dose
For children from age 2 to age 7 there is usually a medication labeled for children.
For older children and adults the medication is labeled for adults.
Maximum dose is 2 drops or inhalations (if spray) in each nostril three times a day.
Maximum treatment duration is 5 days!

6. rhinitis sicca (atrophic rhinitis)
Contraindications
rhinitis sicca (atrophic rhinitis)
hypersensitivity
children under the age of 2 years

7. Nasal decongestants for local use: CORTICOSTEROIDS
fluticasonum
mometasonum
triamcinolonum
...

8. allergic rhinitis (sesonal, chronic)
Indications
allergic rhinitis (sesonal, chronic)

9. Dose
For the most of medications dose is two inhalations (if spray) or nose drops in each nostril once a day (in the morning) or maximum twice a day.
Most of medications are not recommended for small children (under the age of 3 to 6 years depending on the medication) and for children age 6 to 12 years, treatment duration should not be longer than 3 months maximum.
Older children and adults should use minimal effective dose in minimal treatment duration, but if necessary, treatment duration can be longer than 3 months.

10. Decongestives for oral use (tbl.)
Aerinaze: desloratadine + pseudophedrine sulphate
Recommended dose is one tbl. per os twice a day.
Maximum treatment duration is 10 days.
Contraindicated for children under the age of 12 years.
Other contraindications are hypersensitivity, MAO-inhibitors, narrow angle glaucoma, urinary retention, ishemic heart disease, tachyarrhythmias, severe arterial hypertension, hyperthyreosis, hemorrhagic cerebrovascular insult (in history or risk for developing one).

11. Antiasthmatic drugs
II.

12. Short acting beta-2 agonists +
Diagnosis
Daytime symptoms
<2 times a week
>2 times a week
Daily
Continous
Nightime symptoms
<2 times a month
>2 times a month
>5 times a month
Frequent
FEV1
>80%
60-80%
<60%
Type of asthma
Intermittent
Mild persistent
Moderate persistent
Severe persistent
Treatment
Short acting beta-2 agonists +
Low dose inhaled CS
Low to medium dose inhaled CS
High dose inhaled CS
Long acting beta-2 agonists
Oral steroid therapy

13. Inhalation selective beta-2 adrenergic medications
salbutamolum
salmeterolum
indacaterol maleate
formoterolum

14. Indications, dose and contraindications
First line treatment of asthma and for acute asthmatic attack.
Usually for children older than 4 years, adolescents and adults.
For children age 4 to 11 years, dose is one inhalation.
For adults, dose is two inhalations.
For children up to 12 years, maximum dose in chronic treatment is one inhalation up to four times a day.
For chronic treatment in adults and children older than 12 years, maximum dose is two inhalations four times a day.
Contraindications are hypersensitivity and risk for spontaneous abortion.

15. Inhalation drug combinations (adrenergics and corticosteroids)
salmeterol + fluticasone
budesonide + formoterolum
beclometasonum + formoterolum
...

16. Indications, dose and contraindications
Indicated for more severe forms of asthma.
Dose is usually two inhalations twice a day.
Contraindicated in children under the age of 4 years and in case of hypersensitivity.

17. Xanthine derivates
Theophyllinum

18. Teolin (teophyllinum) tbl. 125 mg, 200 mg, 300 mg and 350 mg
Indications are bronchial asthma, chronic obstructive pulmonary disease (COPD), bronchoconstriction in exertion.
Start dose for adults is 125 mg to 150 mg per os every 12 hours.
Every third day dose can be increased up to maximum 600 mg per os twice a day.
Usually the effective dose is 300 mg per os twice a day.
Contraindicated for children under the age of 6 years.
Dose for children age 6 to 12 years is 125 mg per os twice a day up to maximum two tbl. of 125 mg twice a day.

19. Leucotriene receptor antagonists: montelukast 4 mg, 5 mg or 10 mg tbl.
Indicated for more severe forms of asthma.
For children age ≥15 years and adults recommended daily dose is 10 mg per os at evening.
Contraindicated in children under the age of 15 and in the case of hypersensitivity.

20. Roflumilast 500 mcg
Indicated as maintenance therapy in case of severe COPD (FEV1<50%) in dose 500 mcg per os once a day.
Contraindications are children under the age of 18 years, moderate to severe liver damage and hypersensitivity.

21. Antihistaminic drugs
III.

22. Dimenhydrinatum (Dramina 50 mg)
For children age more than 5 years and adults: prevention of nausea, vomiting and vertigo in travel sickness and Menier´s disease.
Dose:
children 5-6 years old: 25 mg every 6-8 hours, maximum dose is 75 mg per os a day
children 7-14 years old: mg every 6-8 hours, maximum dose is 150 mg per os a day
children more than 14 years and adults: mg every 6 hours, maximum daily dose is 400 mg per os

23. Contraindications children under the age of 5 years hypersensitivity
acute asthmatic attack
narrow angle glaucoma
pheochromocytoma
porphiria
epilepsy
eclampsia
prostate hypertrophy

24. Fenistil oral drops 1 mg/mL
Indications:
pruritus caused with eczema, dermatoses, chicken pox, insect bites and urticaria
sesonal rhinitis
chronic allergic rhinitis
allergic reactions on food and drugs

25. Fenistil oral drops 1 mg/mL
Dose for children of one month to 12 years old: 0,1 mg/kg/day or 2 drops/kg/day divided in three doses.
20 drops is 1 mL (1mg).
Children older than 12 years and adults: 3-6 mg per os a day divided in three doses, means drops three times a day.
Contraindicated in children under one month and in case of hypersensitivity.

26. Other antihistaminics
desloratadinum (one tbl. per os a day)
loratadinum (one tbl. per os a day)
fexofenadinum
...

27. Literature
HALMED
MEDIATELY