Inhalants drug interactions

Mukherjee M, Pritchard DI, Bosquillon C (2012) Evaluation of air-interfaced Calu-3 cell layers for investigation of inhaled drug interactions with organic cation transporters in vitro. Int J Pharm 426(l-2) 7-14... 

Theophylline is also considered an alternative to inhaled corticosteroids for the treatment of mild persistent asthma however, limited efficacy compared to inhaled corticosteroids, a narrow therapeutic index with life-threatening toxicity, and multiple clinically important drug interactions have severely limited its use. Theophylline causes bronchodilation through inhibition of phosphodiesterase and antagonism of adenosine and appears to have anti-inflammatory and immunomodulatory properties as well.36... 

Theophylline is a non-specific phosphodiesterase inhibitor that increases intracellular cAMP within airway smooth muscle resulting in bronchodilation. It has a modest bronchodila-tor effect in patients with COPD, and its use is limited due to a narrow therapeutic index, multiple drug interactions, and adverse effects. Theophylline should be reserved for patients who cannot use inhaled medications or who remain symptomatic despite appropriate use of inhaled bronchodilators. 

Review of drug therapy (dosages, adherence, inhaler technique, effectiveness, adverse effects, and drug interactions)... 

Methylxanthines are no longer considered first-line therapy for COPD. Inhaled bronchodilator therapy is preferred over theophylline for COPD because of theophylline s risk for drug interactions and the interpatient variability in dosage requirements. Theophylline may be considered in patients who are intolerant or unable to use an inhaled bronchodilator. A methylxanthine may also be added to the regimen of patients who have not achieved an optimal clinical response to an inhaled anticholinergic and [i2-agonist. 

Eto, K., Y. Gomita, K. Furuno, K. Yao, M. Moriyama, and Y. Araki. Influences of cigarette smoke inhalation on pharmacokinetics of cimetidine in rats. DrugMetab Drug Interact 1991 9(2) 103-114. 

Drug interactions No formal drug interaction studies have been carried out. Clinical trials have indicated that Pulmozyme can be effectively and safely used in conjunction with standard cystic hbrosis therapies including oral, inhaled, and/or parenteral antibiotics, bronchodila-tors, enzyme supplements, vitamins, oral or inhaled corticosteroids, and analgesics. 

Drug Interactions Other antihypertensive agents Carbamazepine (vasodilators, ACE inhibitors, Rifampin diuretics, and beta-blockers) Phenobarbital Digoxin Cyclosporine Disopyramide Theophylline Flecainide Inhalation anesthetics Quinidine Neuromuscular blocking agents Cimetidine Lithium ... 

Drug interactions. Addition of 50% nitrous oxide/ oxygen mixture to another inhalational anaesthetic... 

The relative importance of many of the mediators is not precisely defined but they interact to produce mucosal oedema, mucus secretion and damage to the ciliated epithelium. Breaching of the protective epithelial barrier allows hyperreactivity to be maintained by bronchoconstrictor substances or by local axon reflexes through exposed nerve fibres. Wheezing and breathlessness result. The bronchial changes also obstruct access of inhaled drug to the periphery, which is why they can fail to give full relief. 

Inhalation drug products, also referred to as orally inhaled and nasal drug products (OINDPs including inhalation aerosols and solutions, nasal aerosols and sprays), have a high likelihood of packaging component-dosage form interaction,and therefore have individual USFDA guidance documents. As an example, consider the metered dose inhaler (MDI), shown... 

Figure 1 Fate of inhaled drugs depositing in the airways. Aerosolized compounds delivered to the lumenal surface of central (i.e., tracheobronchial) and peripheral (i.e., alveolus) airways may be subject to different pharmacokinetic pressures. The sites of loss of a drug in passage from the airway lumen to the site of therapeutic action in the central airways (e.g., smooth muscle) and peripheral airways (e.g., blood in pulmonary circulation) are depicted in upper and lower diagrams, respectively. In the central airways, a drug may (1) interact with the mucus layer, (2) be removed by the mucociliary escalator, (3) have restricted access through the epithelium and be biotransformed or be complexed by epithelium-associated...

Drug-drug iuteractions Ritonavir Inhaled fluticasone interacts with ritonavir, resulting in steroid accumulation, adrenal suppression, and even florid Cushing s syndrome. Fluticasone is metabolized by CYP3A4, which is inhibited by ritonavir. A systematic review of the hterature on adrenal suppression and Cushing s... 

Yoganathan K, David L, Williams C, Jones K. Cushing s syndrome with adrenal suppression induced by inhaled budesonide due to a ritonavir drug interaction in a woman with HIV infection. Int J STD AIDS 2012 23(7) 520-1. 

---