Nebulizers administration

Because all inhaled corticosteroids are equally effective if given in equipotent doses, product selection should be individualized based on the available dosage form, delivery device, and patient preference. In infants, administration may require the use of a nebulizer or spacer/holding chamber with a facemask. Caregivers should use a soft, damp cloth to wipe the face of infants receiving an inhaled corticosteroid via a facemask to prevent topical candidiasis.18... 

Inhaled tobramycin (TOBI ) is typically administered to patients 6 years of age and older in alternating 28-day cycles of 300 mg nebulized twice daily, followed by a 28-day washout or off period to minimize development of resistance. Longterm intermittent administration improves pulmonary function, decreases microbial burden, and reduces the need for hospitalization for IV therapy.24,25 Due to minimal systemic absorption, pharmacokinetic monitoring is not necessary with normal renal function. Lower doses of nebulized tobramycin solution for injection have been used in younger children, and studies are underway using 300 mg twice daily in children under age 6. 

The use of the aerosol route for delivery of antibiotics for pulmonary infections remains controversial. The majority of pediatric studies have been conducted in children with cystic fibrosis. In these patients distribution of the antibiotic to the desired tissue site is impeded because of the viscosity of the sputum in patients with acute exacerbations of their pulmonary infections [91,92], Long-term studies have demonstrated preventive benefits of aerosolized antibiotics in children with cystic fibrosis who are colonizing Pseudomonas aeruginosa in their lungs but are not acutely ill [93,94], Cyclic administration of tobramycin administered by nebulizer has received FDA approval [95],... 

Administration via metered-dose inhaler (MDI) or dry-powder inhaler is at least as effective as nebulization therapy and is usually favored for reasons of cost and convenience. Refer to Table 80-1 in Chap. 80 for a comparison of the available agents. 

Many technicians may not be famihar with terms such as sublingual (under the tongue), buccal (between the cheek and gingiva), otic, and so on. A clear description of each of these nontraditional routes (i.e., other than gavage routes) should be discussed with technicians, and instructions may also be written down and given to them. Demonstrations are often useftd to illustrate selected techniques of administration (e.g., to use an inhaler or nebulizer). Some chemicals must be placed by technicians into body orifices (e.g., medicated intrauterine devices such as Proges-terset). 

A number of means may be used to administer materials nasally, nebulizers and aerosol pumps being the most attractive first choices. Accurate dose administration requires careful planning, evaluation of the administration device, and attention to technique. 

Two variables, the concentration of LSD-25 in the nebulizer and the inspiration time were varied. Experiments indicated that this technique of changing the response in this type of experiment has some validity. Table II summarizes the experiments. These preliminary experiments indicated to the writer tiiat the response of a well-tested subject was fairly regular since with a given dose of40,000 mcg-seconds (calculated administration of 56 meg) severe... 

Administration Iloprost is intended for inhalation administration only via the Prodose AAD system, a pulmonary drug delivery device. It has not been studied with any other nebulizers. 

May be administered via aerosol or bulb nebulizer or IPPB administration. 

Budesonide respules - Administer by the inhaled route via jet nebulizer connected to an air compressor in asthmatic patients 12 months to 8 years of age. Improvement in asthma control following inhaled administration of budesonide can occur within 2 to 8 days of initiation of treatment, although maximum benefit may not be achieved for 4 to 6 weeks. It is desirable to downward-titrate to the lowest effective dose once asthma stability is achieved. In symptomatic children not responding to nonsteroidal therapy and in patients who require maintenance therapy of their asthma, a starting dose of 0.25 mg once daily may also be considered. 

Ultrasonic nebulizers are not suitable for the adequate administration of budesonide respules and therefore, are not recommended. The effects of mixing budesonide respules with other nebulizable medications has not been adequately assessed administer separately in the nebulizer. 

Nebulization (tent, croupette) Very large volumes are required, occasionally up to 300 mL during a treatment period. The dose is the volume of solution that will maintain a very heavy mist in the tent or croupette for the desired period. Administration for intermittent or continuous prolonged periods, including overnight, may be desirable. 

Reconstitution-The contents of 1 vial must be dissolved in 6 mL Sterile Water for Injection, LISP. It is important to use only sterile water saline solution will cause the drug to precipitate. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration. Do not mix the pentamidine solution with any other drugs. 

Zanamivir (2) is a potent competitive inhibitor of viral neuraminidase glycoprotein, which is essential in the infective cycle of both influenza A and B viruses. It inhibits a wide range of influenza A and B types in vitro as well as in vivo. The concentrations of inhibiting in vitro plaque formation of influenza A and B virus by 50% in Madin-Darby canine kidney (MDCK) cells were 0.004-0.014 p.mol/L in laboratory-passaged strains, and 0.002-16 p.mol/L in assays of clinical isolates. Due to its low bioavailability, it is delivered by inhalation via the Diskhaler , 10 mg twice daily, or intranasally 2-4 times daily for 5 days. After an intravenous dose of 1 -16 mg, the median elimination half-life was ti/2 = 7 h, the volume of distribution at steady state was Vdss = 16 L, and 90% of the dose was excreted unchanged in the urine. After intranasal and inhaled (dry powder) administration, maximum serum concentrations occurred within 2h and the terminal phase half-lives were 3.4 and 2.9 h, respectively. The bioavailabilities were 10 and 25%, respectively, and 20% after inhalation of zanamivir (2) by nebulizer. 

Route of administration Pulmozyme is administered by inhalation of an aerosol mist produced by a compressed-air-driven nebulizer system. 

Recommended dosage and monitoring requirements The recommended dose of Pulmozyme in most cystic hbrosis patients is 2.5 mg, inhaled once daily using a recommended nebuhzer. Some patients, however, especially those over 21 years old or with an FVC greater than 85%, may beneht from twice daily administration. Pulmozyme should not be diluted or mixed with other agents in the nebulizer. 

Albuterol, terbutaline, metaproterenol, and pirbuterol are available as metered-dose inhalers. Given by inhalation, these agents cause bronchodilation equivalent to that produced by isoproterenol. Bronchodilation is maximal within 15-30 minutes and persists for 3-4 hours. All can be diluted in saline for administration from a hand-held nebulizer. Because the particles generated by a nebulizer are much larger than those from a metered-dose inhaler, much higher doses must be given (2.5-5.0 mg versus 100-400 meg) but are no more effective. Nebulized therapy should thus be reserved for patients unable to coordinate inhalation from a metered-dose inhaler. 

In addition to oral administration for hepatitis C infection in combination with interferon alfa, aerosolized ribavirin is administered by nebulizer (20 mg/mL for 12-18 hours per day) to children and infants with severe respiratory syncytial virus (RSV) bronchiolitis or pneumonia to reduce the severity and duration of illness. Aerosolized ribavirin has also been used to treat influenza A and infections but has not gained widespread use. Systemic absorption is low (< 1%). Aerosolized ribavirin is generally well tolerated but may cause conjunctival or bronchial irritation. Health care workers should be protected against extended inhalation exposure. The aerosolized drug may precipitate on contact lenses. 

Xopenex (levalbuterol HC1) inhalation solution is supplied in unit-dose vials and requires no dilution before administration by nebulization. Each 3-mL unit-dose vial contains either 0.63 mg of levalbuterol (as 0.73 mg of leval-... 

For nebulizer and other aqueous aerosol products that use suspension systems, excipients are used to influence particle physical and chemical stability (e.g., microcrystalline cellulose for nasal sprays). The suitability of the physicochemical properties of these critical excipients should be thoroughly investigated and documented (12). Far more excipients have been included in formulations designed for nasal administration (Table 4). 

Corticosteroids remain the main hallmark for the treatment of allergic disease/ asthma despite their adverse side effects. Although their administration via inhalers and nebulizers has alleviated some concerns because of their less detrimental side... 

In addition to oral administration for hepatitis C infection in combination with interferon alfa (see above), aerosolized ribavirin is administered by nebulizer (20 mg/mL for 12-18 hours per day for... 

Later, Lizio et al. [78] used a new aerosol delivery system (ASTA-ADS) to investigate the pulmonary absorption and tolerability of four different cetrorelix formulations delivered as nebulized aerosols to orotracheally cannulated rats. After only 5 min exposure to the cetrorelix aerosol, serum testosterone concentrations were reduced to subnormal levels over a 24-h period. After dose adjustment (dose delivered minus exhaled amount), the bioavailabilities for pulmonary delivery ranged from 48.4 27.0% to 77.4 44.0% compared to IV administration. In addition, the lung function parameters did not reveal any formulation-related changes. Overall, the results of cetrorelix aerosol administration compared well with those obtained with intratracheal instillation of cetrorelix solution [77]. 

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