Aerocort Inhaler 50 mcg + 50 mcg

About brand name of the drug

Aerocort inhaler is one of the branded product of Cipla, India. It consists of beclomethasone dipropionate and levosalbutamol in the dosage strength of 50 + 50 mcg. The combination of these two drugs is used in the treatment of asthma. The product is available in the USA market with the similar brand name, i.e., aerocort inhaler. The packaging of the product comes in the form of 200 doses of inhalation. The combination is FDA approved and can be purchased only with the prescription of a registered medical practitioner. The patient can purchase the inhaler from drug stores, hospital pharmacies, and e-pharmacies.  

About the drug 

Levosalbutamol and beclomethasone dipropionate the active pharmaceutical ingredients of the formulation have different therapeutic action in the treatment of asthma. Levosalbutamol is the active (R)- enantiomer of racemic salbutamol which belongs to the beta-2 agonist category of drugs. It works as a bronchodilator. Beclomethasone dipropionate belongs to glucocorticoid category of drugs. It possesses potent anti-inflammatory properties. It also contains weak mineralocorticoid properties. The combination of salts are suspended in the propellant HFA-134a. Propellant helps in the upward movement of molecules when the patient inhales the drug. Metered dose inhalers benefit in the term of delivery of the exact quantity of drugs into the lungs.  

About salt of the drug

The two salts of aerocort inhaler show additive effects. Levosalbutamol smoothens the air flow from the trachea to the terminal bronchioles, i.e., covers the whole air passage. Patients suffering from asthma face inflammation in the chest and lungs along with the shortness of breath. Therefore, administration of a corticosteroid along with bronchodilator is considered necessary. Corticosteroids prevent inflammation by inhibiting inflammatory cells (mast cells, eosinophils, basophils, lymphocytes, etc.) as well as inhibiting the release of inflammatory mediators (histamine, eicosanoids, leukotrienes, etc.). Beclomethasone dipropionate shows its action after conversion into beclomethasone 17 monopropionate before absorption into the lungs. 17-BMP shows more significant affinity to receptors over its substitutes such as 13 times of dexamethasone, 1.5 times of budesonide, and 25 times of BDP.

Medical Uses of the drug

Aerocort inhaler is used to treat a medical disorder of asthma and chronic obstructive pulmonary disease. It is available in the dosage form of an aerosol inhaler.

• Asthma: The combination is used in the long term management of symptoms of shortness of breath, chest tightening, wheezing, cough, etc. Its use is restricted in the acute attack of asthma.
• Chronic obstructive pulmonary disease: It is used to prevent as well as treat the symptoms of COPD such as shortening of breath, difficulty in breathing, wheezing, etc. A COPD patient suffers from mucus forming cough. The medication is especially useful for patients suffering from frequent symptoms of COPD.

Working of a drug 

• The drugs act on to the beta-2 adrenergic receptors present on the smooth muscles of the air passage. This activates adenylyl cyclase and increases the concentration Of cyclic AMP. The increase in cyclic AMP will activate protein kinase A; this will inhibit phosphorylation of myosin and lower down intracellular calcium concentration. Lowering of calcium amount will cause muscle relaxation. This is how levosalbutamol cause bronchodilation.
• Beclomethasone dipropionate prevents inflammation in the airway by binding on glucocorticoid receptors. Hence, the absorption of the drug occurs through the lungs. Because of this amount of drug reaches less in quantity in systemic circulation than when the drug is taken orally. 
• The drug can be inhaled with the help of a spacer for the patients who face difficulty in synchronizing inspiration of breath with aerosol actuation. It takes 15 minutes for the medication to its initiate its effect and lasts for 15 hours.

Side effects 

Side effects observed with the use of aerocort inhaler are:

• Paradoxical bronchospasm: in such situation levosalbutamol should be stopped immediately and choose an alternative.
• Cardiovascular effects: drug particles may react on to the beta-2 receptors present on the cardiac muscles. It may bring changes in electrogram studies of a patient such as increased heartbeat, hypertension, etc.
• Hypokalemia: decrease in potassium content of the plasma due to intracellular shunt
• Fungal infections: chances of local infections with Candida albicans in the mouth and pharynx increases on the use of corticosteroids
• Hypersensitivity: allergic reactions such as rashes, urticaria, angioedema, bronchospasm, etc.
• Reduction in bone mineral density: long term administration of corticosteroids causes a decrease in BMD.
• Eye problems: glaucoma, blurred vision, cataract, etc. on long term use of corticosteroids
• Psychiatric & behavioral changes: aggression, mood swings, depression, overthinking, suicidal changes

How to use 

• Sit/stand straight. Breath out air. Keep the inhaler between your teeth and seal with lips. Start breathing in. During breathing, suppress the canister. When lungs are full of air, remove the canister, hold your breath and count for 1 to 10. Release the air. Take the gap of 1 min if advised for more than one puff. Gargle your mouth with water after use.
• The drug should be taken with or without food.
• Missed dose: take the dose when it reminds you. If it is already the time for the next dose, the earlier missed dose can be skipped.
• Overdose: overdose of levosalbutamol may cause worsening of its side effects or even cardiac arrest whereas overdose of BDP may cause adrenal suppression.

Drugs that are known to interact with this medicine

The category of drugs which can interact with this bronchodilator combination are:

• Beta-2 agonists: concomitant use of short-acting bronchodilators (epinephrine) with levosalbutamol may cause a severe effect on heart tissues.
• Diuretics: use of non-sparing diuretics such as loop and thiazide diuretics with beta-2 agonists may worsen the condition of hypokalemia.
• Antidepressants: monoamine oxidase inhibitors or tricyclic antidepressants may potentiate the effect of levosalbutamol.

When to avoid taking the drug

Avoid the use of aerocort inhaler in the following conditions:

• Acute asthma attacks: use of BMP is not allowed in the acute episodes of asthma. In medical terms, this condition is called as status asthmaticus.
• Acute tuberculosis: use of BMP is not permitted in the acute stages of tuberculosis.
• Hypersensitivity/Allergy: when the patient is allergic to any of the component of the formulation. 

Things to avoid when using the drug

• Pediatrics use: Inhaled corticosteroids may retard the growth on long term use. Hence, their use is not considered safe in children below 4 years of age.
• Self-medication: The use of aerocort inhaler in patients who have co-existing conditions such as cardiac arrhythmia, hyperthyroidism, diabetes mellitus, etc. may prove dangerous. Use the inhaler in a fair manner and follow the guidelines described by your doctor.

General Information and Precautions

• Wash the spacer after 3-4 times usage.
• Keep the inhaler in stock. Keep a check on the no. of doses left.

Precautions

• Pregnancy- no sufficient evidence of the safety of usage of the drug in pregnant ladies have been reported yet.
• Driving - it does not cause sleepiness. Driving or other machine operating works can be done without hesitation.
• lactation - no evidence of secretion of drug metabolites into the mother’s milk has been reported yet. But the use of combination is still not considered safe.
• Status asthmaticus: use of a separate levosalbutamol inhaler is necessary in case of acute attacks of asthma.
• Steroid-dependent patients: such patients require an independent steroid based inhaler for their therapy.
• Patients transferred from systemic corticosteroid therapy: Systemic therapy suppress hypothalamic-pituitary-adrenal (HPA) function. Special care is needed to prevent adrenal insufficiency.
• Immunosuppression: patients on treatment of immunosuppressants are more prevalent to infections, especially chicken pox and measles. So, use the inhaler cautiously.

Storage

• Store the drug at below 30-degree celsius
• Do not freeze
• Keep the medicine out of reach from the kids and pets

General FAQs regarding the drug

Does the use of steroid inhaler cause white patches in the mouth?

Ans. Yes, the long term usage of corticosteroids in the form of inhalation can form white patches in the mouth over inside portion of the tongue.

Does aerocort inhaler administer the same quantity of drug in every puff?

Ans. Yes, it is a metered dose inhaler. A measured quantity of drugs reaches the lungs with every puff.

Can the use of drug be stopped abruptly without the knowledge of the doctor?

Ans. No, the use of bronchodilators and steroids cannot be stopped immediately without consulting with the doctor. It may cause withdrawal symptoms in the body.