Asmalin Special Precautions

Syrup: Paradoxical bronchospasm: Paradoxical bronchospasm, a potentially life-threatening event, has been observed with salbutamol. If it occurs, discontinue use of the product immediately.
Deterioration of asthma: Asthma may deteriorate acutely over a period of hours or chronically over several days or longer. Increased use of beta₂-agonists, especially daily use, is a sign of deterioration of asthma control and indicates the need to reassess treatment. Possible need for anti-inflammatory treatment (e.g., corticosteroids) should be considered.
Hypokalemia: Therapy with salbutamol and other beta₂-agonists may produce decrease in plasma potassium concentration possibly through intracellular shunting resulting in cardiovascular undesirable effects. Use with caution in acute severe asthma where concomitant therapy with steroid, xanthine derivatives, or diuretics, and by hypoxia may result in hypokalemia; potassium concentrations should be monitored in severe asthma.
Metabolic Effects: As with other beta₂-agonists, salbutamol can induce reversible metabolic changes (e.g., increased blood sugar levels). The diabetic patient may be unable to compensate for this; and thus, result in the development of ketoacidosis. Concomitant administration of corticosteroids can exaggerate this effect.
Coexisting Conditions: Use with caution in patients with the following conditions: Cardiovascular disorders including coronary insufficiency, cardiac arrhythmias, or hypertension: Salbutamol, like all other beta₂-agonists, can produce clinically significant cardiovascular effects such as changes in pulse rate or blood pressure; Convulsive disorders; Hyperthyroidism; Diabetes mellitus; In patients who are unusually responsive to sympathomimetic amines.
Pulmoneb: Patients should be advised that increased blood glucose has occurred after inhalation of Salbutamol via nebulization of higher than recommended doses of the drug. Use with caution in patients with the following conditions: Cardiovascular disorders including coronary insufficiency, cardiac arrhythmias or hypertension; Convulsive disorders; Hyperthyroidism; Diabetes mellitus; In patients who are unusually responsive to sympathomimetic amines.
Use with caution in acute severe asthma where concomitant therapy with steroid, xanthine derivatives, or diuretics, and by hypoxia may result in hypokalemia. Potassium concentrations should be monitored in severe asthma.
Therapy with Salbutamol and other beta₂-agonists may decrease plasma potassium concentration possibly through intracellular shunting resulting in cardiovascular adverse effects such as palpitation.