Efamed/Efamed Plus Special Precautions

Efamed tablet/syrup: Salbutamol and nonselective B-blocking drugs like propranolol should not usually be prescribed together.
Efamed solution for nebulization: Salbutamol and other beta agonists should be given with caution in hyperthyroidism, myocardial insufficiency, arrythmias, susceptibility to QT- interval prolongation, hypertension, and diabetes mellitus (especially on intravenous use-blood glucose should be monitored since ketoacidosis has been reported).
In severe asthma particular caution is also required to avoid inducing hypokalemia as this effect may be potentiated by hypoxia or by the effect of other antiasthma drugs on potassium plasma-potassium concentrations should be monitored.
Beta 2 agonist such as salbutamol are not appropriate for use alone in the treatment of more than mild asthma. Increasing need for, or decreased duration of effect of, inhaled salbutamol and other short-acting beta 2 agonist indicates deterioration of asthma control and the likely requirement for increased anti-inflammatory therapy.
In women being treated for pre-mature labour the risk of pulmonary oedema means that the patient's state of hydration and cardiac and respiratory function should be monitored very carefully; the volume of infusion fluid should be kept to the minimum (normally using glucose 5% as the diluent), and beta 2-agonist therapy should be stopped immediately and diuretic therapy started if signs of pulmonary oedema develop other risk factors for pulmonary oedema include multiple pregnancy and heart disease. Ischaemic heart disease or significant risk factors for ischaemic heart disease are specific contraindications; where heart disease is suspected assessment by a physician experienced in cardiology is needed. Eclampsia and severe preeclampsia are also contraindications, with special care needed in mild to moderate pre-eclampsia. Other placenta praevia, and cord compression, beta 2 agonists should not be used for threatened miscarriage.
Efamed Plus tablet/syrup: Sympathomimetics may produce a wide range of adverse effects most of which mimic the results of excessive stimulation of the sympathomimetic nervous system. Clinically, this is manifested by confusion, irritability, tremor, insomnia and restlessness. Appetite may be reduced and nausea and vomiting may occur.
There may also be reflex bradycardia because of the stimulation of the beta 1 receptors of the heart. But often they cause tachycardia hypotension, palpitations and sudden death due to cardiac arrhythmias.
Salbutamol also is considered to possess mucolytic property. It is believed to act in the cilia of the respiratory tract and aside from bronchodilation can produce lysis of thick mucus.