INHALEX

Indications

• Lactose intolerance
• As a filler or excipient in pharmaceutical formulations

Dosage

Children: Refer to the BNF for Children for specific dosing information based on age and clinical context.

Adults: Refer to the BNF for specific dosing information based on clinical context.

Mechanism of action

Lactose is metabolized in the intestine by the enzyme lactase into its constituent monosaccharides, glucose and galactose. In individuals with lactase deficiency, unabsorbed lactose passes into the colon, where it is fermented by bacteria, leading to gas production and osmotic effects that contribute to diarrhea.

Pharmacodynamics

The pharmacodynamics of lactose are primarily related to its effects on gastrointestinal function. In healthy individuals, lactose is effectively broken down into glucose and galactose, which are absorbed and utilized for energy. In individuals with lactose intolerance, the unabsorbed lactose can cause osmotic diarrhea and colonic fermentation, leading to discomfort and symptoms associated with lactose intolerance.

Pharmacokinetics

Lactose is not absorbed in the gastrointestinal tract until it is hydrolyzed into glucose and galactose by lactase. The absorption of glucose and galactose occurs in the small intestine. The half-life is not applicable as lactose is not typically administered as a medication but is rather ingested as a natural component of food. Its metabolism primarily occurs in the intestine.

Adverse effects

• Bloating
• Diarrhea
• Abdominal pain
• Flatulence

Precautions

• Use with caution in patients with lactose intolerance.
• Consider potential for gastrointestinal upset in sensitive individuals.

Pregnancy

Lactose is generally considered safe for use during pregnancy. However, consult a healthcare professional for individual advice.

Breast-feeding

Lactose is safe to use while breastfeeding, as it is a natural sugar present in breast milk.

Storage

Store in a cool, dry place, away from direct sunlight.

Formulations

• Powder
• Granules
• Tablets
• Syrup

Indications

• Maintenance treatment of chronic obstructive pulmonary disease (COPD)
• Severe asthma as an add-on therapy to inhaled corticosteroids and other controllers

Dosage

Children: For children aged 6-11 years: 5 micrograms once daily. For children aged 12-17 years, refer to BNF for Children for specific dosing guidance.

Adults: 1 capsule (18 micrograms) once daily by inhalation.

Mechanism of action

Tiotropium exerts its effects by selectively blocking the M3 muscarinic acetylcholine receptors in the bronchial smooth muscle. This blockade leads to relaxation of the bronchial muscles and dilation of the airways. The inhibition of these receptors prevents bronchoconstriction and facilitates easier breathing in patients with obstructive pulmonary diseases.

Pharmacodynamics

Tiotropium has a long duration of action due to its slow dissociation from the M3 receptors, allowing for sustained bronchodilation over a 24-hour period. The onset of action typically begins within 30 minutes of administration, with peak effects occurring around 3 hours post-dose. It significantly improves lung function, reduces exacerbation rates, and enhances exercise tolerance in patients with COPD.

Pharmacokinetics

Tiotropium is primarily absorbed through the lungs when inhaled, with approximately 20% of the delivered dose reaching systemic circulation. The drug undergoes minimal hepatic metabolism, primarily via cytochrome P450 enzymes, and is mainly excreted unchanged in the urine. The elimination half-life is approximately 5 to 6 days, which supports its once-daily dosing regimen.

Contra-indications

• Hypersensitivity to tiotropium, atropine or its derivatives
• Patients with narrow-angle glaucoma
• Patients with urinary retention

Adverse effects

• Cough
• Dizziness
• Dry mouth
• Headache
• Nausea
• Constipation
• Dysphonia
• Palpitations
• Skin reactions
• Stomatitis
• Urinary disorders
• Vision blurred

Interactions

• Clozapine: Unknown (additive effect)
• Second-generation antipsychotics: Unknown (additive effect)

Precautions

• Counsel patients on appropriate administration technique
• Warn against accidental contact with the eye due to risk of ocular complications
• Increased risk of dizziness affecting driving and skilled tasks

Pregnancy

Manufacturer advises only use if potential benefit outweighs risk.

Breast-feeding

No information available-manufacturer advises only use if potential benefit outweighs risk.

Storage

Store in a cool, dry place, away from direct sunlight.

Formulations

• {'name': 'Spiriva® Inhalation Powder', 'dose': '18 micrograms per capsule', 'route': 'inhalation'}
• {'name': 'Braltus® Inhalation Powder', 'dose': '13 micrograms per capsule', 'route': 'inhalation'}
• {'name': 'Nebuliser liquid', 'dose': 'Variable, refer to specific product information', 'route': 'nebulisation'}