OBAT UNTUK ASMA

 Asma memiliki ciri-ciri kondisi klinis yaitu batuk, sesak nafas, dada terikat, wheezing pada
malam hari.
 Terjadi karena penyempitan bronchial Airways, naiknya responsivitas bronchial dengan
stimuli. patologis lymphatic, inflammasi mucosa bronchial. Terjadi remodelling mukosa
bronchial (reposisi kolagen, hiperplasia sel penyusun struktural.
 Treatment dilakukan untuk meringankan bronkokonstriksi ( short term reliever ) dan untuk
mereduksi gejala dan mencegah terjadinya serangan ( long term controller )
 Short term reliever adalah β adrenoreceptor stimulan ( relaksasi otot polos saluran
pernapasan ), theophylline, methylxanthine, obat anti-muscarinic (pengurangan konstruksi
dari jalan napas)
 Long term control adalah agen anti-inflammasi seperti inhaled corticosteroid, leukotriene
pathway antagonist/inhibitor degranulasi sel mast contoh cromolyn atau nedocromil.
Perkembangan clinical trial menemukan treatment efektif untuk asma yaitu dengan
menggunakan humanized monoclonal antibody contoh Omalizumab yang memiliki target
spesifik dengan Ig E (Antibody allergic sensitization).
 Salmeterol dan formoterol ( long acting β adrenoreceptor stimulant ) efektif menaikan
kontrol pada asma ketika ditambahkan dengan kortikosteroid inhalasi
 Asthmatic bronchospasm dapat diatasi dan dicegah dengan obat yang cara kerjanya:
o mengurangi jumlah dari IgE yang terikat pada sel mast (Anti Ig E antibody)
o mencegah degranulasi dari sel mast ( cromolyn, nedocromil, sympathomimetic agen, Ca
Channel Blocker )
o memblok aksi dari pelepasan produk ( anti histamin dan leukotriene reseptor
antagonist)
o menghambat efek dari asetilkolin yang dilepaskan oleh vagal motor nerves ( muscarinic
antagonist )
o secara langsung merelaksasi otot polos pada saluran napas ( agen symphatomimetic,
theophyline)

AGEN ANTIMUSCARINIC

 bekerja sebagai potent kompetitif inhibitor dari asetilkolin pada muscarinic reseptor pada
saraf postganglion, memblok kontraksi dari otot-otot polos saluran pernapasan dan
kenaikan sekresi mukus akibat adanya repon vagal, agen ini bekerja sebagai bronchodilator.
 Bisa diberikan dengan dosis tinggi dengan rute inflasi karena penyerapan yang buruk oleh
sirkulasi dan tidak bisa masuk pada sistem saraf pusat.
 Agen antimuscarinic ini sangat baik untuk pasien yang intoleran dengan inhalasi agen β
agonis.
SOAL

Pirenzepine

Pirenzepine (Gastrozepin), adalah M1 selective antagonist, digunakan untuk treatment peptic ulcer,
karena dapat mereduksi sekresi asam lambung dan mereduksi spasme otot. dimasukkan dalam kelas
obat antagonis reseptor muscarinic. Tidak memiliki efek pada otak dan medula finalis karena tidak
dapat berdifusi melewati blood brain Barrier. Dari sumber yang saya dapat hubungan antara
pirenzepine dan asma sangat lemah mendapati ranjing 381 dari 1079 obat untuk treatment asthma.
dari sumber yang saya dapat, obat ini lebih sering digunakan untuk mengatasi masalah pada
lambung, dan duodenum. Dari sumber yang cari lebih banyak dosis untuk penyakit lambung dan
duodenum. Tidak sesuai dan kurang efektif untuk pasien dengan kasus asma yang tercantum dalam
skenario.

Dicyclomine

Hubungan obat ini dengan penyakit asma sangat lemah, dari sumber yang saya dapat yaitu ranking
746 dari 1079 treatment obat untuk asma lebih lemah lagi daripada pirenzepine. Obat ini lebih
sering digunakan untuk mengurangi spasme pada otot polos saluran pencernaan seperti lambung
dan usus. sehingga obat ini kurang efektif untuk pasien sesuai kasus yaitu menderita asma, dari
sumber yang saya cari lebih banyak dosis untuk penyakit organ-organ digestive seperti irritable
bowel sindrom .

Ipratopium bromida

Ipratropium bromide (memiliki nama dagang Atrovent, Apovent, Ipraxa, Aerovent and Rinatec)
merupakan obat untuk mengurangi spasme dari bronchial. merupakan obat anticholinergic untuk
treatment COPD dan asma akut. obat ini memblok reseptor asetilkolin muscarinic pada otot polos
bronkus di paru, untuk membuka jalan napas di bronkus. Hubungan obat ini dengan penyakit asma
adalah kuat menempati ranking 14 dari 1079 treatment obat untuk asma.

Mekanisme Aksi
Ipratropium bromida memblok aksi dari asetilkolin pada stimulus parasimpatis pada otot polos
bronchial yang menyebabkan bronchodilatasi.

Absorpsi: Sangat sedikit yang diabsorpsi oleh GIT tract.

Distribusi: Sedikit yang terikat dengan protein plasma.
Ekskresi: Melalui urine and faeces ( sebagai unchanged drug and metabolites).

Nama dagang : Atrovent, Apovent, Ipraxa, Aerovent, Rinatec

Indikasi : Inhaler: Sebagai bronkodilator utk terapi pemeliharaan bronkospasme yg berhubungan dg

PPOK, termasuk bronkitis kronik, emfisema. Lar inhalasi: Sebagai bronkodilator utk pencegahan &
pengobatan gejala obstruksi sal nafas kronik dg bronkospasme reversibel, seperti asma bronkial &
terutama bronkitis kronik dg atau tanpa emfisema.

Dosis : Inhaler Dws & anak ≥12 thn 2 semprot 4 x/hr. Utk mempertahankan keadaan bebas dr gejala,
lakukan inhalasi teratur dg interval 4 jam. Pemeliharaan: maks 12 semprot/hr. Lar inhalasi Dws
termasuk usia lanjut, remaja >14 thn 0.4-2 mL (8-40 tetes/hr) 3-4 x/hr, anak 6-14 thn 0.4-1 mL (8-20
tetes/hr) 3-4 x/hr .

Sediaan dipasaran :

Atrovent inhalation soln 0.025 % 20 mL x 1's (Rp172,590/botol)

Atrovent inhaler 20 mcg/puff 10 mL x 1's (Rp135,300/canister)

Berikut ini saya tampilkan informasi lengkap peresepan dari obat ini :
Manufacturer Boehringer Ingelheim

Contents Ipratropium bromide.

Indications Metered-Dose Inhaler/Metered-Aerosol: Bronchodilator for maintenance treatment of

bronchospasm associated with chronic obstructive pulmonary disease, including chronic
bronchitis and emphysema.
Solution for Inhalation: Bronchodilator for the prevention and treatment of symptoms in
chronic obstructive airway disorders with reversible bronchospasm eg, bronchial asthma an
especially chronic bronchitis with or without emphysema.

Dosage & Metered-Dose Inhaler/Metered-Aerosol: The dosage should be adapted to the individual
Administration requirements. Unless otherwise prescribed, the following dosages are recommended: Adult
and Children ≥12 years: 2 metered doses (puffs) 4 times daily.
Since a requirement for increasing doses suggests that additional therapeutic modalities ma
be needed, a total daily dose of 12 puffs should generally not be exceeded.
If therapy does not produce a significant improvement or if the patient's condition gets
worse, medical advice must be sought in order to determine a new plan of treatment. In the
case of acute or rapidly worsening dyspnoea (difficulty in breathing), a doctor should be
consulted immediately.
For acute exacerbations of chronic obstructive pulmonary disease, treatment with Atrovent
inhalation solution or unit dose vials may be indicated.
Because of insufficient information in children, Atrovent metered-aerosol should only be
used on medical advice and under the supervision of an adult.
Inhalation Solution: The dosage should be adapted to the individual requirements of the
patient. Patients should also be kept under medical supervision during treatment. Unless
otherwise prescribed, the following doses are recommended: Adults (Including the Elderly)
and Adolescents >14 years: 0.4-2 mL (8-40 drops=0.1-0.5 mg) 3-4 times daily. Children 6-14
years: 0.4-1 mL (8-20 drops=0.1-0.25 mg) 3-4 times daily.
The recommended dose is to be diluted with physiological saline to a final volume of 3-4 mL
and nebulised and inhaled until the solution is consumed. The solution should be rediluted
each time before use; any residual diluted solution should be discarded.
Dosage may be dependent upon the mode of inhalation and the quality of nebulisation. In
the case of particle sizes up to 5 micrometer or with assisted ventilation, dose levels may be
reduced to approximately 0.4 mL (8 drops=0.1 mg). The duration of inhalation can be
controlled by the dilution volume.
The dose may be repeated after intervals of at least 4 hrs, if required.
Daily doses exceeding 2 mg should be given under medical supervision.
Patients should be advised to consult a physician or the nearest hospital immediately in the
case of acute or rapidly worsening dyspnoea (difficulty in breathing) if additional inhalations
do not produce an adequate improvement. Where wall oxygen is available, the solution is
best administered at a flow rate of 6-8 L/min.
Atrovent inhalation solution is suitable for concurrent inhalation with secretomucolytics and
Berotec inhalation solutions.
Administration: The correct operation of the metered aerosol apparatus is essential for
successful therapy.
Depress the valve twice before the apparatus is used for the 1st time.
Before each use, the following rules should be observed: Remove protective cap. Breathe ou
 deeply. Hold the metered aerosol and close lips over the mouthpiece. The arrow and the
base of the container should be pointing upwards. Breathe in as deeply as possible, pressing
the base of the container firmly at the same time; this releases 1 metered dose. Hold breath
for a few seconds, then remove mouthpiece from the mouth and breathe out. The same
action should be repeated for a 2nd inhalation. Replace the protective cap after use.
After not using the metered aerosol for 3 days, the valve has to be actuated once.
The container is not transparent. It is not therefore possible to see when it is empty. The
aerosol will deliver 200 doses. When these have all been used, the aerosol may still appear t
contain a small amount of fluid. The aerosol should, however, be replaced in order to get th
right amount of treatment.
The amount of treatment in aerosol can be checked as follows: Remove the aerosol from th
plastic mouthpiece and put the aerosol into a container of water. The contents of the aeros
can be estimated by observing its position in the water.
The mouthpiece should always be kept clean and can be washed with warm water. If soap o
detergent is used, the mouthpiece should be thoroughly rinsed in clear water.
Warning: The plastic mouthpiece has been specially designed for use with Atrovent metered
aerosol to ensure that you get the right amount of medicine. The mouthpiece must never be
used with any other metered aerosol nor must the Atrovent metered aerosol be used with
any mouthpiece other than the one supplied with the product.
The container is under pressure and should by no account be opened by force or exposed to
temperatures above 50°C.

Overdosage No symptoms specific to overdosage have been encountered. In view of the wide therapeut
range and topical administration of Atrovent metered-aerosol, no serious anticholinergic
symptoms are to be expected. Minor systemic manifestations of anticholinergic action,
including dry mouth, visual accommodation disturbances and increases of heart rate may
occur.

Contraindications Patients with known hypersensitivity to atropine or its derivative or to any component of
Atrovent.

Special Precautions Atrovent 0.025% inhalant solution contains the (antimicrobial) preservative benzalkonium
chloride and the stabiliser disodium edetate. It has been shown that these components may
cause bronchoconstriction in some patients.
Atrovent should be used with caution in patients predisposed to narrow-angle glaucoma or
with prostatic hyperplasia or bladder-neck obstruction.
Patients with cystic fibrosis may be more prone to gastrointestinal motility disturbances.
Immediate hypersensitivity reactions may occur after administration of Atrovent as
demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, oropharyngeal
oedema and anaphylaxis.
Ocular Complications: There have been isolated reports of ocular complications (ie, mydrias
increased intraocular pressure, narrow-angle glaucoma, eye pain) when aerosolised
ipratropium bromide either alone or in combination with an adrenergic β2-agonist has com
into contact with the eyes. Thus, patients must be instructed in the correct administration o
Atrovent metered aerosol.
Eye pain or discomfort, blurred vision, visual halos or colored images in association with red
eyes from conjunctival congestion and corneal edema may be signs of acute narrow-angle
glaucoma. Should any combination of these symptoms develop, treatment with miotic drop
 should be initiated and specialist advice sought immediately.
Patients must be instructed of the correct administration of Atrovent solution for inhalation
Care must be taken not to allow the solution or mist to enter into the eyes. It is
recommended that the nebulised solution is administered via a mouth piece. If this is not
available and a nebuliser mask is used, it must fit properly. Patients who may be predispose
to glaucoma should be warned specifically to protect their eyes.
Use in pregnancy & lactation: The safety of Atrovent during human pregnancy has not been
established. The benefits of using Atrovent during a confirmed or suspected pregnancy mus
be weighed against possible hazards to the unborn child. Preclinical studies have shown no
embryotoxic or teratogenic effects following inhalation or intranasal application at doses
considerably higher than those recommended in man.
It is not known whether Atrovent is excreted in breast milk. Although lipid-insoluble
quaternary cations pass into breast milk, it is unlikely that Atrovent would reach the infant t
an important extent, when administered by inhalation. However, because many drugs are
excreted in breast milk, caution should be exercised when Atrovent is administered to
nursing mothers.
Use in children: Safety and effectiveness in children <12 years have not been established.

Side Effects The most frequent nonrespiratory adverse events reported in clinical trials were GI motility
disorders (eg, constipation, diarrhea and vomiting), dryness of the mouth and headache.
Further, the following side effects have been observed with Atrovent: Increased heart rate,
palpitations, supraventricular tachycardia and atrial fibrillation, ocular accommodation
disturbances, nausea and urinary retention. These side effects have been reversible. The ris
of urinary retention may be increased in patients with preexisting outflow tract obstruction.
Ocular side effects have been reported (see Precautions).
As with other inhaled therapy including bronchodilators, cough, local irritation and
inhalation-induced bronchoconstriction have been observed.
Allergic-type reactions eg, skin rash, angioedema of the tongue, lips and face, urticaria
(including giant urticaria), laryngospasm and anaphylactic reactions have been reported, wit
positive rechallenge in some cases.

Drug Interactions Beta-adrenergics and xanthine preparations may intensify the bronchodilatory effect of
Atrovent.
The risk of acute glaucoma in patients with a history of narrow-angle glaucoma (see
Precautions) may be increased when nebulised ipratropium bromide and β-mimetics are
administered simultaneously.

Pregnancy Category (US

FDA)

Category B: Either animal-reproduction studies have not demonstrated a foetal risk but ther
are no controlled studies in pregnant women or animal-reproduction studies have shown an
adverse effect (other than a decrease in fertility) that was not confirmed in controlled studie
in women in the 1sttrimester (and there is no evidence of a risk in later trimesters).

Storage Store below 30°C.

Description Ipratropium bromide is (8r)-3α-hydroxy-8-isopropyl-1αH, 5αH-tropanium bromide (±)-tropa
monohydrate.

Mechanism of Action Atrovent is a quaternary ammonium compound with anticholinergic (parasympatholytic)

properties. In preclinical studies, it appears to inhibit vagally mediated reflexes by
antagonising the action of acetylcholine, the transmitter agent released from the vagus
nerve. Anticholinergics prevent the increase in intracellular concentration of cyclic guanosin
monophosphate (cyclic GMP) caused by interaction of acetylcholine with the muscarinic
receptor on bronchial smooth muscle.
The bronchodilation following inhalation of Atrovent is induced by a local drug concentratio
sufficient for anticholinergic efficacy at the bronchial smooth muscle and not by systemic
drug concentrations.
In controlled 90-day studies in patients with chronic obstructive pulmonary disease (chronic
bronchitis and emphysema), significant improvements in pulmonary function (FEV1 and
FEF25-75% increases of ≥15%) occurred within 15 min, reached a peak in 1-2 hrs, and
persisted in the majority of patients up to 6 hrs.
Preclinical and clinical evidence suggest no deleterious effect of ipratropium bromide on
airway mucous secretion, mucociliary clearance or gas exchange.
The bronchodilator effect of ipratropium bromide in the treatment of acute bronchospasm
associated with asthma has been shown in studies in adults and children >6 years. In most o
these studies ipratropium bromide was administered in combination with an inhaled β-
agonist.
Data are limited to show that ipratropium bromide has a therapeutic effect in the treatmen
of bronchospasm associated with viral bronchiolitis and bronchopulmonary dysplasia in
infants and very small children.

MIMS Class Antiasthmatic & COPD Preparations

ATC Classification R03BB01 - ipratropium bromide ; Belongs to the class of other inhalants used in the
treatment of obstructive airway diseases, anticholinergics.

Drug Classification G

Presentation/Packing Aerosol 0.02 mg/dose x 200 dose (10 mL). Inhalation soln 0.025% x 20 mL x 1's

Salmeterol

Salmeterol merupakan obat long-acting beta2-adrenergic receptor agonist yang diresepkan untuk
treatment asthma dan COPD. Tersedia sebagai dry powder inhaler dan juga tersedia dalam metered-
dose inhaler. Hubungan obat ini dengan penyakit asma sangat kuat menempati peringkat 6 dari
1079 treatment obat untuk asma

Mechanisme Aksi
Salmeterol adalah obat direct-acting sympathomimetic yang berfungsi untuk merelaksasikan otot
polos bronchial dengan bekerja pada reseptor β2 dengan sedikit efek pada denyut jantung

Onset: inhalasi: 10-20 min.

Durasi: 12 hr.
Absorpsi: konsentrasi plasma bisa ditiadakan setelah inhalasi.
Distribusi: 96% terikat dengan protein plasma.
Metabolisme: Hepatically hydroxylated.
Eksresi: 25-60% dosis dieliminasi melalui urin dan faeces selama 7 hari

Dipasaran salmeterol sering dikombinasikan dengan fluticasone

Mechanism of Action
Salmeterol, adalah long acting β2-agonist yang bekerja secara lokal pada paru untuk mediasi
bronchodilatasi which acts locally in the lung to mediate bronchodilation. Fluticasone adalah
corticosteroid dengan mayoritas aktivitas glukokortikoid mereduksi gejala dan eksaserbasi dari

Onset: Bronchodilation: 10-20 minutes.

Durasi: Bronchodilation: 12 hr
Absorpsi: Salmeterol: Tidak diabsorbsi setelah diinhalasi. Fluticasone: Sedikit yang diabsorpsi oleh
traktus digestivus; oral bioavailabilitas <1%; absolute bioavailabilitas of inhaled fluticasone: 5-11%
Distribution: Salmeterol: Protein binding: 96%. Fluticasone: Protein binding: 91%.
Metabolism: Salmeterol: Extensive hepatic metabolism by hydroxylation; terminal elimination half-
lives: 5.5 hr. Fluticasone: Extensive first-pass metabolism by cytochrome CYP3A4.
Ekskresi: Salmeterol: dieliminasi terutama melalui faeces;. Fluticasone: terutama diekskresi melalui
faeces sebagau metabolit dan unchanged drug; <5% ekskresi melalui urine.

Merek dagang : Flutias dan Seretide

Flutias

Komposisi Per Flutias 50 inhaler Salmeterol 25 mcg, fluticasone propionate 50 mcg. Per Flutias 125
inhalerSalmeterol 25 mcg, fluticasone propionate 125 mcg.

Indikasi Terapi reguler utk asma jika diperlukan penggunaan kombinasi bronkodilator &
kortikosteroid inhalasi.

Dosis Hanya untuk inhalasi oral. Dws & anak ≥12 thn 2 inhalasi Flutias 50 atau Flutias 125 2
x/hr. Anak ≥4 thn 2 inhalasi Flutias 50 2 x/hr.

Kontra Indikasi Hipersensitivitas.

Perhatian Khusus Tdk utk pengobatan gejala asma akut atau penanganan awal asma. Jangan dihentikan secar
mendadak. Pasien dg TB paru, ggn KV berat misalnya kelainan irama jantung, DM,
hipokalemia yg tdk diterapi atau tirotoksikosis. Hentikan terapi jika timbul bronkospasme
paradoksikal. Efek sistemik spt supresi adrenal, retardasi pertumbuhan, penurunan densitas
mineral tulang, katarak, & glaukoma dpt terjadi pd penggunaan dosis tinggi dlm waktu lama
Pantau tinggi badan anak secara berkala. Anak. Hamil & laktasi.

Reaksi Simpang Obat Tremor, palpitasi, sakit kepala, aritmia jantung, artralgia, mialgia, kram otot, reaksi
hipersensitivitas misalnya ruam, edema, angiodema; suara serak, sariawan, hipersensitivitas
pd kulit.
Lihat Formulir Pemantauan Reaksi Simpang Obat
Interaksi Obat Penggunaan bersama dg obat yg mgd adrenergik memiliki efek aditif potensial. Substrat ata
inhibitor CYP3A4.

Kategori Kehamilan (US

FDA)

Kategori C: Studi pada binatang percobaan telah memperlihatkan adanya efek samping pad
janin (teratogenik atau embroisidal atau lainnya) dan tidak ada studi terkontrol pada wanita
atau studi pada wanita dan binatang percobaan tidak dapat dilakukan. Obat hanya boleh
diberikan jika besarnya manfaat yang diharapkan melebihi besarnya risiko terhadap janin.

Kelas MIMS Preparat Antiasma & PPOK

Klasifikasi ATC R03AK06 - salmeterol and fluticasone ; Belongs to the class of adrenergics and other inhalan
used in the treatment of obstructive airway diseases.

Klasifikasi Obat G

Seretide

Komposisi Per Seretide dosis 50 Salmeterol 25 mcg, fluticasone propionate 50 mcg. Per Seretide dosis
125Salmeterol 25 mcg, fluticasone propionate 125 mcg. Per Diskus Seretide 100 Salmeterol
xinafoate 50 mcg, fluticasone propionate 100 mcg. Per Diskus Seretide 250 Salmeterol
xinafoate 50 mcg, fluticasone propionate 250 mcg. Per Diskus Seretide 500 Salmeterol
xinafoate 50 mcg, fluticasone propionate 500 mcg.

Indikasi Terapi reguler utk peny obstruktif sal napas yg reversibel, mencakup asma pd dws & anak,
serta terapi reguler utk PPOK termasuk bronkitis kronik & emfisema.

Dosis Penyakit Obstruksi Sal Napas yg Reversibel Dws & anak ≥12 thn Dws & anak ≥12 thn 2 inhala
Inhaler Seretide 50 atau 125 atau 1 inhalasi Diskus Seretide 100, 250, atau 500. Anak ≥4 thn
inhalasi Inhaler Seretide 50 atau 1 inhalasi Diskus Seretide 100. PPOK Dws 2 inhalasi Inhaler
Seretide 125 atau 1 inhalasi Diskus Seretide 250 atau 500. Semua dosis diberikan 2 x/hr.

Perhatian Khusus Tdk utk meredakan gejala asma akut. TB paru, ggn KV berat, DM, hipokalemia yg tdk diterap
tirotosikosis. Lakukan pengawasan berkala thd laju pertumbuhan pd anak yg mendapat tera
jangka panjang. Hamil, laktasi.

Reaksi Simpang Obat Serak atau disfonia, sakit kepala, kandidiasis mulut & tenggorokan, iritasi tenggorokan,
palpitasi, tremor, bronkospasme paradoksikal, artralgia; kram otot.
Lihat Formulir Pemantauan Reaksi Simpang Obat
Interaksi Obat Penyekat β selektif & non selektif; penghambat CYP450 (ritonavir, eritromisin, ketokonazol)
MAOI, antidepresan trisiklik, L-dopa, L-tiroksin, oksitosin, antiaritmia; xantin.

Kategori Kehamilan (US

FDA)

Kategori C: Studi pada binatang percobaan telah memperlihatkan adanya efek samping pad
janin (teratogenik atau embroisidal atau lainnya) dan tidak ada studi terkontrol pada wanita
atau studi pada wanita dan binatang percobaan tidak dapat dilakukan. Obat hanya boleh
diberikan jika besarnya manfaat yang diharapkan melebihi besarnya risiko terhadap janin.

Kelas MIMS Preparat Antiasma & PPOK

Klasifikasi ATC R03AK06 - salmeterol and fluticasone ; Belongs to the class of adrenergics and other inhalan
used in the treatment of obstructive airway diseases.

Klasifikasi Obat G

Referensi :

Katzung, BG, 2006, Basic and Clinical Pharmacology, 10 edn, Lange Medical Books/McGraw-Hill, San
Fransisco.

n.d., viewed 27 Oktober 2014, < www.mims.com >.

n.d., viewed 27 Oktober 2014, < www.drugs.com >.

n.d., viewed 27 Oktober 2014, < wellpilot.com/conditions/asthma >.

(Tambahan pirenzepine) monggo mau dimasukkan gak nu, soalnya hubungan obat untuk yang
pirenzepine dan dicyclomine ke asma sangat lemah, dan aku gak nemu dosis yang untuk asma,
malah banyak dosis untuk penyakit digestive saranku gausah dimasukkin nu. sip suwun

Nama dagang : Bisvanil dan gastrozepine

sediaan obat :

Injectable; Injection; Pirenzepine Hydrochloride 5 mg / ml

Tablet; Oral; Pirenzepine Hydrochloride 25 mg

Tablet; Oral; Pirenzepine Hydrochloride 50 mg

Komposisi:
Tiap tablet mengandung:
25 mg 5,11-dihydro-11-[(4-methyl-1-piperazinyl)acetyl]-6H-pyrido[2,3,b] = [1,4]benzodiazepin-6-
onedihydrochloride monohydrate (= pirenzepine dihydrochloride).

Cara kerja:
Pirenzepine bekerja secara selektif dengan memblok reseptor muskarinik, sehingga menurunkan
produksi asam lambung dan meningkatkan pH lambung. Pada dosis terapeutik pirenzepine tidak
menembus sawar darah otak.

Perhatian:
Pirenzepine sebaiknya digunakan secara hati-hati pada pasien dengan:
- galukoma
- hipertrofi prostat.

Masa Kehamilan dan Menyusui:

Hasil uji preklinis menunjukkan tidak berbahaya, tetapi keamanan penggunaan selama kehamilan
masih memerlukan p0enelitian lebih lanjut. Seperti pada semua obat, pemakaian pada triwulan
pertama kehamilan harus diperhatikan.
Pirenzepine masuk ke dalam air susu ibu, sehingga efek antikolinergik dapat terjadi pada bayi yang
disusui.

Interaksi Obat:
Perangsangan sekresi asam lambung oleh makanan dan obat-obatan tertentu (misalnya alkohol,
kafein, dan sebagainya) kadang-kadang dapat dikurangi.
Pemakaian pirenzepine bersama-sama obat penghambat reseptor-H2 menimbulkan pengurangan
sekresi asam lambung yang lebih jelas lagi, hal ini sangat berguna untuk pasien yang menderita
simdrom Zollinger-Ellison.
Efek obat antiimflamasi tidak terganggu kalau diberikan bersama-sama dengan pirenzepine. Bahkan
toleransi gastrointestinal obat-obat ini diperbaiki.

Dosis dan Cara Pemberian:

Kecuali kalau ditentukan lain, 50 - 150 mg per hari dalam dosis terbagi.
Pada umumnya berikanlah 50 mg dua kali sehari, pagi dan malam. Selama 2 - 3 hari pertama
pengobatan, kadang-kadang pasien perlu diberikan dosis tambahan di siang hari.
Obat ini harus diminum 1/2 jam sebelum makan.
Meskipun terjadi perbaikan subyektif yang cepat, bagaimanapun juga pasien seharusnya tidak
mengurangi atau menghentikan terapi yang ditentukan dokter.
Terapi dengan Gastrozepin seharusnya dilakukan 4 - 6 minggu.

Kelebihan Dosis:
Gejala-gejala:
Sampai saat ini, gejala-gejala kelebihan dosis pada manusia belum pernah dilaporkan. Tetapi, dalam
dosis besar pirenzepine dapat menimbulkan efek antikolinergik seperti: kulit terasa panas, kering
dan kemerahan, mulut kering, midriasis, delirium, takikardia, ileus, retensi urin, gerakan mioklonus
yang mendadak, choreo-athetosis.
Terapi:
Walaupun kejadian kelebihan dosis Gastrozepin sangat jarang, tetapi bila terjadi segera lakukan
penanganan secara umum seperti: pemberian "activated charcoal", kuras lambung.
Hemodialisa, hemoperfusi, diarisa pertonial dan pemberian charcoal berulang-ulang tidak efektif
untuk menghilangkan efek antikolinergik. Pada kasus keracunan berat (misalnya hipertemia,
delirium berat atau takikardia) dapat diberikan physotigmine secara intravena.
Bila terjadi glaukoma akut berikan obat tetes miotik dan segera dibawa ke dokter spesialis.

Penyimpanan:
Simpan di tempat sejuk dan kering, di tempat aman, jauh dari jangkauan anak-anak.

Jenis: Tablet