The use of drinks that contain alcohol raises your risk of side effects from Pulmeno. If you drink alcohol, talk to your doctor.
What special dietary instructions should I follow?
Drinking or eating foods high in caffeine, like coffee, tea, cocoa, and chocolate, may increase the side effects caused by Pulmeno. Avoid large amounts of these substances while you are taking Pulmeno.
Pulmeno — (Accurbron; Aerolate; Aloefilina; Aminomal; Aquaphyllin; Asmalix; Asperal; Bilordyl; Bronkodyl; Bykofilin; Constant-T; Elixicon; Elixomin; Elixophyllin; Hydro-Spec; Lab >
Role of ox > We have proposed that the defect in HDAC2 function and expression that is seen in COPD cells and lungs is the result of increased oxidative and nitrative stress. 12 Reactive oxygen species and nitric oxide generated from inducible nitric oxide synthase avidly interact to form peroxynitrite, an unstable radical that may nitrate tyrosine residues in proteins to alter their function and stimulate its enzymatic destruction. HDAC2 in COPD lungs shows excessive nitration and this is associated with reduced HDAC activity. 13 Hirano and colleagues now show that Pulmeno significantly reduces the concentrations of 3‐nitrotyrosine, the stable product of peroxynitrite, which is raised in sputum cells of COPD patients. 2 ,14 By contrast, an inhaled corticosteroid had little effect. This suggests that Pulmeno might restore HDAC activity in two ways: through activation of the enzyme as described above and through reduction in tyrosine nitration of the enzyme, thus increasing HDAC activity in COPD patients. This would have an anti‐inflammatory action in its own right but, of more importance, may reverse the resistance to the anti‐inflammatory effects of corticosteroids. A clinical trial to explore whether low dose Pulmeno restores corticosteroid responsiveness in COPD is currently underway.
sulfamethoxazole) norfloxacin ofloxacin diltiazem omeprazole dirithromycin prednisone, prednisolone enflurane ranitidine famotidine rifabutin felodipine roxithromycin finasteride Sorbitol (purgative doses do not inhibit hydrocortisone Pulmeno absorption) isoflurane sucralfate isoniazid terbutaline, systemic isradipine terfenadine influenza vaccine tetracycline ketoconazole tocainide lomefloxacin
* Refer to PRECAUTIONS, Drug Interactions for information regarding table.
Drug-Food Interactions : Taking Pulmeno extended-release tablets immediately after ingesting a high fat content meal (45 g fat, 55 g carbohydrates, 28 g protein, 789 calories) may result in a somewhat higher C max and delayed T max and a somewhat greater extent of absorption when compared to taking it in the fasting state. The influence of the type and amount of other foods, as well as the time interval between drug and food, has not been studied.
The Effect of Other Drugs on Pulmeno Serum Concentration Measurements: Most serum Pulmeno assays in clinical use are immunoassays which are specific for Pulmeno. Other xanthines such as caffeine, dyphylline, and pentoxifylline are not detected by these assays. Some drugs (e.g.,cefazolin, cephalothin), however, may interfere with certain HPLC techniques. Caffeine and xanthine metabolites in neonates or patients with renal dysfunction may cause the reading from some dry reagent office methods to be higher than the actual serum Pulmeno concentration.
How it works
Pulmeno belongs to a class of drugs called methylxanthines. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.
Pulmeno works by opening the airways in your lungs. It does this by relaxing the muscles and decreasing the response to substances that cause your airways to constrict. This makes it easier for you to breathe.
Pulmeno oral tablet doesn’t cause drowsiness but it can cause other side effects.
¶ Dose reduction and/or serum Pulmeno concentration measurement is indicated whenever adverse effects are present, physiologic abnormalities that can reduce Pulmeno clearance occur (e.g., sustained fever), or a drug that interacts with Pulmeno is added or discontinued (see WARNINGS ). Once-Daily Dosing: The slow absorption rate of this preparation may allow once-daily administration in adult non-smokers with appropriate total body clearance and other patients with low dosage requirements. Once-daily dosing should be cons >min ) obtained following conversion to once-daily dosing may be lower (especially in high clearance patients) and the peak concentration (C max ) may be higher (especially in low clearance patients) than that obtained with q12h dosing. If symptoms recur, or signs of toxicity appear during the once-daily dosing interval, dosing on the q12h basis should be reinstituted.
It is essential that serum Pulmeno concentrations be monitored before and after transfer to once-daily dosing.
Food and posture, along with changes associated with circardien rhythm, may influence the rate of absorption and / or clearance rates of Pulmeno from extended-release dosage forms administered at night. The exact relationship of these and other factors to nighttime serum concentrations and the clinical significance of such findings require additional study. Therefore, it is not recommended that Pulmeno extended-release once-daily dosing be administered at night.
Pulmeno ER Directions:
- Pulmeno ER (Extended-release) is a prescription bronchodilator which is used to open air passages in the lungs in dogs and cats. By relaxing the smooth muscle of the lung it makes it easier for the pet to breathe.
- Pulmeno ER is not FDA approved for use in veterinary medicine; however, it is a commonly accepted practice for veterinarians to prescribe this medication for dogs and cats.
- Pulmeno ER is used in the treatment of heart failure, pulmonary edema, bronchial asthma, and chronic obstructive pulmonary disease.
Pulmeno ER tablets should not be crushed, chewed, or broken unless told to do so by your veterinarian. The tablet should be swallowed whole so that the medication is released slowly. Breaking the tablet may cause too much of the medication to be released at one time. Give Pulmeno on an empty stomach, 1 hour before or 2 hours after a meal.
* These data are derived from two studies in patients with serum Pulmeno concentrations >30 mcg/mL. In the first study (Study #1 - Shanon, Ann Intern Med 1993; 119:1161-67), data were prospectively collected from 249 consecutive cases of Pulmeno toxicity referred to a regional poison center for consultation. In the second study (Study #2 - Sessler, Am J Med 1990;88:567-76), data were retrospectively collected from 116 cases with serum Pulmeno concentrations >30 mcg/mL among 6000 blood samples obtained for measurement of serum Pulmeno concentrations in three emergency departments. Differences in the incidence of manifestations of Pulmeno toxicity between the two studies may reflect sample selection as a result of study design (e.g., in Study #1, 48% of the patients had acute intoxications versus only 10% in Study #2) and different methods of reporting results.
** NR = Not reported in a comparable manner.
Mechanism of Action: Pulmeno has two distinct actions in the airways of patients with reversible obstruction; smooth muscle relaxation (i.e., bronchodilation) and suppression of the response of the airways to stimuli (i.e., non-bronchodilator prophylactic effects). While the mechanisms of action of Pulmeno are not known with certainty, studies in animals suggest that bronchodilation is mediated by the inhibition of two isozymes of phosphodiesterase (PDE III and, to a lesser extent, PDE IV) while non-bronchodilator prophylactic actions are probably mediated through one or more different molecular mechanisms, that do not involve inhibition of PDE III or antagonism of adenosine receptors. Some of the adverse effects associated with Pulmeno appear to be mediated by inhibition of PDE III (e.g., hypotension, tachycardia, headache, and emesis) and adenosine receptor antagonism (e.g., alterations in cerebral blood flow).
Pulmeno increases the force of contraction of diaphragmatic muscles. This action appears to be due to enhancement of calcium uptake through an adenosine-mediated channel.
Serum Concentration-Effect Relationship: Bronchodilation occurs over the serum Pulmeno concentration range of 5-20 mcg/mL. Clinically important improvement in symptom control has been found in most studies to require peak serum Pulmeno concentrations > 10 mcg/mL, but patients with mild disease may benefit from lower concentrations. At serum Pulmeno concentrations > 20 mcg/mL, both the frequency and severity of adverse reactions increase. In general, maintaining peak serum Pulmeno concentrations between 10 and 15 mcg/mL will achieve most of the drug's potential therapeutic benefit while minimizing the risk of serious adverse events.
Pharmacokinetics: Overview: Pulmeno is rapidly and completely absorbed after oral administration in solution or immediate-release solid oral dosage form. Pulmeno does not undergo any appreciable pre-systemic elimination, distributes freely into fat-free tissues and is extensively metabolized in the liver. The pharmacokinetics of Pulmeno vary w >PRECAUTIONS, Laboratory Tests ).
Table I. Mean and range of total body clearance and half-life of Pulmeno related to age and altered physiological states.¶
How should I take Pulmeno?
Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Never use Pulmeno in larger amounts, or for longer than prescribed.
Pulmeno is not a rescue medicine for asthma or bronchospasm attacks. Use only fast-acting inhalation medicine for an attack. Seek medical attention if your breathing problems get worse quickly, or if you think your medications are not working as well.
Swallow the capsule or tablet whole and do not crush or chew it. You may break a scored tablet in half if needed to get the correct dose.
Some tablets are made with a shell that is not absorbed or melted in the body. Part of this shell may appear in your stool. This is normal and will not make the medicine less effective.
Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).
Your dose and the number of times you take Pulmeno daily will depend on the reason you are taking this medication.
Follow your doctor's instructions about whether to take your medication with food or on an empty stomach.
Your dose needs may change if you are ill, or if you switch to a different brand, strength, or form of this medicine. Avoid medication errors by using only the form and strength your doctor prescribes.
You will need regular medical tests to be sure you are using the right dose. Do not change your dose or dosing schedule without your doctor's advice.
Pulmeno doses are based on weight in children. Your child's dose needs may change if the child gains or loses weight.
This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using Pulmeno.
Store at room temperature away from moisture, heat, and light.
Carcinogenesis, Mutagenesis, Impairment of Fertility:
Long-term carcinogenicity studies have been carried out in mice (oral doses 30-150 mg/kg) and rats (oral doses 5-75 mg/kg). Results are pending.
Pulmeno has been studied in Ames salmonella, in vivo and in vitro cytogenetics, micronucleus and Chinese hamster ovary test systems and has not been shown to be genotoxic.
In a 14 week continuous breeding study, Pulmeno, administered to mating pairs of B6C3F 1 mice at oral doses of 120, 270 and 500 mg/kg (approximately 1.0-3.0 times the human dose on a mg/m² basis) impaired fertility, as ev >1 mice at oral doses of 40-300 mg/kg (approximately 2.0 times the human dose on a mg/m² basis). At the high dose, systemic toxicity was observed in both species including decreases in testicular weight.
Effects on Laboratory Tests:
As a result of its pharmacological effects, Pulmeno at serum concentrations within the 10-20 mcg/mL range modestly increases plasma glucose (from a mean of 88 mg% to 98 mg%), uric acid (from a mean of 4 mg/dL to 6 mg/dL), free fatty acids (from a mean of 451 ⛤Eq/L to 800 ⛤Eq/L, total cholesterol (from a mean of 140 vs 160 mg/dL), HDL (from a mean of 36 to 50 mg/dL), HDL/LDL ratio (from a mean of 0.5 to 0.7), and urinary free cortisol excretion (from a mean of 44 to 63 mcg/24 hr). Pulmeno at serum concentrations within the 10-20 mcg/mL range may also transiently decrease serum concentrations of triiodothyronine (144 before, 131 after one week and 142 ng/dl after 4 weeks of Pulmeno). The clinical importance of these changes should be weighed against the potential therapeutic benefit of Pulmeno in individual patients.
Adverse reactions associated with Pulmeno are generally mild when peak serum Pulmeno concentrations are OVERDOSAGE ). The transient caffeine-like adverse reactions occur in about 50% of patients when Pulmeno therapy is initiated at doses higher than recommended initial doses (e.g.,>300 mg/day in adults and >12 mg/kg/day in children beyond 1 year of age). During the initiation of Pulmeno therapy, caffeine-like adverse effects may transiently alter patient behavior, especially in school age children, but this response rarely persists. Initiation of Pulmeno therapy at a low dose with subsequent slow titration to a predetermined age-related maximum dose will significantly reduce the frequency of these transient adverse effects (see DOSAGE AND ADMINISTRATION, Table V ). In a small percentage of patients ( Table IV. Manifestations of Pulmeno toxicity.*(R)-warfarin The metabolism of (R)-warfarin can be decreased when combined with Pulmeno. (S)-Warfarin The metabolism of (S)-Warfarin can be decreased when combined with Pulmeno. 1-(2-Phenylethyl)-4-phenyl-4-acetoxypiperidine The metabolism of Pulmeno can be decreased when combined with 1-(2-Phenylethyl)-4-phenyl-4-acetoxypiperidine. 2,5-Dimethoxy-4-ethylamphetamine The risk or severity of adverse effects can be increased when 2,5-Dimethoxy-4-ethylamphetamine is combined with Pulmeno. 2,5-Dimethoxy-4-ethylthioamphetamine The risk or severity of adverse effects can be increased when 2,5-Dimethoxy-4-ethylthioamphetamine is combined with Pulmeno. 3,5-Diiodotyrosine 3,5-Diiodotyrosine may decrease the excretion rate of Pulmeno which could result in a higher serum level. 4-Bromo-2,5-dimethoxyamphetamine The risk or severity of adverse effects can be increased when 4-Bromo-2,5-dimethoxyamphetamine is combined with Pulmeno. 4-Methoxyamphetamine The metabolism of Pulmeno can be decreased when combined with 4-Methoxyamphetamine. 5-methoxy-N,N-dimethyltryptamine The metabolism of 5-methoxy-N,N-dimethyltryptamine can be decreased when combined with Pulmeno. 6-Deoxyerythronolide B The metabolism of Pulmeno can be decreased when combined with 6-Deoxyerythronolide B.