Hivent EM/Hivent DS/Hivent Plus Special Precautions

Hivent EM: Administer with caution to patients with cardiovascular diseases like ischemic heart disease, arrhythmia or tachycardia, hypertension, occlusive vascular disorders including arteriosclerosis, and aneurysms.
Administer with caution in patients with convulsive disorders, hyperthyroidism or diabetes mellitus.
Anginal pain may be precipitated in patients with angina pectoris.
Administer with caution to patients taking other sympathomimetic drugs.
Instruct patients receiving treatment at home to seek medical advice if usual relief is not obtained after the usual dose, or if the usual duration of effectiveness is reduced. The dose should not be increased.
Adjustment of dose and frequency of administration should only be by medical advice.
Salbutamol should be used by lactating mothers only if the overall benefits outweigh any potential risk.
Salbutamol is not indicated for the prevention of premature labor associated with toxemia of pregnancy or antepartum hemorrhage.
Give cautiously to patients with hypokalemia, as this may result in increased susceptibility to digitalis-induced cardiac arrhythmias.
Hivent DS: Salbutamol should be administered cautiously to patients with thyrotoxicosis. Potentially serious hypokalemia may result from β2-agonist therapy mainly from parenteral and nebulized administration. Particular caution is advised in acute severe asthma as this may be potentiated by concomitant treatment with xanthine derivatives, steroids, diuretics and by hypoxia. Serum potassium levels should be monitored in such situations.
As with other β-adrenoceptor agonists, Salbutamol can induce reversible metabolic changes, for example increased blood sugar levels. The diabetic patient may be unable to compensate for this and the development of ketoacidosis has been reported. Concurrent administration of corticosteroids can exaggerate this effect.
Hivent Plus: The drug product should not be given to patients with close-angle and narrow-angle glaucoma.
Administer with caution to conditions characterized by tachycardia such as thyrotoxicosis, heart failure and in cardiac surgery.
Care is required in patients with acute myocardial infarction and cardiovascular disease such as ischemic heart disease, arrhythmia, arteriosclerosis, hypertension and aneurysm.
It should be used with caution in pregnancy and lactation.