Punol Special Precautions

In case of acute rapidly worsening dyspnea, consult the physician immediately.
Use with caution in patients with cardiovascular disease (especially coronary insufficiency, cardiac arrhythmias, or hypertension), seizure disorder, hyperthyroidism, diabetes mellitus, and in those who are unusually responsive to β-adrenergic agents.
Temporary blurred vision, mydriasis, occular pain, or precipitation or worsening of angle-closure glaucoma has occurred following inadvertent contact of ipratropium bromide with the eyes; therefore, when the drug is administered via a nebulizer, procedures to minimize ocular exposure should be employed (e.g., using a mouthpiece rather than a face mask to deliver the drug). In addition, the patients should be instructed to close their eyes during administration.
Immediate hypersensitivity reactions may occur after administration of ipratropium bromide as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema.
Use with caution in patients with narrow-angle glaucoma, prostatic hyperplasia or bladder-neck obstruction, particularly if they are receiving an anticholinergic by another route.