ANTIASTHMATICS: A TOXICITY PROFILE

Several new drugs with fewer side effects have been developed for treatment of asthma. Isoetharine, orciprenaline (metaproterenol), terbutaline and salbutamol (albuterol) offer some advantage over adrenaline (epinephrine), isoprenaline (isoproterenol), and ephedrine in that cardiac adverse effects with the former group of drugs are minimal or non-existent compared with the latter group. Following oral use, tremor seems to be the most frequent adverse effect with salbutamol, terbutaline and orciprenaline. New slow release preparations of theophylline have made oral administration easier and therapeutic plasma concentrations can be maintained by drug administration every 8-12 hours. Theophylline's adverse effects include headache, insomnia, nervousness, nausea and vomiting. For IV use, theophylline or its salts should be diluted and given over 30 min to avoid adverse effects such as hypotension and cardiac arrhythmias which accompany rapid IV administration. Although oral glucocorticoids are very effective for the treatment of asthma, systemic side effects such as osteoporosis, aggravation of diabetes, aseptic bone necrosis, and adrenocortical suppression have confined their use to resistant cases. Nevertheless, beclomethasone dipropionate which can be inhaled, can often be substituted for high doses of oral or parenteral glucocorticoids. In some patients using the aerosol, oral candidiasis may occur, the incidence of which can be reduced by rinsing the throat after drug use. Medical Letter 24: 83 (17 Sep 1982)

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