Respiratory drugs

Brochodilators

Cough suppressants

Decongestants

Mucolytics

Aminophyllin

By M. Younus, BVSc, MVSc, SKUAST-K

Aminophylline (Theophyllin).

  • Phosphodiesterase inhibitor.
  • Bronchodilator.

MOA:

  • Aminophylline inhibits type III and type IV phosphodiesterase (PDE) enzymes that are responsible for breaking down cyclic AMP in smooth muscle cells, possibly resulting in bronchodilation.
  • Theophylline also binds to the adenosine A2B receptors and blocks adenosine mediated bronchoconstriction In inflammatory states.
  • Theophylline activates histone deacetylase to prevent the transcription of inflammatory genes by inhibiting histone acetylation.

Effects:

  • Relaxation of the smooth muscles of the bronchial airways.

Species:

  • Dog, Cat and Horse.

Indication:

  • Asthma .
  • Chronic bronchitis.

Side effects:

  • Anxiety , Nervousness, and GIT problems.

Dose:

  • 12mg/kg I V BD.

Contraindication:

  • Not for use in horse intended for race .
  • Not for use in horse suffering from gastric upset and heart problems.

Brands :

Human brands:

  • Aminophylline 10 ml inj vial (Actiza Pharmaceuticals India).

Composition: Each mI contains 25mg/ ml Aminophyllin.

  • AMINOPHYLLINE 2ml ampule ( Welcome India).

Composition: Each ml contains 125mg Aminophyllin.

  • AMINARC 10ml inj vial ( Arco Lifesciences India).

Composition: Each mI contains 25mg/ ml Aminophyllin.

Clenbuterol

By M. Younus, BVSc, MVSc, SKUAST-K

Clenbuterol ( Sympathomimetic amine ).

  • Approved for horses in allergic respiratory diseases.

MOA:

  • Clenbuterol acts as Beta 2 agonist.
  • Clenbuterol also acts as PGF2 Alfa and oxytocin antagonist.

Effects:

  • Net effect is smooth muscle relaxation in lungs and uterus.

Side effects:

  • Arrhythmia at high doses.
  • Effects on cardiac function .

Species:

  • Horse and Cow.

Indication:

  • Suppression of premature contraction in mare.
  • Equine Asthma.
  • Tocolysis in mare and cow.

Dose:

  • 0.8mcg/kg PO/ IM/ IV BD x10days in Horse
  • 0.8mcg/kg single parenteral injection in Cow and Mare in uterine treatment.

Contraindication:

  • Animals intended for food.

Brands:

  • Clenbuterol hydrochloride 50 ml inj vial ( Offered by e Expoters India).

Fluticasone

By M. Younus, BVSc, MVSc, SKUAST-K

Fluticasone (synthetic trifluorinated glucocorticoid )

  • Extra label drug.

MOA:

  • Fluticasone binds and activates glucocorticoid receptor, resulting in the activation of lipocortins which inhibit cytosolic phospholipase A2.
  • Cytosolic phospholipase A2 is responsible for synthesis of inflammatory mediators, such as prostaglandins and leukotrienes.
  • There is also inhibition of cyclooxygenase 2, which is essential for prostaglandin production.

Effects:

  • The net effect is anti allergic, anti-inflammatory and antipruritic.

Side effects:

  • Cushingoid effects when high dose is used for prolonged period.

Species:

  • Horse, CAT and DOG.

Indication:

  • Asthma in Cat.
  • Asthma in Dog.
  • Asthma in Horse.

Dose:

  • 44 mcg-110 mcg OD using a metered dose inhaler in cat.
  • 1750mcg-2000mcg OD/BD using Equine inhaler for 2-3 weeks in horse.
  • 110mcg- 220mcg BD using a metered dose inhaler in dog.

Contra Indication:

  • Hypersensitivity to Fluticasone.
  • Pregnancy.
  • Acute respiratory obstruction.

Brands:

Available as human brands in India.

  • Floease 200md inhaler (Sun India).

Composition: 125mcg Fluticasone /puff

  • Flohale120 md inhaler (Cipla India).

Composition: 125mcg Fluticasone /puff

Guaifenesin

By M. Younus, BVSc, MVSc, SKUAST-K

Guaifenesin (ether of guaicol and glycerine ).

  • Expectorant.
  • Cough suppressant.

MOA:

  • Guaifenesin Irritates gastric mucosa followed by reflex stimulation of the respiratory tract. This is followed by increase in respiratory tract fluid secretions, which helps to loosen phlegm.
  • Viscosity of secretions in reduced and mucociliary clearance is increased thereby removing accumulated secretions from the upper and lower airway.

Effects:

  • Mucolytic effect.

Species:

  • Horse and Dog.

Indications:

  • As expectorant for cough relief.

Drug combination:

  • Guaifenesin is combined Ammonium chloride, Potassium chloride and Dextromethorphan.

Dose:

  • As expectorant:
  • 2mg/kg PO TID in dog.
  • 3mg/kg PO total daily dose given BID in horse.

Contraindication:

  • Horse receiving physostigmine.
  • Close angle glaucoma in dog.
  • Hypotension.
  • Prostrate enlargement.

Brands:

  • Equi-Spectorant Powder (Neogen Corporation USA)

Composition: Each 28.4 g contains 2000mg Guaifenesin.

  • Clear cough 1000ml bottle( Next Gen USA).

Composition: Each ml contains 22 mg Guaifenesin, 20mg Ammonium chloride and 20mg Potassium chloride

Codeine

By M. Younus, BVSc, MVSc, SKUAST-K

Codeine ( Methyl Morphine).

  • Morphinane alkaloid found in the opium poppy.
  • Has analgesic, anti-tussive and anti-diarrhoeal properties.
  • Extra label drugs for use in dogs.
  • Should not be used in cats.

MOA:

  • Codeine suppresses cough center in the brain, there by increases threshold for cough.

Effects:

  • Antitussives action.

Side effects:

  • Sedation.
  • Constipation.
  • Respiratory depression at higher dose.

Drug combination:

  • The drugs that can be formulated with codiene are Chlorpheniramine Maleate, Phenyl Propanolamine , Paracetamol, Asprin, Caffeine and Menthol.

Species:

  • Dog and Horse.

Indication:

  • Chronic cough.

Dose:

  • 1-2mg / kg PO 6-12 hrly in dogs.

Contraindication:

  • Cats.
  • Head trauma.
  • Seizure.
  • Gut obstruction.
  • Diarrhea due to toxins.

Brands:

Human brands:

  • Tossex Antitussive cough syrup 100ml(Abbot India).
  • Codistar Syrup 100ml( Mankind India).
  • Ascoril C Syrup 120ml(Glenmark Pharmaceuticals India).
  • Planokuf Syrup 100ml (Shreya Life Sciences India).
  • Topex-CD Syrup 100ml ( Ozone Pharmaceuticals India)

Composition: Chlorpheniramine Maleate 4mg/5ml and Codeine 10mg/5ml

Hydrocodone

By M. Younus, BVSc, MVSc, SKUAST-K

Hydrocodone (Morphinane like compound).

  • Stronger cough suppressant as compared to codeine.
  • Hydrocodone with acetaminophen and ibuprofen is highly toxic to cats.
  • Hydrocodone-ibuprofen formulations are highly toxic to dogs.
  • Extra label drug for use in dogs.

MOA:

  • Hydrocodone suppresses cough center in the brain, there by increases threshold for cough.

Effects:

  • Relief from cough.

Side effects:

  • Drowsiness and constipation.
  • Severe side effects include anorexia ,yellowing in the whites of the eyes, persistent vomiting or diarrhea, or blood in the vomit or stool

Note: Stop drug if severe side effects are observed.

Species:

  • Dog.

Indication:

  • Chronic cough in dogs.

Dose:

  • 0.22-0.25mg/kg PO TID or QID.

Contraindication:

  • Severe respiratory disease.
  • Hypothyroidism.
  • Renal disease and Hepatic disease.
  • Head trauma and seizures.
  • Gut obstruction.

Brands :

Human brand in India:

  • Hydrcodone bitartarate 7.5mg + Acetaminophen 325 mg tab ( Imorted from Tris Pharma).

Acetylcysteine

By M. Younus, BVSc, MVSc, SKUAST-K

Acetylcysteine(acetylated amino acid cysteine).

  • antioxidant and glutathione inducer.
  • Indicated for mucolytic therapy and in the management of acetaminophen toxicity.

MOA:

  • Sulfhydryl groups of Acetylcysteine acts on mucin and hydrolize disulfide bonds within mucin, breaking down the oligomers, and making the mucin less viscous.

Effects:

  • Mucolytic action.

Side effects:

  • Nausea, vomiting, and occasionally generalized itching and rash.

Species:

  • Dog ,Cat and Horse.

Indication:

  • As expectorants in productive cough.

Dose:

  • First dose @140 mg/kg PO or IV (as a 5% solution), then 70 mg/kg PO or IV every 6 h for 2-3 days in dog and cat.
  • 10 mg/ Kg PO BD for 20 days in horses.

Contraindication:

  • Donot use with cough suppressant .
  • Gastric ulceration .

Brands:

  • Taurians tab( Sava Vet India).

Composition: Each tab contains N-Acetylcysteine 150 mg and Taurine 500 mg.

Human brands:

  • Mucomix 2 ml Inj(Samarth Life Science India).

Composition: Each ml contains N-Acetylcysteine 400 mg .

  • Mucoact 2ml/5 ml Inj (Vintek Pharmaceuticals India).

Composition: Each ml contains N-Acetylcysteine 200 mg .

  • Acumyst 5 ml Inj (Oron Health care India).

Composition: Each ml contains N-Acetylcysteine 200 mg .

Ephedrine

By M. Younus, BVSc, MVSc, SKUAST-K

Ephedrine(phenethylamine alkaloid).

  • Extracted along with pseudoephedrine from ephedra plant.
  • Both act as direct and indirect sympathomimetic agents.

MOA:

  • Ephedrine stimulates alpha-1, beta-1 and beta-2-adrenergic receptors.
  • The stimulation of alpha-1-adrenergic receptors causes the constriction of veins and a rise in blood pressure.
  • The stimulation of beta-1-adrenergic receptors increases cardiac chronotropy and inotropy,
  • The stimulation of beta-2-adrenergic receptors cause vasodilation and bronchodilation.

Effects:

  • Vasoconstiction.
  • Cardiac chronotropy and inotropy.
  • Vasodilation and bronchodilation in lungs.

Side effects:

  • Increase in blood pressure.

Species :

  • Dog and Cat.

Indication:

  • Nasal congestion and bronchial constriction.

Drug combination:

  • Ephedrine is combined wit Dextromethorphan, Promethazine , Bromhexine, Chlorpheniramine for treatment symtomatic cough and nasal congestion.

Dose:

  • No dose is determined.
  • Suggested dose is 0.5mg/kg PO B D.

Contraindication:

  • Cardiac arrhythmias.
  • Should be used cautiously in hyperthyroidism, diabetes, and prostrate hyperplasia.
  • Hypertension.

Brands:

Available as human brands in India:

  • Ephedrine hydrochloride 15mg tab ( Cyper pharma India).

Bromhexine

By M. Younus, BVSc, MVSc, SKUAST-K

Bromhexine (2,4-dibromoaniline).

  • Mucolytic used for treatment of productive cough.
  • Mucolytic action is limited in purulent bronchial inflammation because bromhexine does not affect the DNA fibers present in the pus.
  • Ambroxol is a known metabolite of bromhexine.

MOA:

  • Bromhexine increases lysosomal activity and enhances hydrolysis of mucopolysaccharide polymers in the respiratory tract.
  • This increases the production of serous mucus in the respiratory tract, which makes the phlegm thinner and decreases mucus viscosity.
  • Bromhexine increases concentrations of IgA and IgG in respiratory secretions.
  • Bromhexine also increases the permeability of the alveolar/capillary barrier. resulting in increased concentrations of certain antibiotics in luminal secretions.

Effects:

  • Clearance of excess mucus, improving breathing and reducing cough.
  • Secretomotoric effect, and allows the cilia to more easily transport the phlegm out of the lungs.

Side effects:

  • Dizziness.
  • Sweating.
  • Allergy.
  • GIT upset.

Drug combination :

  • Bromhexine and antibiotic for respiratory tract infection.
  • Bromhexine + Guaifenesin + Menthol + Terbutaline for broader action.

Species:

  • Cattle , Horse, Dog , Cat, Poultry and Pig.

Dose:

  • Cattle: 0.50 mg/ kg PO OD for 5 days.
  • Horse: 0.20-0.40 mg/ kg PO OD for 5 days.
  • Dog and Cat: 2mg/kg PO BD for 7 to 10 days then 1mg/kg for a further 7-10 days.
  • Poultry: 1 g/4-5 liter of drinking water once daily for 5-7 days.
  • Pigs: 0.20-0.50 mg/ kg PO OD for 5 days.

Indication:

  • Productive cough.
  • Respiratory tract infection.

Contraindication:

  • Hypersensitivity to drug.
  • Pulmonary edema.

Brands:

  • Bromox-Tr 500ml/1liter suspension ( Sriwalls Health Care India).

Composition::

Each 5ml contains Terbutaline Sulphate  1.5 mg  ,Bromhexine Hydrochloride 4 mg   and Menthol  1 mg.

  • Enrotas-Bh 100ml solution( Intas India).

Composition:

Each ml contains Enrofloxaxin 100mg and Bromhexine 7.5 mg.

  • Levo -Bh 250ml/500ml/1000ml solution( Sonia Enterprises India).

Composition::

Each ml contains Levofloxacin Hemihydrate 125 mg, Bromhexine hcl 7.5 mg , Nicotinamide 5 mg.

  • Bromhexine 500ml Syrup( Laxicare Pharma India).

Composition:

Each ml contains Levofloxacin 100 mg and Bromhexine hcl 7.5 mg.