PAlu ent sulphate~~orciprenaline the beta2bronchodilator PRESCRIBING INFORMATION Indications Alupent is indicated for the treatment of bronchospasm associated with. bronchial asthma. chronic bronchitis. pulmonaryemphysema. silicosis, tuberculosis, sarcoidosis, carcinoma of the lung. 1E Dosage As with all drugs, the ideal dosage of Alupent varies from patient to patient. The following recommended dosages represent general guidelines which will be found suitable for the majority of patients, Alupent Tablets 20 mg Ages 4-12, 10 mg (CX tablet) t.li.d above 12. 20 mg (1 tablet) t.i.d.-qi d Alupent Syrup 10 mg/5 ml Ages 4-12. 10 mg (one teaspoonful) t d. above 12. 20 mg (two teaspoonfuls) t i.d - q.i.d Alupent Metered Aerosol One to two inhalations will usually provide control of an acute attack of bronchospasm for periods of 5 hours or longer As a general rule, patients should not exceed a total of 12 inhalations per day Alupent Solution 5% Hand nebulizer 5 to 15 inhalations of 5% solution by hand nebulizer DeVilbiss No. 40 or 42 administered up to three times daily. Intermittent positive pressure breathing: Vi to 1 cc of 5% solution diluted if desired and administered over a period of about 20 minutes. A friend, whose advice I usually re- that perhaps your friend felt it would Side Eftects be In the recommended dosage, adverse reactions to Alupent are infre- spect, recently tried to convince me better to have the $145,000 in your quent. Mild tachycardia. nausea, vomiting, palpitations, minimal hy- pertension, nervousness, bad taste and tremor have been reported. that I would be better off in the long hands with no obligations to buy an Precautions run by an after-tax savings plan, rather annuity, than to receive a taxable In acute tests, Alupent has shown minimal effect on blood pressure and pulse The drug should be used with care, however in asthmatic than a registered retirement savings $500,000. He did point out that even or emphysematous patients who also have systemic hypertension, coronary artery disease, acute and recurring congestive heart failure, plan tax-free investment of $4,000 per with this premise the registered retire- diabetes mellitus. glaucoma or hyperthyroidism. Extreme care must also be exercised in the concomitant use of Alupent with epinephrine year. I have 25 years to go to age 65, ment savings plan is better. He calcu- or MAO inhibitors Warnings and I can't quite see his logic, but I lated that the income tax on $500,000 Alupent should pot be administered to pregnant women or to women (what you would receive if the plan of childbearing potential unless in the opinion of the physician the suppose he might have a point. expected benefits outweigh the possible risks to the foetus. In rabbits, high oral doses (100 mg kg) and low subcutaneous doses (0.2 mg kg) What do you think? Suppose I were cashed in) would be about have resulted in malformed offspring in some experiments, but not in others. Studies in the rat, mouse and rhesus monkey have shown no invest $2,000 ($4,000 less tax) per $300,000, leaving a net of $200,000 as adverse effect on the developing foetus. Other sympathomirnetic drugs tested, viz., ephedrine and phenylephrine produced teratogenic effects year for 25 years, and have a practi- opposed to $145,000. in the rabbit when given orally at high doses as did isoproterenol given subcutaneously at low doses. The significance of these findings is not cally taxfree return at age 65, would I known However, clinical evidence presently available from the use of Alupent be better off in the end than with a in pregnancy is limited taxable income by investing $4,000 Occasional patients have been reported to have developed severe paradoxical airways resistance with repeated excessive use of sym- tax free in a registered retirement plan pathomimetic inhalation preparations The cause of this refractory state is unknown. It is advisable that in such instances the use of the preparation be discontinued immediately and alternative therapy insti- for the same 25 years? tuted. since in the reported cases the patients did not respond to other forms of therapy until the drug was withdrawn. Fatalities have been J. H. reported following excessive use of isoproterenol inhalation prepara- tions and the exact cause is unknown. Cardiac arrest was noted in Winnipeg Do you think this is a good time to several instances. start a Paflents should be advised to seek medical aid in the event that they building program? do not respond to their usual dose of a sympathomimetic amine tax rates aerosol. The failure to respond may be due to retention of viscid No one can predict 25 D.P. bronchial secretions. associated with an allergic or infective exacerba- tion of the patient's condition Increased airways resistance on the basis years from now, nor can one accurat- Quebec of bronchospasm alone is reversed promptly by bronchodilators, and if this does not occur. a more serious condition should be suspected. ely predict growth of the investment Admission to hospital for intensive support of the cardiovascular and respiratory systems may be necessary. over 25 years. Your friend may feel it I don't think I can give you a good Contraindications is better to know you will pay no tax, answer to your question. Mortgage Known sensitivity to the drug or other sympathomimetic amines. The use of Alupent and other beta stimulators is generally considered to than to await an unknown tax situa- interest rates are very high just now, be contraindicated in patients with cardiac arrhythmias associated with tachycardia. tion. It is however possible to make while building materials are expensive Beta blocking agents. e.g. propranolol, effectivelyantagonize the action of Alupent. Their concomitant use. except in the treatment of accidental some comparisons. Suppose you invest and scarce in some areas. How to overdosage is therefore contraindicated. $4,000 tax-free money each year for predict future trends is beyond my Availability Alupent 20 mg tablets are available as round, white. single scored 25 years at approximately 11 percent capabilities, but on the assumption compressed tablets. They are printed on one side with the Boehringer symbol, Supplied in bottles of 50 and 500. interest compounded yearly. You that inflation will continue to spiral Alupent Syrup isclear, sugar-free and woodruff flavoured 5ml contains 10 mg of active ingredient would accumulate just over $500,000. and costs increase rather than de- Supplied in bottles of 125 ml, The annual income by purchasing crease, perhaps now is the time to Alupent Metered Aerosol is supplied as a 15 ml metal vial (with free disposable mouthpiece) containing 300 individual doses Each de- an annuity would be between build before things get worse. If pression of the valve releases 0 75 mg of active ingredient as a micron- ized powder. $51-52,000. Income Tax payable money continues to depreciate in Alupent Solution 5% is supplied in bottles containing 7.5 ml would be about $22,000, leaving value, a fixed debt incurred now, even For full prescribing information. consult the Alupent Product Mono- graph. about $30,000 per year after-tax in- at high interest rates, will decrease REFERENCES come. By investing $2,000 per year proportionately with the rate of infla- 1 Bilodeau. M. & Roy. J.C.: C.M A.J. 99585. 1968 2 Shanks. R.G. (after deducting tax from $4,000) you tion. By this I mean that a debt of et at Brit Med J 1-160. 1967. 3. Redwood. D Brit Med J. 1419, 1968. 4. Howard, LrA. & Coleman. M. American Coll. of All. Meeting. would accumulate about $145,000. $100,000 incurred now when your March 22. 1967 5 Pelz. H.H.: Amer J. Med. Sci 253 321, 1967 6. Kessler, F. & Weisinger. P.I Ann Allergy 28:176. 1970 7. Morton, The annuity income, mostly tax free, after-tax income is is still J.W. & Ostensoe, L.G.: J, Allergy 3416, 1963. 8 Choo-Kang, Y.F.H. $30,000 et al Brit Med. J. 2 287. 1969. 9. Holmes, T.H. & Morton, B.. Clin. Pharm. Ther. 9 615. 1968. 10. Rebuck, A. & Read, J. Med. J. of Aunt., on $145,000 would be about $15,000 $100,000 ten years hence when infla- 445, 1969 11. Simon. S. 8 Lipman, W. Ann. of Allergy. 260. 1963. per year. So under the given circum- tion has pushed your after-tax income ~~Boehringer Ingelheim stances it appears that after-tax in- up to $50,000. Thus you have (iIIIiiil (Canada) Ltd. come would be about double from the $50,000 per year to apply against the \BOEHRIN6ERJ/ 2121 Trans Canada Highway registered retirement savings plan, $100,000 debt. I hope you can follow \JBLEH Dorval 740, P0.Q.BR7 compared to an after-tax savings pro- this reasoning, but I don't think any- 1_ ....,~~~~~~~9R7 gram. one can give a comforting answer to One consultant I questioned said your auestion. < CANADIAN FAMILY PHYSICIAN/JUNE, 1974 33.