In order to ensure maximum safety of treatment, as well as to maintain control over the symptoms and to select the minimum effective doses, it is necessary to carry out constant monitoring of the patient's condition.
The use, especially prolonged, of drugs for topical application can cause sensitization,and in exceptional cases - the development of systemic side effects. In any of these cases, you should stop treatment and begin appropriate therapy.
When using inhaled glucocorticosteroids, do not exceed the recommended doses: in the case of non-curable bronchospasm, additional doses of the beta2-adrenoreceptor agonist may be required.
Treatment of patients already taking systemic GCS requires special care and careful monitoring of such patients, since recovery of adrenal function, suppressed by long-term administration of systemic SCS, is slow. Before starting the use of SabaComb®, the patient's condition should be stabilized by taking systemic GCS. First the preparation SabaComb® should be used simultaneously with the administration of systemic SCS, then their dose should gradually decrease under regular monitoring of the patient's condition (in particular, the adrenal function should be periodically performed), followed by correction of the dosage regimen of the SabaComb® preparation in accordance with the results of the studies.Patients who were transferred to receive inhaled GCS should receive additional systemic GCS during stress or severe attacks of bronchial asthma.
In patients with increased sensitivity to the effects of sympathomimetics, the latter should be used with extreme caution. In patients with coronary heart disease, rhythm disturbances, arterial hypertension, as well as in patients with glaucoma, hyperthyroidism, pheochromocytoma, diabetes mellitus and benign prostatic hyperplasia, the drug should be used only in case of emergency.
In the postmarketing use of the drug, there were few reports of rare cases of myocardial ischemia associated with the use of salbutamol. Patients with severe heart disease (eg, ischemic cardiomyopathy, tachyarrhythmia or severe heart failure) who receive salbutamol for respiratory diseases, should be warned about the need to inform the doctor about the occurrence of chest pains or heavier symptoms of heart disease.
With inhaled use of GCS, especially at high doses and for a long time, some systemic effects of SCS, the occurrence of which with inhalation mode of administration is less likely than with oral glucocorticosteroid therapy, may develop. Possible systemic effects of SCS are: exogenous Cushing's syndrome, suppression of adrenal function, growth retardation in children and adolescents, decreased bone mineral density, cataracts, glaucoma and, more rarely, various psychological or behavioral disorders, including psychomotor hyperactivity, sleep disorders, anxiety , depression or aggression. Thus, it is important to apply the minimum effective doses of inhaled glucocorticosteroids necessary for the control of bronchial asthma.
The initial and nonspecific symptoms of adrenal insufficiency are: anorexia, abdominal pain, weight loss, fatigue, headache, nausea, vomiting. Specific symptoms of adrenal insufficiency with the use of inhaled glucocorticosteroids are: hypoglycemia with turbidity and / or convulsions.Development of adrenal crises can cause: trauma, surgery, infection and rapid dose reduction. Patients taking high doses of the drug SabaComb® require careful medical supervision, and a reduction in its dose should be gradual. It may also be necessary to determine the adrenal reserve.
It should be noted that this drug contains a small amount of ethanol (about 8 mg in a single dose) (see the section "With caution" and "Interaction with other drugs").