Discontinue use if immediate hypersensitivity reactions & paradoxical bronchospasm occur. Not indicated for acute bronchospasm epidoses or COPD exacerbation. Pneumonia in patients w/ COPD. Cardiac arrhythmias especially 3rd-degree AV block & tachyarrhythmias, idiopathic subvalvular aortic stenosis, hypertrophic obstructive cardiomyopathy, severe heart disease (eg, acute MI, ischaemic heart disease, CHF), occlusive vascular diseases (eg, arteriosclerosis), arterial HTN, aneursym; known or suspected QTc interval prolongation; thyrotoxicosis, DM, pheochromocytoma, untreated hypokalaemia; Cushing's syndrome, Cushingoid features, adrenal suppression, growth retardation, decreased bone mineral density, cataract, glaucoma, psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression (particularly in childn); active or quiescent pulmonary TB, fungal & viral airway infections; narrow-angle glaucoma, prostatic hyperplasia or urinary retention. Risk of oropharyngeal Candida infection. Evaluate for possible causes of visual disturbances. Monitor serum K & blood glucose levels. Avoid abrupt w/drawal. High-dose & long-term use. Not to be administered for at least 12 hr prior to halogenated anaesth. Not recommended w/ other anticholinergic-containing medicinal products. Concomitant use w/ xanthine derivatives, steroids & diuretics. Severe hepatic & renal impairment; ESRD requiring dialysis. Avoid use during pregnancy & labour. Lactation. Paed <18 yr.
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