Discontinue use if signs suggesting allergic reactions [particularly angioedema (including difficulties in breathing or swallowing, swelling of tongue, lips & face), urticaria or skin rash] or paradoxical bronchospasm occurs. Avoid abrupt discontinuation of treatment. Not indicated for acute bronchospasm episodes or acute disease exacerbation (ie, as rescue therapy). Patients w/ cardiac arrhythmias especially 3rd-degree AV block & tachyarrhythmias (accelerated &/or irregular heartbeat including atrial fibrillation), idiopathic subvalvular aortic stenosis, hypertrophic obstructive cardiomyopathy, severe heart disease (particularly acute MI, ischemic heart disease, CHF), occlusive vascular diseases (particularly arteriosclerosis), arterial HTN & aneurysm; known or suspected prolongation of QTc interval; thyrotoxicosis, DM, pheochromocytoma & untreated hypokalemia; active or quiescent pulmonary TB, fungal & viral infections in the airways; narrow-angle glaucoma, prostatic hyperplasia or urinary retention. Pneumonia in patients w/ COPD. Possible systemic effects (particularly at high doses) including Cushing's syndrome, Cushingoid features, adrenal suppression, growth retardation, decreased bone mineral density & more rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression (particularly in childn). Stepping-down treatment. Monitor serum K levels; blood glucose levels in patients w/ diabetes. Rinse mouth or gargle w/ water w/o swallowing or brush the teeth after inhalation of dose to reduce risk of oropharyngeal Candida infection. Consider referral to ophthalmologist for evaluation of possible causes if patient presents w/ symptoms eg, blurred vision or other visual disturbances. Not to be administered for at least 12 hr prior to start of halogenated anesth. Not recommended in long-term co-administration w/ other anticholinergic-containing medicinal products. Concomitant use w/ other medicinal products which can induce hypokalemia eg, xanthine derivatives, steroids & diuretics. Contains ethanol which may have potential interaction in particularly sensitive patients taking disulfiram or metronidazole. Severe renal impairment (GFR <30 mL/min/1.73 m
2) or ESRD (GFR <15 mL/min/1.73 m
2) requiring dialysis. Severe hepatic impairment (Child-Pugh class C). Avoid use during pregnancy & labour. Lactation. Childn <18 yr.
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