What is the recommended dosage of procaterol for asthma and COPD?

Procaterol Dosing for Asthma and COPD

For asthma, procaterol should be dosed at 50 micrograms twice daily orally, which can be increased to 100 micrograms twice daily if needed for optimal bronchodilation. 1, 2

Oral Formulation Dosing

• Standard starting dose: 50 micrograms (0.05 mg) twice daily orally 1, 2
• Higher dose option: 100 micrograms (0.10 mg) twice daily for patients requiring greater bronchodilation 1, 2
• The 100 microgram dose generally provides more effective bronchodilation and higher daily peak flow rates compared to the 50 microgram dose 2
• Bronchodilation is evident within 30 minutes, peaks at 2 hours, and maintains effect above baseline for at least 8 hours after the 100 microgram dose 2

Inhaled Dry Powder Formulation

• Single dose: 20 micrograms via dry powder inhaler (DPI) 3, 4
• The inhaled route provides rapid bronchodilation comparable to other beta-2 agonists like salbutamol 4
• FEV1 measurements should be obtained at baseline and at 15,30,60,90,120,180,240,360, and 480 minutes post-dose to assess response 3

Pharmacokinetic Considerations

• Procaterol demonstrates dose-proportional pharmacokinetics across the 25-100 microgram range 5
• Peak plasma concentrations (tmax), elimination rate, and renal clearance remain consistent across dosage levels 5
• The twice-daily regimen is appropriate given the drug's pharmacokinetic profile 1, 5

Comparative Efficacy Context

While procaterol is effective, the European Respiratory Society guidelines indicate that beta-2 agonists as a class have comparable or less bronchodilator effect than anticholinergic agents in COPD, though individual patient responses vary 6. The choice between beta-2 agonists should consider patient preference, cost, and adverse effect profile 7.

Adverse Effects and Monitoring

• Common side effects: Tremor and nervousness occur in a dose-related frequency but are typically mild, transient, and occur early in treatment 2
• Cardiovascular effects: Slight increases in heart rate and systolic blood pressure may occur, particularly with the inhaled formulation 4
• Other effects: Tachycardia, skeletal muscle tremor, hypokalemia, hyperglycemia, and headache are possible 6
• No significant drug-related changes in ECGs, blood pressure, or laboratory data have been documented at therapeutic doses 2

Important Contraindications

Avoid procaterol and all beta-agonists in patients with asthma, obstructive airway disease, decompensated heart failure, and pre-excited atrial fibrillation or flutter 6. This contraindication applies when procaterol might be confused with beta-blockers in acute cardiac settings.