Procaterol Hydrochloride: Indication and Clinical Use
Procaterol hydrochloride 25 mcg (note: not 25mg) is a selective beta-2 adrenergic bronchodilator used for the treatment of reversible airway obstruction in patients with asthma and chronic obstructive pulmonary disease (COPD). 1, 2
Mechanism and Pharmacology
- Procaterol is a potent beta-2 adrenergic receptor agonist that induces bronchodilation by selectively stimulating beta-2 receptors in the airways 1, 3
- The drug demonstrates high selectivity for beta-2 receptors, minimizing cardiac beta-1 effects 2
- Bronchodilation begins within 30 minutes of administration, peaks at 1.5-3 hours, and maintains effect for at least 5-8 hours 1, 4
Dosing and Administration
Oral Formulation
- The effective oral dose is 0.05-0.10 mg (50-100 mcg) administered twice daily 1, 4
- The 0.10 mg twice-daily dose demonstrates superior efficacy compared to lower doses, with sustained bronchodilation at 8 hours post-dose 1
- Critical dosing clarification: The medication is dosed in micrograms (mcg), not milligrams (mg)—25mg would represent a 250-fold overdose 1
Inhaled Formulation
- Metered-dose inhaler delivers 0.01 mg (10 mcg) per inhalation 5
- Recommended dosing is 1-2 inhalations (10-20 mcg) three times daily 5
- Dry powder inhaler formulation delivers 20 mcg per inhalation 3
Clinical Efficacy
- Procaterol produces statistically significant improvements in FEV1, FVC, and FEF25-75 compared to placebo (p<0.05) 1, 5
- Mean FEV1 improvement reaches 29-35% at 2 weeks of treatment 5
- The drug demonstrates superior efficacy and longer duration of action compared to albuterol, with no evidence of tolerance during 12 weeks of continuous treatment 4
- Albuterol shows diminished duration of response with long-term use, while procaterol maintains consistent bronchodilation 4
Safety Profile and Adverse Effects
- Tremor and nervousness are the most common side effects, occurring in a dose-related manner 1, 5
- These effects are typically mild, transient, and occur early in treatment 1
- No clinically significant changes occur in ECG parameters, heart rate, blood pressure, or laboratory values 1, 5
- The medication is well-tolerated in patients with documented reversible airway disease 2, 4
Contraindications and Precautions
- Avoid in patients with reactive airways disease or COPD when beta-blockers are contraindicated (based on general beta-agonist principles from 6)
- Use caution in patients with cardiovascular disease, given the beta-adrenergic mechanism of action 1
- Monitor for excessive tremor or tachycardia, particularly during dose titration 1, 5
Common Prescribing Error
The most critical pitfall is confusing milligrams with micrograms—procaterol is dosed in micrograms (mcg), with typical doses of 50-100 mcg orally or 10-20 mcg inhaled, never in milligram quantities. 1, 3