Dosing

Asthma: Maintenance

Type	Age Range	Dose	Licensed
Maintenance	From 12 years to 18 years	2 actuations - TWICE a DAY - inhalation - using a metered dose device
Maintenance	From 18 years	2 actuations - TWICE a DAY - inhalation - using a metered dose device

Safety Advice Warnings

Adverse effects (report/action)

• COPD - symptomatic decompensation may follow cessation of therapy
• High doses may cause adrenal suppression/bone metabolism changes
• If growth in children is slowed, consider referral to a paediatrician
• If visual disturbances occur, perform ophthalmic evaluation
• May decrease glucose tolerance in patients with diabetes mellitus
• May reduce serum potassium levels
• Systemic effects possible with any inhaled corticosteroid

Advice concerning formulation

• Not all available brands are indicated for all uses
• Not all available brands are licensed for all age groups
• Not all strengths are suitable for use in children under 18 years

Advice on Administration

• Consider use of a spacer device for suitable patients and formulations

Advice on drug withdrawal

• Do not withdraw this drug suddenly

Advice on possible excipients

• Some formulations contain lactose

Discontinue due to test or exam

• Discontinue if paradoxical bronchospasm occurs

Dose changes (other conditions)

• Maintain treatment at the lowest effective dose

Patient Counselling

• Advise patient not to reduce steroid therapy without medical advice
• Advise patient not to use for relief of acute attacks
• Advise patient to rinse mouth with water after each dose
• Advise patient to seek medical advice if treatment is ineffective
• Consider issuing Steroid Treatment/Steroid Emergency Card
• Ensure patient has a fast acting bronchodilator available
• High dose:Advise patient to avoid chickenpox,measles etc; see Dr if exposed
• Patient should seek medical advice if signs of pulmonary infection develop
• Use regularly to maintain freedom from symptoms

Pre-treatment points to consider

• Correct electrolyte disorders before treatment
• Therapy should not be initiated during exacerbation of asthma

Recommended monitoring

• Check patient is using correct inhaler technique
• Consider adrenal suppression when transferring from systemic steroid
• Consider monitoring ECG in patients at risk of QT prolongation
• Monitor adrenal function in stressed patients e.g.surgery/intensive care
• Monitor for signs/symptoms of pneumonia in patients at risk
• Monitor regularly the height of children receiving prolonged treatment
• Monitor serum K+ in patients on high dose steroids/xanthines/diuretics
• Monitor serum electrolytes
• Re-evaluate therapy in active or quiescent pulmonary tuberculosis

Safety/advice in other condition

• Systemic corticosteroids may be needed during elective surgery
• Systemic corticosteroids may be needed during periods of stress

Drug Interactions

With	Risk	Severity
(LEVACETYLMETHADOL)	Hypokalaemia with high dose beta-agonist increases risk of arrhythmias	Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
ATOMOXETINE	May increase risk of cardiac effects	Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
DOMPERIDONE	Predisposing factors may increase risk of arrhythmias	Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
METHACHOLINE	Methacholine effect reduced; review dosing, see product literature	Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
SOTALOL	Effect antagonised/ predisposing factors increase risk of arrhythmias	Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
(ASTEMIZOLE)	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
(HALOFANTRINE)	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
(RETIGABINE)	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
(SODIUM STIBOGLUCONATE)	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AJMALINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AMIFAMPRIDINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AMIODARONE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ANAGRELIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ARSENIC TRIOXIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ARTEMETHER AND LUMEFANTRINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AVAPRITINIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AZITHROMYCIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CHLOROQUINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CILOSTAZOL	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CIPROFLOXACIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CITALOPRAM / ESCITALOPRAM	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CLARITHROMYCIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
COCAINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DELAMANID	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DISOPYRAMIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DONEPEZIL	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DRONEDARONE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DROPERIDOL	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ENTRECTINIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ERYTHROMYCIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ETELCALCETIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
FLECAINIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
FLUCONAZOLE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
GLASDEGIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
HALOPERIDOL	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
HYDROXYCHLOROQUINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
HYDROXYZINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
IBUTILIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
INOTUZUMAB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
IVOSIDENIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
LEVOFLOXACIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
MELPERONE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
METHADONE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
MOBOCERTINIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
MOXIFLOXACIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ONDANSETRON	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
OSILODROSTAT	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
OSIMERTINIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
OXALIPLATIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PAPAVERINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PENTAMIDINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PHENOTHIAZINES (QT 1)	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PIMOZIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PIPERAQUINE AND ARTENIMOL	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PRALSETINIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PROPOFOL	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
QUINIDINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
SELPERCATINIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
SERTINDOLE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
SEVOFLURANE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
SULPIRIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
TERLIPRESSIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
VANDETANIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ACE INHIBITORS WITH THIAZIDE DIURETICS	Increased risk of hypokalaemia with high doses of beta agonist	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ACETAZOLAMIDE	Increased risk of hypokalaemia with high doses of beta agonist	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ANGIOTENSIN II INHIBITORS AND THIAZIDE DIURETICS	Increased risk of hypokalaemia with high doses of beta agonist	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
BETA BLOCKER EYE DROPS	May antagonise effect of each other	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
BETA BLOCKERS	May antagonise effect of each other	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
BETA BLOCKERS AND THIAZIDE DIURETICS	May antagonise effect of each other	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
LOOP DIURETICS	Increased risk of hypokalaemia with high doses of beta agonist	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
THEOPHYLLINE	Increased risk of hypokalaemia with high doses of beta agonist	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
THIAZIDE DIURETICS	Increased risk of hypokalaemia with high doses of beta agonist	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.

Precautions

• Adrenal insufficiency
• Cardiac arrhythmias
• Children aged 4 to 18 years
• Diabetes mellitus
• Electrolyte imbalance
• Family history of long QT syndrome
• Galactosaemia
• Glucose-galactose malabsorption syndrome
• History of torsade de pointes
• Hypertension
• Hyperthyroidism
• Hypokalaemia
• Lactose intolerance
• Major risk factors for decreased bone mineral content
• Predisposition to hypokalaemia
• Pregnancy
• Pulmonary tuberculosis
• Severe cardiovascular disorder
• Thyrotoxicosis

Contraindications

• Breastfeeding
• Children under 4 years
• Long QT syndrome
• Torsade de pointes

Side Effects

• Adrenal suppression
• Aggression
• Anaphylactic reaction
• Anaphylactic shock
• Angina pectoris
• Angioedema
• Anxiety
• Arthralgia
• Atrial fibrillation
• Back pain
• Behavioural disturbances (children)
• Blurred vision
• Bronchitis
• Bronchospasm
• Candidiasis (mouth or throat)
• Cardiac arrhythmias
• Cataracts
• Central serous chorioretinopathy
• Contact dermatitis
• Contusion
• Cough
• Cushing's syndrome
• Cushingoid facies
• Cutaneous reactions
• Decrease in bone mineral density
• Depression
• Dizziness
• Dyspepsia
• Dysphonia
• Dyspnoea
• Extrasystoles
• Extremity pain
• Facial oedema
• Glaucoma
• Growth retardation (children)
• Headache
• Hoarseness
• Hyperactivity in children
• Hyperglycaemia
• Hypersensitivity reactions
• Hypokalaemia
• Influenza
• Irritability
• Laceration
• Muscular cramps
• Myalgia
• Nasal congestion
• Nasopharyngitis
• Oesophageal candidiasis
• Oropharyngeal oedema
• Oropharyngeal pain
• Palpitations
• Paradoxical bronchospasm (on inhalation)
• Pharyngitis
• Pneumonia
• Rhinitis
• Sinusitis
• Sleep disturbances
• Supraventricular tachycardia
• Systemic effects (large quantities and/or prolonged use)
• Tachycardia
• Throat irritation
• Traumatic fractures
• Tremor
• Upper abdominal pain
• Visual disturbances