Adult Dosing
Maintenance treatment, Asthma
- Prior bronchodilator alone: Start 220 mcg INH qpm; can increase to 440 mcg/day div daily-bid. [Max: 440 mcg/day]
- Prior inhaled steroids: Start 220 mcg INH qpm; can increase to 440 mcg/day div daily-bid. [Max: 440 mcg/day]
- Prior oral steroids: Start 440 mcg INH bid; taper oral steroids gradually after 1 wk. [Max: 880 mcg/day]
Note: Rinse mouth after use
Pediatric Dosing
- Note: Safety and effectiveness in children < 4 yrs of age have not been established
Maintenance treatment, Asthma
Child 4-11 yrs
- 110 mcg INH qpm [Max: 110 mcg/day]
Child 
12 yrs
- Prior bronchodilator alone: Start 220 mcg INH qpm; can increase to 440 mcg/day div daily-bid. [Max: 440 mcg/day]
- Prior inhaled steroids: Start 220 mcg INH qpm; can increase to 440 mcg/day div daily-bid. [Max: 440 mcg/day]
- Prior oral steroids: Start 440 mcg INH bid; taper oral steroids gradually after 1 wk. [Max: 880 mcg/day]
Note:
- Rinse mouth after use
- Titrate to lowest effective dose and monitor patients for signs of asthma instability, adrenal insufficiency following discontinuation of oral steroid therapy. Advise patients to rinse mouth after use due to the risk of development of Candida albicans infection of the mouth and pharynx
[Outline]
See Supplemental Patient Information
- It is not a bronchodilator and hence not indicated for rapid relief of bronchospasm or other acute episodes of asthma
- May result in the development of glaucoma and/or cataracts; close monitoring is recommended in patients with a change in vision or with a history of increased intraocular pressure, glaucoma, and/or cataracts
- May cause hypersensitivity reactions including instances of wheezing; discontinue spray if such reactions occur
- If exposed to measles or chickenpox, consider anti-infective prophylactic therapy
- Corticosteroids may cause reduction in growth velocity in pediatric patients. Monitor growth routinely in pediatric patients
- Chronic use may cause reduction in bone mineral density; monitor patients with major risk factors for decreased bone mineral content
- Monitor for hypercorticism and Adrenal Suppression (if occur discontinue gradually)
- In long term treatment, periodically perform nasal examinations due to the risk of nasal septal perforation and localized infections
- Hypoadrenalism may occur in infants born to women receiving corticosteroids during pregnancy. Such infants should be carefully monitored
- Discontinue if nasopharyngeal candida infection occurs and appropriate local or systemic therapy instituted, if required
- Discontinue if Paradoxical bronchospasm occurs and treat bronchospasm immediately with a fast acting inhaled bronchodilator
- Immunosuppression may result in more susceptibility to infections
Cautions: Use cautiously in
Supplemental Patient Information
- Advise patients to rinse mouth after use due to the risk of development of Candida albicans infection of the mouth and pharynx
- Advise patients to maintain regular regimen
- Persons on immunosuppressant doses of corticosteroids should be warned to avoid exposure to chickenpox or measles; advise patients that if they are exposed, medical advice should be sought without delay
Pregnancy Category:C
Breastfeeding: Safety unknown; however amounts of inhaled corticosteroids that are excreted in breastmilk are too small to affect a breastfed infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 15 January 2011). Manufacturer advises caution.
