Inhaled Corticosteroid Comparative DosingPatients 12 years who received bronchodilators alone. Patients 12 years who received inhaled corticosteroids. Patients 12 years who received oral corticosteroids 1. Prednisone should be reduced gradually, no faster than inhaled corticosteroids conversion chart. Patients should be carefully monitored for signs of asthma instability, including monitoring of serial objective measures of airflow, and for signs of adrenal insufficiency during steroid taper and following discontinuation of oral corticosteroid therapy.
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Patients 12 years who received bronchodilators alone. Patients 12 years who received inhaled corticosteroids. Patients 12 years who received oral corticosteroids 1. Prednisone should be reduced gradually, no faster than 2. Patients should be carefully monitored for signs of asthma instability, including monitoring of serial objective measures of airflow, and for signs of adrenal insufficiency during steroid taper and following discontinuation of oral corticosteroid therapy.
QVAR is also indicated for asthma patients who require systemic corticosteroid administration, where adding QVAR may reduce or eliminate the need for the systemic corticosteroids.
Beclomethasone dipropionate is NOT indicated for the relief of acute bronchospasm. Hypersensitivity to any of the ingredients of this preparation contraindicates its use. Avoid spraying in the eyes or face when priming QVAR. QVAR is a solution aerosol, which does not require shaking.
Consistent dose delivery is achieved, whether using the 40 or 80 mcg strengths, due to proportionality of the 2 products i. QVAR should be administered by the oral inhaled route in patients 5 years of age and older.
The onset and degree of symptom relief will vary in individual patients. Improvement in asthma symptoms should be expected within the first or second week of starting treatment, but maximum benefit should not be expected until 3 to 4 weeks of therapy.
For patients who do not respond adequately to the starting dose after 3 to 4 weeks of therapy, higher doses may provide additional asthma control. The safety and efficacy of QVAR when administered in excess of recommended doses has not been established. Recommended Dosing for Adults and Adolescents: Recommended Dosing for Children 5 to 11 Years: Patient's Previous Therapy Recommended Starting Dose Highest Recommended Dose Bronchodilators Alone 40 mcg twice daily 80 mcg twice daily Inhaled Corticosteroids 40 mcg twice daily 80 mcg twice As with any inhaled corticosteroid, physicians are advised to titrate the dose of QVAR downward over time to the lowest level that maintains proper asthma control.
This is particularly important in children since a controlled study has shown that QVAR has the potential to affect growth in children. Patients should be instructed on the proper use of their inhaler. Patients Not Receiving Systemic Corticosteroids Patients who require maintenance therapy of their asthma may benefit from treatment with QVAR at the doses recommended above.
In patients who respond to QVAR, improvement in pulmonary function is usually apparent within 1 to 4 weeks after the start of therapy. Once the desired effect is achieved, consideration should be given to tapering to the lowest effective dose. Patients Maintained on Systemic Corticosteroids QVAR may be effective in the management of asthmatics maintained on systemic corticosteroids and may permit replacement or significant reduction in the dosage of systemic corticosteroids.
The patient's asthma should be reasonably stable before treatment with QVAR is started. Initially, QVAR should be used concurrently with the patient's usual maintenance dose of systemic corticosteroids. After approximately one week, gradual withdrawal of the systemic corticosteroids is started by reducing the daily or alternate daily dose. Reductions may be made after an interval of one or two weeks, depending on the response of the patient. A slow rate of withdrawal is strongly recommended.
Generally these decrements should not exceed 2. During withdrawal, some patients may experience symptoms of systemic corticosteroid withdrawal, e. Such patients should be encouraged to continue with the inhaler but should be monitored for objective signs of adrenal insufficiency.
If evidence of adrenal insufficiency occurs, the systemic corticosteroid doses should be increased temporarily and thereafter withdrawal should continue more slowly. During periods of stress or a severe asthma attack, transfer patients may require supplementary treatment with systemic corticosteroids. QVAR 40 mcg is supplied either in a 7. QVAR 80 mcg is supplied either in a 4.
The correct amount of medication in each inhalation cannot be assured after 50 actuations from the 4. The canister should be discarded when the labeled number of actuations have been used. Store QVAR Inhalation Aerosol when not being used, so that the product rests on the concave end of the canister with the plastic actuator on top.
For optimal results, the canister should be at room temperature when used. Individual patients will experience a variable onset and degree of symptom relief.
After approximately one week, gradual withdrawal of the systemic corticosteroid is started by reducing the daily or alternate daily dose. The next reduction is made after an interval of one or two weeks, depending on the response of the patient. Generally, these decrements should not exceed 2. During reduction of oral corticosteroids, patients should be carefully monitored for asthma instability, including objective measures of airway function, and for adrenal insufficiency see WARNINGS.
In all patients it is desirable to titrate to the lowest effective dose once asthma stability is achieved. The inhaler is protected by a white outer tubular cover screwed onto the inhaler.
The body of the inhaler is white and the turning grip is brown. Maintenance treatment of asthma as prophylactic therapy in adult and adolescent patients 12 years of age and older. Inhaler includes a built-in spacer. Do not use with external spacers or holding chambers. Adults and adolescents 12 years: The recommended starting dose is mcg twice daily. Do not exceed mcg twice daily. Children 6 - 11 years: The recommended starting dose is 80 mcg twice daily. Administer under adult supervision.
Maintenance treatment of asthma as prophylactic therapy in patients aged 4 years and older. Treatment of asthma for patients requiring oral corticosteroid therapy.
Click links for more info. Fluticasone furoate is a synthetic trifluorinated corticosteroid with anti-inflammatory activity. Fluticasone furoate has been shown in vitro to exhibit a binding affinity for the human glucocorticoid receptor that is approximately The clinical relevance of these findings is unknown.
The precise mechanism of corticosteroid action on asthma is not known. Inflammation is an important component in the pathogenesis of asthma. Corticosteroids have been shown to have a wide range of actions on multiple cell types e. These anti-inflammatory actions of corticosteroids contribute to their efficacy in asthma. Though effective for the treatment of asthma, corticosteroids may not affect symptoms immediately. Individual patients will experience a variable time to onset and degree of symptom relief.
Maximum benefit may not be achieved for 1 to 2 weeks or longer after starting treatment. When corticosteroids are discontinued, asthma stability may persist for several days or longer. Trials in subjects with asthma have shown a favorable ratio between topical anti-inflammatory activity and systemic corticosteroid effects with recommended doses of orally inhaled fluticasone furoate.
This is explained by a combination of a relatively high local anti-inflammatory effect, negligible oral systemic bioavailability approximately 1.
Important Limitation of Use: Disposable light grey and orange plastic inhaler containing a foil blister strip of powder intended for oral inhalation only. Each blister contains fluticasone furoate or mcg. Instruct patients to inhale rapidly and deeply. Advise patients to rinse the mouth after inhalation.
Maximum benefit may not be achieved for 1 to 2 weeks or longer after initiation of treatment. After asthma stability has been achieved, it is desirable to titrate to the lowest effective dosage to reduce the possibility of side effects.
Prednisone should be reduced no faster than 2. Monitor patients carefully for signs of asthma instability, including serial objective measures of airflow, and for signs of adrenal insufficiency during steroid taper and following discontinuation of oral corticosteroid therapy. Patients should be carefully monitored for signs of asthma instability, including serial objective measures of airflow, and for signs of adrenal insufficiency.
Once prednisone reduction is complete, the dosage of mometasone furoate should be reduced to the lowest effective dosage. Instructions for Use Patients should be instructed to record the date of pouch opening on the cap label and discard the inhaler 45 days after opening the foil pouch or when the dose counter reads "00" and the final dose has been inhaled, whichever comes first.
The inhaler should be held upright while removing the cap. The medication should be taken as directed, breathing rapidly and deeply, and patients should not breathe out through the inhaler.
The mouthpiece should be wiped dry and the cap replaced immediately following each inhalation and rotated fully until the click is heard. Rinsing of mouth after inhalation is advised.
Patients should store the unit as instructed. The dose counter displays the doses remaining. When the dose counter indicates zero, the cap will lock and the unit must be discarded.
Patients should be advised that if the dose counter is not working correctly, the unit should not be used and it should be brought to their physician or pharmacist. Please review the latest applicable package insert for additional information and possible updates.
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