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The Most Common Asthma Medications: Inhalers, Nebulizers


The Most Common Asthma Medications: Inhalers, Nebulizers

Asthma Medications

The Most Famous 5 drugs most Commonly used as Asthma Inhalers are:

1- Albuterol💊

2- Budesonide and Formoterol 💊 

3- Fluticasone and Salmeterol 💊

4- Ipratropium and Albuterol 💊

5- Tiotropium 💊

   

Albuterol

  • Brand Names: Ventolin
  • Therapeutic Category: Beta2 Agonist used as Asthma Medications
  • Dosage Forms: Aerosol Powder, Inhalation/ Nebulization Solution, Inhalation/ Oral syrup, tablet
  • Use: Labeled Indications: Bronchospasm/ Exercise-induced bronchospasm
  • Off Label: Hyperkalemia
  • Dosing : Bronchospasm: Oral inhalation :Metered-dose inhaler (MDI) or dry powder inhaler (90 mcg/actuation): 2 inhalations every 4 to 6 hours as needed
  • Pediatric: Asthma, acute exacerbation: Infants and Children ≤5 years:
  • Metered-dose inhaler: 90 mcg/actuation: Oral inhalation: 2 to 6 inhalations every 20 minutes for 2 to 3 doses, if initial response to 2 doses is good, administer 2 to 6 inhalations every 3 to 4 hours for 24 to 48 hours
  • Children ≥6 years and Adolescents: Metered-dose inhaler: 90 mcg/actuation: Oral inhalation: 2 to 10 inhalations every 20 minutes for 2 to 3 doses during the first hour ,if initial response to 2 doses is good, administer 2 to 6 inhalations every 3 to 4 hours for 24 to 48 hours
  • Dose Adjustments
  • Renal Impairment: No dosage adjustment
  • Hepatic Impairment: No dosage adjustment
  • Adverse Drug Interaction:
    Excitement/ nervousness/ Tremor/ Upper respiratory tract infection/ rhinitis
  • Pharmacodynamics/Kinetics:
  • Half-life elimination: Oral inhalation: 3.8 to 5 hours
  • Time to peak, serum: Nebulization solution: 30 minutes
  • Onset of action: Nebulization solution: ≤5 minutes
  • Important Notes:
  • CNS stimulation, hyperactivity, and insomnia occur more frequently in younger children than in adults. In children receiving oral albuterol therapy
  • Pregnancy & Lactation: crosses the placenta / not known if present in breast milk
  • Medication Safety Issues:

Salbutamol may be confused with salmeterol

Ventolin may be confused with phentolamine, Benylin, Vantin

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Budesonide and Formoterol

  • Brand Names: Symbicort
  • Therapeutic Category: Beta2 Agonist/ Corticosteroid
  • Dosage Forms: oral Inhalation
  • Use: Labeled Indications: Asthma Medications/ Chronic obstructive pulmonary disease
  • Off-Label: Asthma, acute exacerbations
  • Dosing: Asthma (maintenance): Oral inhalation: Starting dose is based on asthma severity. Budesonide 80 mcg/formoterol 4.5 mcg or budesonide 160 mcg/formoterol 4.5 mcg: Metered-dose inhaler: 2 inhalations twice daily; if response is inadequate, may increase to higher dose combination after 1 to 2 weeks (maximum: budesonide 160 mcg/formoterol 4.5 mcg: 2 inhalations twice daily).
  • Pediatric: Asthma; maintenance treatment: Oral inhalation: Children 5 to 11 years: Budesonide 80 mcg/formoterol 4.5 mcg: Two inhalations twice daily; maximum daily dose: 4 inhalations (Budesonide 320 mcg/formoterol 18 mcg)/day
  • Children ≥12 years and Adolescents:
  • Budesonide 80 mcg/formoterol 4.5 mcg: Two inhalations twice daily; maximum daily dose: 4 inhalations (Budesonide 320 mcg/formoterol 18 mcg)/day. In patients not adequately controlled following 1 to 2 weeks of therapy, consider the higher dose combination. Budesonide 160 mcg/formoterol 4.5 mcg: Two inhalations twice daily; maximum daily dose: 4 inhalations (Budesonide 640 mcg/formoterol 18 mcg)/day
  • Dose Adjustments
  • Renal Impairment: No dosage adjustment
  • Hepatic Impairment: No dosage adjustment
  • Adverse Drug Interaction:
    Headache/ Upper respiratory tract infection / Nasopharyngitis
  • Important Notes:
  • Adrenal suppression: Fluticasone may cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis in sensitive patients.
  • Asthma-related deaths: The use of long-acting beta-2 agonists (LABAs) as monotherapy is associated with an increased risk of asthma-related deaths.
  • Pregnancy & Lactation: Adverse events were observed in animal reproduction studies / not known if present in breast milk

 

 

Fluticasone and Salmetero

  • Brand Names: Advair Diskus
  • Therapeutic Category: Beta2 Agonist/ Corticosteroid
  • Dosage Forms: oral Inhalation
  • Use: Labeled Indications: Asthma Medications/ Chronic obstructive pulmonary disease
  • Dosing : Asthma: Advair Diskus: Dry powder inhaler: Initial: 1 inhalation of fluticasone propionate 100 mcg/salmeterol 50 mcg, or fluticasone propionate 250 mcg/salmeterol 50 mcg, or fluticasone propionate 500 mcg/salmeterol 50 mcg twice daily (maximum dose: 1 inhalation of fluticasone propionate 500 mcg/salmeterol 50 mcg twice daily)
  • Pediatric: Children 4 to 11 years: Fluticasone propionate 100 mcg/salmeterol 50 mcg: Oral inhalation: 1 inhalation twice daily.
  • Children ≥12 years and Adolescents: Oral inhalation:
  • The Fluticasone propionate 100 mcg/salmeterol 50 mcg: 1 inhalation twice daily.
  • In addition to, Fluticasone propionate 250 mcg/salmeterol 50 mcg: 1 inhalation twice daily.
  • Fluticasone propionate 500 mcg/salmeterol 50 mcg: 1 inhalation twice daily.
  • Dose Adjustments
  • Renal Impairment: No dosage adjustment
  • Hepatic Impairment: No dosage adjustment
  • Adverse Drug Interaction:
    Headache/ Upper respiratory tract infection /pneumonia/ Cardiac arrhythmia
  • Important Notes:
  • Adrenal suppression: Fluticasone may cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis in sensitive patients.
  • Asthma-related deaths: The use of long-acting beta-2 agonists (LABAs) as monotherapy is associated with an increased risk of asthma-related deaths.
  • Pregnancy & Lactation: Adverse events were observed in animal reproduction studies / not known if present in breast milk
  • Medication Safety Issues: Advair may be confused with Adcirca, Advicor

Ipratropium and Albuterol

Asthma Medications

  • Brand Names: Combivent Respimat
  • Therapeutic Category: Anticholinergic Agent/ Beta2 Agonist
  • Dosage Forms: Solution, for nebulization/ inhalation
  • Use: Labeled Indications: Chronic obstructive pulmonary disease
  • Off-Label: Asthma, acute exacerbations
  • Dosing: COPD: Oral inhalation: Soft-mist inhaler: One inhalation 4 times daily (maximum: 6 inhalations/day)
  • Nebulization solution: Initial: 1 vial (3 mL) (ipratropium bromide 0.5 mg/albuterol 2.5 mg) every 6 hours (maximum: 6 vials [18 mL]/day)
  • Pediatric: Infants and Children: Nebulization solution (ipratropium bromide 0.5 mg/albuterol 2.5 mg): Oral inhalation: 1.5 to 3 mL every 20 minutes for 3 doses, then as needed for up to 3 hours.
  • Adolescents: Nebulization solution (ipratropium bromide 0.5 mg/albuterol 2.5 mg): Oral inhalation: 3 mL every 20 minutes for 3 doses, then as needed for up to 3 hours.
  • Dose Adjustments
  • Renal Impairment: No dosage adjustment
  • Hepatic Impairment: No dosage adjustment
  • Adverse Drug Interaction:
    Angina pectoris/ cardiac arrhythmia/ Headache / pain / dizziness / fatigue / insomnia
  • Important Notes:
  • Bronchospasm: Paradoxical bronchospasm that may be life-threatening may occur with use of inhaled bronchodilating agents.
  • CNS effects: May cause dizziness and blurred vision; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving)
  • Pregnancy & Lactation: Risk Factor C/ not known if present in breast milk.
  • Medication Safety Issues:
  • DuoNeb may be confused with DuoTrav, Duovent UDV

 

Tiotropium

Asthma Medications

 

  • Brand Names: Spiriva
  • Therapeutic Category: Anticholinergic Agent
  • Dosage Forms: inhalation (Aerosol Solution/ Capsule)
  • Use: Labeled Indications: Asthma Medications/ Chronic obstructive pulmonary disease
  • Dosing: Asthma: Oral inhalation: Spiriva Respimat (1.25 mcg/actuation): Soft-mist inhaler: Two inhalations (2.5 mcg) once daily (maximum: 2 inhalations per 24 hours).
  • Pediatric: Asthma: Children ≥6 years of age and Adolescents: Inhalation: Spiriva Respimat (1.25 mcg/actuation)
  • Dose Adjustments
  • Renal Impairment: No dosage adjustment
  • Hepatic Impairment: No dosage adjustment
  • Adverse Drug Interaction:
    Xerostomia/ Upper respiratory tract infection / pharyngitis /sinusitis
  • Pharmacodynamics:
  • Metabolism: Hepatic
  • Bioavailability: Following inhalation, 19.5% (dry powder inhaler) or ~33% (soft-mist inhaler)
  • Time to peak, plasma:Dry powder inhaler: 7 minutes
  • Important Notes:
  • Bronchospasm: Paradoxical bronchospasm may occur with use of inhaled agents; discontinue use and consider other therapy if bronchospasm occurs.
  • CNS effects: May cause dizziness and blurred vision; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery or driving).
  • Pregnancy & Lactation: Adverse events have been observed in animal reproduction studies/ not known if present in breast milk.
  • Medication Safety Issues:

Spiriva may be confused with Apidra, Inspra, Serevent

Tiotropium may be confused with ipratropium

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