Asmanex 400micrograms / dose Twisthaler (Merck Sharp & Dohme Ltd) 60 dose

Type Dry powder inhaler (DPI)
Medicine Mometasone 400micrograms/dose
Adult steroid dose Medium adult steroid dose
Activation mechanism Breath actuated
Dose counter Has dose counter
Price £18.03 / 30 days
(based on 1 puffs / day)
Inhaled corticosteroid information For adults, a total of 2 puffs/day gives a medium dose of ICS
Steroid safety card recommendation (for adults) Steroid safety card recommended
Licences
  • Adult Asthma Licence
  • Adolescent Asthma Licence 12 to adult

Training material

Pathways

The use of each medicine included in Right Breathe has been considered in relation to international, national, and regional prescribing pathways. The pathway points at which this medicine is considered a viable prescribing option are included below. If you wish to view the entire pathway, click on its heading, from where you can also access all the prescribing options for each pathway and each pathway point.

Prescribing

Detailed prescribing information is provided below. This content has not been generated by the RightBreathe team, but has been integrated from a 3rd party solution: Multilex (provided by FirstDataBank). Use of this prescribing content is subject to the FirstDataBank disclaimer, which is set out in the "About" section of RightBreathe.

As RightBreathe is a bespoke decision support tool, it covers each and every individual known inhaler option on the UK market to a high level of specificity. Multilex, as a more general resource, does not offer the same level of specificity. There are therefore a small number of medicines for which there are discrepancies between RightBreathe and Multilex content, most notably in relation to licensed particulars and associated licensed doses.

Given the high level of specificity the RightBreathe team work to, details of the individual inhaler licence are most likely to be summarised accurately in the content provided at the top of this page, rather than in the Multilex content below. Where there is ambiguity, users may also wish to refer to individual summaries of product characteristics prior to prescribing.

Dosing

Asthma - prophylaxis

Type Age Range Dose Licensed
Maintenance From 12 years 1 actuation - TWICE a DAY - inhalation
Maintenance From 12 years 1 actuation - every NIGHT - inhalation

Safety Advice Warnings

Adverse effects (report/action)

  • During transfer from oral steroids allergic conditions may be unmasked
  • 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
  • Systemic effects possible with any inhaled corticosteroid

Advice on drug withdrawal

  • Do not withdraw this drug suddenly

Advice on possible excipients

  • Contains lactose

Discontinue due to test or exam

  • Discontinue if paradoxical bronchospasm occurs

Dose changes (other conditions)

  • Use lowest dose at which effective control of asthma is maintained

Patient Counselling

  • Advise patient to rinse mouth with water after each dose
  • Advise patient to seek medical advice if asthma seems to be worsening
  • Advise patient to seek medical advice if treatment is ineffective
  • Advise patients to avoid chickenpox, measles etc - see doctor if exposed
  • Consider issuing Steroid Treatment/Steroid Emergency Card
  • Ensure patient has a fast acting bronchodilator available
  • Patient should seek medical advice if signs of pulmonary infection develop
  • Use regularly to maintain freedom from symptoms

Pre-treatment points to consider

  • Stabilise patient prior to transfer from systemic steroids
  • Treat and control infections prior to commencing therapy

Recommended monitoring

  • Check patient is using correct inhaler technique
  • Consider adrenal suppression when transferring from systemic steroid
  • Monitor adrenal function in stressed patients e.g.surgery/intensive care
  • Monitor regularly the height of children receiving prolonged treatment
  • Re-evaluate therapy in active or quiescent pulmonary tuberculosis

Safety/advice in other condition

  • Not to be used to relieve an acute asthmatic attack
  • Systemic corticosteroids may be needed during elective surgery
  • Systemic corticosteroids may be needed during periods of stress

Drug Interactions

With Risk Severity
(BOCEPREVIR) plasma level may be increased by Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
(INDINAVIR) Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
(NELFINAVIR) Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
(SAQUINAVIR) Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
(TELITHROMYCIN) Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
ATAZANAVIR WITH COBICISTAT Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
CLARITHROMYCIN Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
COBICISTAT Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
DARUNAVIR WITH COBICISTAT Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
DARUNAVIR, COBICISTAT, EMTRICITABINE AND TENOFOVIR ALAFENAMIDE Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
ELVITEGRAVIR, COBICISTAT, EMTRICITABINE AND TENOFOVIR ALAFENAMIDE Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
ELVITEGRAVIR, COBICISTAT, EMTRICITABINE AND TENOFOVIR DISOPROXIL Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
IDELALISIB Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
ITRACONAZOLE Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
KETOCONAZOLE Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
OMBITASVIR, PARITAPREVIR AND RITONAVIR Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
POSACONAZOLE Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
RIBOCICLIB Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
RITONAVIR Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
TIPRANAVIR Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
VORICONAZOLE Increased risk of systemic corticosteroid adverse effects Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
AMPRENAVIR / FOSAMPRENAVIR Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
APREPITANT / FOSAPREPITANT Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ATAZANAVIR Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CICLOSPORIN Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CIMETIDINE Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CIPROFLOXACIN Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CRIZOTINIB Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DARUNAVIR Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DILTIAZEM Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DRONEDARONE Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ERYTHROMYCIN Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
FLUCONAZOLE Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
IMATINIB Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ISAVUCONAZOLE Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
MICONAZOLE (ORAL AND PARENTERAL) Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
MIFEPRISTONE Corticosteroid effect may be reduced for 3 to 4 days after treatment Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
NEFAZODONE plasma level may be increased by Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
NETUPITANT Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
NILOTINIB Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
STIRIPENTOL Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
VERAPAMIL Increased risk of systemic corticosteroid adverse effects Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
(DACLATASVIR) Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
(SIMEPREVIR) Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ALPRAZOLAM Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
AMIODARONE Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
AMLODIPINE Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ATORVASTATIN Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
AZITHROMYCIN Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
BICALUTAMIDE Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
CILOSTAZOL Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
COMBINED ORAL CONTRACEPTIVES Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ELBASVIR WITH GRAZOPREVIR Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
EVEROLIMUS Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
FLUVOXAMINE Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ISONIAZID Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
IVACAFTOR Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
LACIDIPINE Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
LINAGLIPTIN Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
LOMITAPIDE Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
OBETICHOLIC ACID Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
PALBOCICLIB Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
PAZOPANIB Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
PROPIVERINE Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
RANITIDINE / NIZATIDINE Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
RANOLAZINE Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
TACROLIMUS (ORAL AND PARENTERAL) Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
TERIFLUNOMIDE Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
TOLVAPTAN Increased risk of systemic corticosteroid adverse effects Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.

Precautions

  • Adrenal insufficiency
  • Breastfeeding
  • Glucose-galactose malabsorption syndrome
  • Lactose intolerance
  • Major risk factors for decreased bone mineral content
  • Ocular herpes simplex infection
  • Pregnancy
  • Tuberculosis of respiratory tract

Contraindications

  • Children under 12 years
  • Galactosaemia

Side Effects

  • Adrenal suppression
  • Aggravation of existing asthma
  • Aggression
  • Anaphylactic reaction
  • Angioedema
  • Anxiety
  • Blurred vision
  • Bronchospasm
  • Candidiasis (mouth or throat)
  • Cataracts
  • Cough
  • Decrease in bone mineral density
  • Depression
  • Dry mouth
  • Dry throat
  • Dyspepsia
  • Dysphonia
  • Dyspnoea
  • Erythema
  • Facial oedema
  • Glaucoma
  • Headache
  • Hypersensitivity reactions
  • Increased intra-ocular pressure
  • Ocular oedema
  • Oedema of the lips
  • Oedema of the throat
  • Palpitations
  • Pharyngitis
  • Pruritus
  • Psychomotor hyperactivity
  • Rash
  • Sleep disturbances
  • Suppression of growth in children and adolescents
  • Urticaria
  • Weight gain
  • Wheezing