Dosing

Asthma - prophylaxis

Type	Age Range	Dose	Licensed
Maintenance	From 5 years to 18 years	1 actuation - TWICE a DAY - inhalation - using a metered dose device
Maintenance	From 18 years	1 actuation - TWICE a DAY - inhalation - using a metered dose device
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
Maintenance	From 12 years to 18 years	4 actuations - TWICE a DAY - inhalation - using a metered dose device
Maintenance	From 18 years	4 actuations - TWICE a DAY - inhalation - using a metered dose device

Safety Advice Warnings

Adverse effects (report/action)

• Corticosteroids may cause growth retardation in children under 18 years
• 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 concerning formulation

• Not all formulations are suitable for use in children under 18 years

Advice on Administration

• Consider use of a spacer device for suitable patients and formulations
• Different brands may not be interchangeable

Advice on drug withdrawal

• Do not withdraw this drug suddenly

Advice on possible excipients

• Contains alcohol

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 that CFC-free inhalers may have different taste or sensation
• Advise patient to rinse mouth with water after each dose
• Advise patient to seek medical advice if asthma seems to be worsening
• Advise patients to avoid chickenpox, measles etc - see doctor if exposed
• Advise visual disturbances may affect ability to drive or operate machinery
• 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

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
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.
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.
(INDINAVIR)	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
(NELFINAVIR)	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
(SAQUINAVIR)	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
(TELITHROMYCIN)	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ATAZANAVIR WITH COBICISTAT	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CLARITHROMYCIN	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
COBICISTAT	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DARUNAVIR WITH COBICISTAT	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DARUNAVIR, COBICISTAT, EMTRICITABINE AND TENOFOVIR ALAFENAMIDE	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ELVITEGRAVIR, COBICISTAT, EMTRICITABINE AND TENOFOVIR ALAFENAMIDE	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ELVITEGRAVIR, COBICISTAT, EMTRICITABINE AND TENOFOVIR DISOPROXIL	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
IDELALISIB	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ITRACONAZOLE	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
KETOCONAZOLE	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.
OMBITASVIR, PARITAPREVIR AND RITONAVIR	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
POSACONAZOLE	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
RITONAVIR	Increased risk of systemic corticosteroid adverse effects	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
VORICONAZOLE	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.
AMPRENAVIR / FOSAMPRENAVIR	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.
APREPITANT / FOSAPREPITANT	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.
ATAZANAVIR	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.
CICLOSPORIN	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.
CIMETIDINE	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.
CIPROFLOXACIN	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.
CRIZOTINIB	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.
DARUNAVIR	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.
DILTIAZEM	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.
DRONEDARONE	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.
ERYTHROMYCIN	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.
FLUCONAZOLE	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.
IMATINIB	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.
ISAVUCONAZOLE	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.
MICONAZOLE (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.
NETUPITANT	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.
NILOTINIB	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.
STIRIPENTOL	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.
VERAPAMIL	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
• Children aged 5 to 18 years
• Major risk factors for decreased bone mineral content
• Pregnancy
• Pulmonary tuberculosis

Contraindications

• Children under 5 years

Side Effects

• Adrenal suppression
• Aggression
• Anaphylactic reaction
• Anaphylactoid reaction
• Angioedema
• Anxiety
• Behavioural disturbances (children)
• Blurred vision
• Bronchospasm (paradoxical)
• Bruising
• Candidiasis (mouth or throat)
• Cataracts
• Cough
• Cushing's syndrome
• Cushingoid facies
• Decrease in bone mineral density
• Depression
• Dyspnoea
• Erythema
• Facial oedema
• Glaucoma
• Headache
• Hoarseness
• Hypersensitivity reactions
• Nausea
• Ocular oedema
• Oedema of the lips
• Oedema of the throat
• Pharyngitis
• Pruritus
• Psychomotor hyperactivity
• Purpura
• Rash
• Shortness of breath
• Sleep disturbances
• Suppression of growth in children and adolescents
• Systemic effects
• Taste disturbances
• Thinning of skin
• Throat irritation
• Tremor
• Urticaria
• Vertigo
• Visual disturbances
• Wheezing