Dosing

Asthma - prophylaxis

Type	Age Range	Dose	Licensed
Maintenance	From 5 years	2 actuations - TWICE a DAY - inhalation - using a metered dose device

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 concerning formulation

• Not all available brands are licensed for all age groups
• 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

Advice on drug withdrawal

• Do not withdraw this drug suddenly

Discontinue due to test or exam

• Discontinue if paradoxical bronchospasm occurs

Dose changes (other conditions)

• Adjustment of hypoglycaemic therapy may be necessary in diabetes mellitus
• Maintain treatment at the lowest effective dose

Patient Counselling

• Advise patient medication contains small amount of alcohol
• Advise patient not to use for relief of acute attacks
• Advise patient to rinse mouth with water after each dose
• Advise patient to seek medical advice if treatment is ineffective
• Consider issuing Steroid Treatment/Steroid Emergency Card
• Ensure patient has a fast acting bronchodilator available
• High dose:Advise patient to avoid chickenpox,measles etc; see Dr if exposed
• Patient should seek medical advice if signs of pulmonary infection develop
• Use regularly to maintain freedom from symptoms

Pre-treatment points to consider

• Correct electrolyte disorders before treatment
• Stabilise patient prior to transfer from systemic steroids
• Therapy should not be initiated during exacerbation of asthma

Recommended monitoring

• Check patient is using correct inhaler technique
• Consider adrenal suppression when transferring from systemic steroid
• Consider monitoring ECG in patients at risk of QT prolongation
• Monitor adrenal function in stressed patients e.g.surgery/intensive care
• Monitor for signs/symptoms of pneumonia in patients at risk
• Monitor regularly the height of children receiving prolonged treatment
• Monitor serum K+ in patients on high dose steroids/xanthines/diuretics
• Monitor serum electrolytes
• Monitor serum potassium regularly in patients with severe asthma
• Re-evaluate therapy in active or quiescent pulmonary tuberculosis

Safety/advice in other condition

• Systemic corticosteroids may be needed during elective surgery
• Systemic corticosteroids may be needed during periods of stress

Drug Interactions

With	Risk	Severity
(LEVACETYLMETHADOL)	Hypokalaemia with high dose beta-agonist increases risk of arrhythmias	Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
ATOMOXETINE	May increase risk of cardiac effects	Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
DOMPERIDONE	Predisposing factors may increase risk of arrhythmias	Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
METHACHOLINE	Methacholine effect reduced; review dosing, see product literature	Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
SOTALOL	Effect antagonised/ predisposing factors increase risk of arrhythmias	Significant Risk: Usually avoid combination. Use combination only under special circumstances, taking any necessary action to reduce risk.
(ASTEMIZOLE)	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
(HALOFANTRINE)	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
(RETIGABINE)	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
(SODIUM STIBOGLUCONATE)	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AJMALINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AMIFAMPRIDINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AMIODARONE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ANAGRELIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ARSENIC TRIOXIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ARTEMETHER AND LUMEFANTRINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AVAPRITINIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
AZITHROMYCIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CHLOROQUINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CILOSTAZOL	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CIPROFLOXACIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CITALOPRAM / ESCITALOPRAM	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
CLARITHROMYCIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
COCAINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DELAMANID	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DISOPYRAMIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DONEPEZIL	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DRONEDARONE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
DROPERIDOL	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ENTRECTINIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ERYTHROMYCIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ETELCALCETIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
FLECAINIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
FLUCONAZOLE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
GLASDEGIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
HALOPERIDOL	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
HYDROXYCHLOROQUINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
HYDROXYZINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
IBUTILIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
INOTUZUMAB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
IVOSIDENIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
LEVOFLOXACIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
MELPERONE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
METHADONE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
MOBOCERTINIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
MOXIFLOXACIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ONDANSETRON	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
OSILODROSTAT	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
OSIMERTINIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
OXALIPLATIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PAPAVERINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PENTAMIDINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PHENOTHIAZINES (QT 1)	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PIMOZIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PIPERAQUINE AND ARTENIMOL	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PRALSETINIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
PROPOFOL	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
QUINIDINE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
SELPERCATINIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
SERTINDOLE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
SEVOFLURANE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
SULPIRIDE	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
TERLIPRESSIN	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
VANDETANIB	Predisposing factors may increase risk of arrhythmias	Moderate Risk: Minimise risk. Take action necessary to reduce risk. Counsel patient.
ACE INHIBITORS WITH THIAZIDE DIURETICS	Increased risk of hypokalaemia with high doses of beta agonist	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ACETAZOLAMIDE	Increased risk of hypokalaemia with high doses of beta agonist	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
ANGIOTENSIN II INHIBITORS AND THIAZIDE DIURETICS	Increased risk of hypokalaemia with high doses of beta agonist	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
BETA BLOCKER EYE DROPS	May antagonise effect of each other	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
BETA BLOCKERS	May antagonise effect of each other	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
BETA BLOCKERS AND THIAZIDE DIURETICS	May antagonise effect of each other	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
LOOP DIURETICS	Increased risk of hypokalaemia with high doses of beta agonist	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
THEOPHYLLINE	Increased risk of hypokalaemia with high doses of beta agonist	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.
THIAZIDE DIURETICS	Increased risk of hypokalaemia with high doses of beta agonist	Low Risk: No action needed. Risk of adverse outcomes appears small and depends upon the condition of the patient. Counsel patient.

Precautions

• Adrenal insufficiency
• Arterial aneurysm
• Cardiac arrhythmias
• Cardiac disorder
• Children aged 5 to 18 years
• Diabetes mellitus
• Electrolyte imbalance
• Family history of long QT syndrome
• History of torsade de pointes
• Hypertrophic obstructive cardiomyopathy
• Idiopathic subvalvular aortic stenosis
• Ischaemic heart disease
• Major risk factors for decreased bone mineral content
• Phaeochromocytoma
• Pregnancy
• Pulmonary tuberculosis
• Severe cardiac failure
• Severe hepatic impairment
• Severe hypertension
• Thyrotoxicosis

Contraindications

• Breastfeeding
• Children under 5 years
• Long QT syndrome
• Torsade de pointes

Side Effects

• Adrenal suppression
• Aggression
• Agitation
• Angina pectoris
• Angioedema
• Angioneurotic oedema
• Anxiety
• Asthenia
• Behavioural disturbances
• Blurred vision
• Bronchospasm (paradoxical)
• Candidiasis (mouth or throat)
• Cataracts
• Contusion
• Cough
• Cushing's syndrome
• Cushingoid facies
• Decrease in bone mineral density
• Depression
• Diarrhoea
• Dizziness
• Dream abnormalities
• Dry mouth
• Dysgeusia
• Dyspepsia
• Dysphonia
• Dyspnoea
• Exacerbation of pre-existing asthma
• Exanthema
• Glaucoma
• Headache
• Hyperactivity
• Hyperglycaemia
• Hypersensitivity reactions
• Hypertension
• Hypokalaemia
• Increased blood lactate levels
• Increased susceptibility to infection
• Insomnia
• Muscle spasm
• Myalgia
• Nausea
• Palpitations
• Peripheral oedema
• Prolongation of QT interval
• Pruritus
• Psychomotor impairment
• Rash
• Sinusitis
• Skin atrophy
• Sleep disturbances
• Suppression of growth in children and adolescents
• Tachycardia
• Throat irritation
• Tremor
• Urticaria
• Ventricular extrasystoles
• Vertigo