Dosing

Prophylaxis of bronchial asthma where inhaled corticosteroid is indicated

Type	Age Range	Dose	Licensed
Maintenance	From 6 years	1 actuation - ONCE a DAY - inhalation
Maintenance	From 6 years	1 actuation - TWICE a DAY - inhalation
Maintenance	From 18 years	2 actuations - TWICE a DAY - inhalation

Prevention of exercise-induced bronchospasm

Type	Age Range	Dose	Licensed
Maintenance	From 6 years	1 actuation - when required - 10 to 15 minutes before exertion - inhalation

Symptom relief of broncho-obstruction in asthma when steroids insufficient

Type	Age Range	Dose	Licensed
Maintenance	From 6 years	1 actuation - when required - inhalation

Chronic obstructive pulmonary disease

Type	Age Range	Dose	Licensed
Maintenance	From 18 years	1 actuation - ONCE a DAY - inhalation
Maintenance	From 18 years	1 actuation - TWICE a DAY - inhalation

Symptom relief of bronchospasm in chronic obstructive pulmonary disease

Type	Age Range	Dose	Licensed
Maintenance	From 18 years	1 actuation - when required - inhalation
Maintenance	From 18 years	2 actuations - when required - inhalation

Safety Advice Warnings

Adverse effects (report/action)

• CSM (CHM) requests reporting of adverse reactions to cfc-free inhalers

Advice concerning formulation

• Not all available brands are licensed for all indications
• Not all available brands are licensed for use in children under 12 years

Advice on drug withdrawal

• Do not withdraw this drug suddenly

Advice on possible excipients

• Some formulations contain lactose

Discontinue due to test or exam

• Discontinue at least 12 hours before the start of anaesthesia
• 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 dizziness may affect ability to drive or operate machinery
• Advise patient not to exceed stated dose
• Advise patient that CFC-free inhalers may have different taste or sensation
• Advise patient to continue taking corticosteroid therapy
• Patient should seek medical advice if usual relief is diminished

Pre-treatment points to consider

• Do not substitute for steroid therapy
• Not to be used as the sole or main treatment for severe or unstable asthma
• Therapy should not be initiated during exacerbation of asthma

Recommended monitoring

• Check patient is using correct inhaler technique
• If frequent need for prophylaxis of exercise induced asthma,review therapy
• Monitor serum K+ in patients on high dose steroids/xanthines/diuretics
• Monitor serum potassium regularly in patients with severe asthma

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

• Arterial aneurysm
• Breastfeeding
• Cardiac arrhythmias
• Cardiac disorder
• Children 6 to 12 years
• Diabetes mellitus
• Galactosaemia
• Glucose-galactose malabsorption syndrome
• Hepatic cirrhosis
• Hyperthyroidism
• Hypertrophic obstructive cardiomyopathy
• Hypokalaemia
• Idiopathic subvalvular aortic stenosis
• Ischaemic heart disease
• Lactose intolerance
• Long QT syndrome
• Occlusive peripheral vascular disorder
• Phaeochromocytoma
• Pregnancy
• Severe decompensated cardiac failure
• Severe hypertension
• Third degree atrioventricular block
• Thyrotoxicosis

Contraindications

• Children under 6 years

Side Effects

• Agitation
• Angina pectoris
• Angioedema
• Anxiety
• Arrhythmias
• Atrial fibrillation
• Behavioural disturbances
• Blood pressure changes
• Bronchospasm
• Bronchospasm (paradoxical)
• CNS stimulation
• Cough
• Dizziness
• Dry mouth
• Dysgeusia
• Dyspnoea
• Exacerbation of pre-existing asthma
• Exanthema
• Hallucinations
• Headache
• Hyperglycaemia
• Hyperhidrosis
• Hypersensitivity reactions
• Hypertension
• Hypokalaemia
• Hypotension
• Insomnia
• Muscular cramps
• Myalgia
• Nausea
• Nephritis
• Nervousness
• Oropharyngeal irritation
• Palpitations
• Peripheral oedema
• Prolongation of QT interval
• Pruritus
• Rash
• Restlessness
• Sleep disturbances
• Supraventricular tachycardia
• Tachycardia
• Taste disturbances
• Thrombocytopenia
• Tremor
• Urticaria
• Ventricular extrasystoles