Indications for ASMANEX TWISTHALER:
Maintenance treatment of asthma as prophylactic therapy.
Limitations of Use:
Not for relief of acute bronchospasm.
Previously on bronchodilators alone or inhaled corticosteroids: initially 220mcg once in the PM; max 440mcg daily (either as 220mcg twice daily or 440mcg once daily). Previously on oral corticosteroids (wean gradually): initially 440mcg twice daily; max 880mcg daily. Rinse mouth after use.
<4yrs: not established. 4–11yrs: 110mcg once in the PM; max 110mcg daily. Rinse mouth after use.
Primary treatment of status asthmaticus or acute asthma attacks. Milk protein allergy.
Maintain regular regimen. Re-evaluate immediately during rapidly deteriorating asthma; may need oral corticosteroid therapy. Immunosuppressed. Untreated infections (eg, fungal, bacterial, viral, parasitic), TB, ocular herpes simplex. If exposed to chickenpox or measles, consider anti-infective prophylactic therapy. Transferring from systemic steroids: taper gradually. If adrenal insufficiency exists following systemic corticosteroids, replacement with inhaled steroids may exacerbate symptoms of adrenal insufficiency (eg, lassitude). Monitor for bone mineral density if other osteoporosis risk factors exist; and for growth suppression in children; hypercorticism and HPA axis suppression (if occurs, reduce gradually). Glaucoma, increased intraocular pressure, and cataracts: consider eye evaluation if ocular symptoms develop or in long term use. Severe hepatic impairment. Pregnancy. Nursing mothers.
Potentiated by ketoconazole or other strong CYP3A4 inhibitors (eg, ritonavir, cobicistat-containing products, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin); use caution and monitor.
Headache, allergic rhinitis, pharyngitis, upper respiratory tract infection, sinusitis, oral candidiasis, dysmenorrhea, musculoskeletal pain, back pain, dyspepsia; hypersensitivity reactions, paradoxical bronchospasm; discontinue if occurs. Children: also fever, bruise.
Twisthaler 110mcg (30 inh)—1; 220mcg (30 inh, 60 inh, 120 inh)—1