Inhaled Corticosteroids

Pulmonary - Inhaled Corticosteroids

beclomethasone (Vanceril ® Beclovent ®)	budesonide (Pulmicort ®)
flunisolide (Aerobid ®)	fluticasone (Flovent ® )
mometasone furoate (Asmanex ®)	triamcinolone (Azmacort ® )
Comparable Daily Doses for Inhaled Corticosteroids

beclomethasone (Vanceril ® Beclovent ®)

Adult (usual): Inhale 2 puffs 3 to 4 times daily or 4 puffs twice a day.

budesonide (Pulmicort ®)

Adult (usual): Asthma: 1-4 puffs twice daily (Max of 4 puffs bid). Note: patients with mild symptoms may be converted to once daily administration (1-2 puffs qd).

[Supplied: MDI 200 mcg/inhalation]

flunisolide (Aerobid ®)

Adult (usual): Inhale 2-4 puffs twice a day.

fluticasone (Flovent ® )

Adult (usual): Inhale Adult (usual): 2-4 puffs twice a day.

Supplied: [44,110,220 mcg]

mometasone furoate (Asmanex ®)

In-vitro studies show that mometasone is similar in potency to fluticasone and more potent than budesonide, beclomethasone, and triamcinolone.

Adult (usual): Asthma:

Previous Therapy	Recommended Starting Dose	Highest Recommended Daily Dose
Bronchodilators alone	220 mcg QD PM*	440 mcg**
Inhaled corticosteroids	220 mcg QD PM*	440 mcg**
Oral corticosteroids†	440 mcg BID	880 mcg

When administered once daily ASMANEX should only be taken in the PM. The 440 mcg daily dose may be administered in divided doses of 220 mcg twice daily or as 440 mcg once daily. NOTE: In all patients, it is desirable to titrate to the lowest effective dose once asthma stability is achieved.

For Patients Currently Receiving Chronic Oral Corticosteroid Therapy: Prednisone should be reduced no faster than 2.5 mg/day on a weekly basis, beginning after at least 1 week of ASMANEX TWISTHALER therapy. Patients should be carefully monitored for signs of asthma instability, including serial objective measures of airflow, and for signs of adrenal insufficiency. Once prednisone reduction is complete, the dosage of mometasone furoate should be reduced to the lowest effective dosage.

HOW TO USE - Remove the ASMANEX TWISTHALER from its foil pouch and write the date on the cap label. It’s important to throw away the inhaler 45 days after this date or when the dose counter reads “00,” whichever comes first.
Step 1. Open inhaler - Hold the inhaler straight up with the pink portion (the base) on the bottom. It is important that you remove the cap of the TWISTHALER® while it is in this upright position to make sure that you get the right amount of medicine with each dose. Holding the pink base, twist the cap in a counterclockwise direction to remove it. As you lift off the
cap, the dose counter on the base will count down by one. (If you began with the dose counter reading “30,” this action will cause it to now read “29.”) This action loads the device with the medicine that you are now ready to inhale. IT IS IMPORTANT TO NOTE that the indented arrow (located on the white portion of the TWISTHALER®, directly above the pink base) is pointing to the dose counter.
Step 2. Inhale dose - Exhale fully. Then bring the TWISTHALER®up to your mouth with the mouthpiece facing toward you. Place it in your mouth, holding it in a horizontal position as illustrated. Firmly closing your lips around the mouthpiece, take in a fast, deep breath. Since the medication is a very fine powder, you may not be able to feel or taste it after inhalation.
Remove the TWISTHALER from your mouth and hold your breath for about 10 seconds, or as long as you comfortably can. IMPORTANT: DO NOT BREATHE OUT THROUGH THE INHALER. After you take your medicine, it is important that you wipe the mouthpiece dry, if necessary, and immediately replace the cap firmly closing the TWISTHALER.
This is the only way to be sure that your next dose is properly loaded. Be sure that the arrow is in line with the dose-counter window. The cap needs to be put back on and turned in a clockwise direction, as you gently press down. You’ll hear a distinctive “click” to let you know that the cap is fully closed.

Supplied: Powder for oral inhalation: Asmanex® Twisthaler®: 220 mcg (14 units, 30 units, 60 units, 120 units)

triamcinolone (Azmacort ® )

Adult (usual): inhale: 2 puffs 3 to 4 times a day or 4 puffs twice a day. Maximum: 16 puffs/day.

Comparable Daily Doses for Inhaled Corticosteroids

A D U L T S
Drug	Low Dose	Medium Dose	High Dose
Beclomethasone dipropionate	168 – 504 mcg	504 – 840 mcg	>840 mcg
42 mcg/puff	(4-12 puffs – 42 mcg)	(12-20 puffs – 42 mcg)	(>20 puffs – 42 mcg)
84 mcg/puff	(2-6 puffs – 84 mcg)	(6-10 puffs – 84 mcg)	(>10 puffs – 84 mcg)

Budesonide DPI: 200 mcg/dose	200 – 400 mcg (1-2 inhalations)	400 – 600 mcg (2-3 inhalations)	>600 mcg (>3 inhalations)

Flunisolide 250 mcg/puff	500 – 1000 mcg (2-4 puffs)	1000 – 2000 mcg (4-8 puffs)	>2000 mcg (>8 puffs)

Fluticasone	88 – 264 mcg	264 – 660 mcg	>660 mcg
MDI: 44, 110, 220 mcg/puff	(2-6 puffs – 44 mcg OR 2 puffs – 110 mcg)	(2-6 puffs – 110 mcg)	(>6 puffs – 110 mcg OR >3 puffs – 220 mcg)
DPI: 50, 100, 250 mcg/dose	(2-6 inhalations – 50 mcg)	(3-6 inhalations – 100 mcg)	(>6 inhalations – 100 mcg OR >2 inhalations – 250 mcg)

Triamcinolone acetonide 100 mcg/puff	400 – 1000 mcg (4-10 puffs)	1000 – 2000 mcg (10-20 puffs)	>2000 mcg (>20 puffs)

CHILDREN
Drug	Low Dose	Medium Dose	High Dose
Beclomethasone dipropionate	84 – 336 mcg	336 – 672 mcg	>672 mcg
42 mcg/puff	(2-8 puffs – 42 mcg)	(8-16 puffs – 42 mcg)	(>16 puffs – 42 mcg)
84 mcg/puff	(1-4 puffs – 84 mcg)	(4-8 puffs – 84 mcg)	(>8 puffs – 84 mcg)
Budesonide DPI: 200 mcg/dose	100 – 200 mcg	200 – 400 mcg (1-2 inhalations)	>400 mcg (>2 inhalations)
Flunisolide 250 mcg/puff	500 – 750 mcg (2-3 puffs)	1000 – 1250 mcg (4-5 puffs)	>1250 mcg (>5 puffs)
Fluticasone	88 – 176 mcg	176 – 440 mcg	>440 mcg
MDI: 44, 110, 220 mcg/puff	(2-4 puffs – 44 mcg)	(4-10 puffs – 110 mcg OR 2-4 puffs – 110 mcg)	(>4 puffs – 110 mcg, OR >2 puffs – 220 mcg)
DPI: 50, 100, 250 mcg/dose	(2-4 inhalations – 50 mcg)	(2-4 inhalations – 100 mcg)	(>4 inhalations – 100 mcg OR >2 inhalations – 250 mcg)
Triamcinolone acetonide 100 mcg/puff	400 – 800 mcg (4-8 puffs)	800 – 1200 mcg (8-12 puffs)	>1200 mcg (>12 puffs)
DPI = dry powder inhaler MDI = metered dose inhaler

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.