page209
Compound preparations
For prescribing information on salmeterol, see section
3.1.1.1
Seretide
c
(A&H) A
Seretide 100 Accuhaler
c
(dry powder for inhala-
tion),
disk containing 60 blisters of fluticasone
propionate 100 micrograms,
salmeterol (as xinafoate)
50 micrograms/blister with
Accuhaler
c
device,
net
price = £31.19.
Label:
8,
counselling,
administration
Dose
by inhalation of powder, prophylaxis of asthma, ADULT and
CHILD over 5 years, 1 blister twice daily, reduced to 1 blister once
daily if control
maintained
Seretide 250 Accuhaler
c
(dry powder for inhala-
tion),
disk containing 60 blisters of fluticasone
propionate 250 micrograms,
salmeterol (as xinafoate)
50 micrograms/blister with
Accuhaler
c
device,
net
price = £35.00.
Label:
8,
counselling,
administration,
10,
steroid card
Dose
by inhalation of powder, prophylaxis of asthma, ADULT and
CHILD over 12 years,
1 blister twice daily
Seretide 500 Accuhaler
c
(dry powder for inhala-
tion),
disk containing 60 blisters of fluticasone
propionate 500 micrograms,
salmeterol (as xinafoate)
50 micrograms/blister with
Accuhaler
c
device,
net
price = £40.92.
Label:
8,
counselling,
administration,
10,
steroid card
Dose
by inhalation of powder, prophylaxis of asthma, ADULT and
CHILD over 12 years,
1 blister twice daily
Chronic obstructive pulmonary disease with forced expiratory
volume in 1 second <60% of predicted (but see notes, p.
171),
ADULT 1 blister twice daily
Note
The
Scottish Medicines Consortium
has advised (December
2008) that
Seretide 500 Accuhaler
c
is not recommended for use
within NHS Scotland for chronic obstructive pulmonary disease in
patients with a forced expiratory volume in 1 second (FEV
1
) less
than 60% and greater than 50% of the predicted normal value,
with significant symptoms despite regular bronchodilator therapy,
and a history of repeated exacerbations
Seretide 50 Evohaler
c
(aerosol inhalation),
flutica-
sone propionate 50 micrograms,
salmeterol (as
xinafoate) 25 micrograms/metered inhalation,
net
price 120-dose unit = £18.00.
Label:
8,
counselling,
administration
Dose
by aerosol inhalation,
prophylaxis of asthma,
ADULT and
CHILD over 5 years,
2 puffs twice daily,
reduced to 2 puffs once
daily if control
maintained
Seretide 125 Evohaler
c
(aerosol inhalation),
flu-
ticasone propionate 125 micrograms,
salmeterol (as
xinafoate) 25 micrograms/metered inhalation,
net
price 120-dose unit = £35.00.
Label:
8,
counselling,
administration,
10,
steroid card
Dose
by aerosol inhalation,
prophylaxis of asthma,
ADULT and
CHILD over 12 years,
2 puffs twice daily
Seretide 250 Evohaler
c
(aerosol inhalation),
flu-
ticasone propionate 250 micrograms,
salmeterol (as
xinafoate) 25 micrograms/metered inhalation,
net
price 120-dose unit = £59.48.
Label:
8,
counselling,
administration,
10,
steroid card
Dose
by aerosol inhalation,
prophylaxis of asthma,
ADULT and
CHILD over 12 years,
2 puffs twice daily
MOMETASONE FUROATE
Indications
prophylaxis of asthma (see also Manage-
ment of Chronic Asthma, p.
172)
Cautions
see notes above
Pregnancy
see p.
170
Breast-feeding
see p.
170
Side-effects
see notes above;
also pharyngitis,
head-
ache;
less commonly
palpitation
Dose
. By inhalation of powder,
200–400 micrograms as a
single dose in the evening or in 2 divided doses; dose
increased to 400 micrograms twice daily if necessary;
CHILD
not recommended
Asmanex
c
(Schering-Plough) T A
Twisthaler
(= dry powder inhaler), mometasone fur-
oate 200 micrograms/metered inhalation,
net price
30-dose unit = £15.70,
60-dose unit = £23.54;
400 micrograms/metered inhalation,
30-dose unit =
£21.78,
60-dose unit = £36.05.
Label:
8,
counselling,
administration,
10,
steroid card
Note
The
Scottish
Medicines
Consortium
has
advised
(November 2003) that
Asmanex
c
is restricted for use
following failure of first-line inhaled corticosteroids
3.3
Cromoglicate and related
therapy, leukotriene
receptor antagonists, and
phosphodiesterase type-
4 inhibitors
3.3.1 Cromoglicate and related therapy
3.3.2 Leukotriene receptor antagonists
3.3.3 Phosphodiesterase type-4 inhibitors
3.3.1
Cromoglicate and related
therapy
The mode of action of sodium cromoglicate and nedo-
cromil
is not completely understood.
They may be of
value in asthma with an allergic basis, but, in practice, it
is difficult to predict who will
benefit;
they could prob-
ably be given for 4 to 6 weeks to assess response. Dose
frequency is
adjusted according to response but
is
usually 3 to 4 times a day initially; this may subsequently
be reduced.
Withdrawal
of
sodium cromoglicate or
nedocromil
should be done gradually over a period of
one week—symptoms of asthma may recur.
In general,
prophylaxis
with sodium cromoglicate is less
effective
than prophylaxis
with corticosteroid inha-
lations
(see Management
of
Chronic Asthma table,
p.
172).
There is evidence of
efficacy of nedocromil
in
children aged 5–12 years.
Sodium cromoglicate and
nedocromil
are of
no value in the treatment
of
acute
attacks of asthma.
Sodium cromoglicate
can
prevent
exercise-induced
asthma. However, exercise-induced asthma may reflect
poor
overall
control
and the patient
should be re-
assessed.
Paradoxical bronchospasm
If paradoxical broncho-
spasm occurs,
a short-acting beta
2
agonist such as sal-
butamol
or terbutaline (section 3.1.1.1) should be used
to control symptoms;
treatment with sodium cromogli-
cate or nedocromil should be discontinued.
Side-effects
Side-effects associated with inhalation of
sodium cromoglicate and nedocromil
include throat
irritation,
cough,
bronchospasm (including paradoxical
bronchospasm—see above),
and headache.
BNF 61
3.3.1 Cromoglicate and related therapy
189
3
Respiratory system