page208
(500-microgram) unit = £20.02;
500 micrograms/mL,
20 2-mL (1-mg) unit = £30.30. May be diluted with
sterile sodium chloride 0.9%.
Label:
8,
counselling,
administration,
10,
steroid card
Dose
prophylaxis of asthma,
by inhalation of nebulised sus-
pension
,
ADULT and CHILD over 12 years,
1–2 mg twice daily,
reduced to 0.5–1 mg twice daily;
CHILD 3 months–12 years, 0.5–
1 mg twice daily,
reduced to 250–500 micrograms twice daily
Croup,
by inhalation of nebulised suspension,
2 mg as a single
dose (
or
as two 1-mg doses separated by 30 minutes)
Note
Not suitable for use in ultrasonic nebulisers
Compound preparations
For prescribing information on formoterol
fumarate,
see section 3.1.1.1
Symbicort
c
(AstraZeneca) A
Symbicort 100/6 Turbohaler
c
(= dry powder
inhaler),
budesonide 100 micrograms, formoterol
fumarate 6 micrograms/metered inhalation, net price
120-dose unit = £33.00.
Label:
8,
counselling,
administration
Dose
by inhalation of powder, asthma maintenance therapy, 1–2
puffs twice daily increased if necessary to max. 4 puffs twice daily,
reduced to 1 puff once daily if control maintained;
CHILD 6–12
years, 1–2 puffs twice daily reduced to 1 puff once daily if control
maintained;
12–17 years,
1–2 puffs twice daily reduced to 1 puff
once daily if control
maintained
Asthma, maintenance and reliever therapy, (but see p.
185) 2 puffs
daily in 1–2 divided doses; for relief of symptoms, 1 puff as needed
up to max. 6 puffs at a time; max. 8 puffs daily; up to 12 puffs daily
can be used for a limited time but medical assessment should be
considered;
CHILD 12–18 years,
see
BNF for Children
Symbicort 200/6 Turbohaler
c
(= dry powder
inhaler),
budesonide 200 micrograms, formoterol
fumarate 6 micrograms/metered inhalation, net price
120-dose unit = £38.00.
Label:
8,
counselling,
administration;
also 10 and steroid card with high
doses
Dose
by inhalation of powder, asthma maintenance therapy, 1–2
puffs twice daily increased if necessary to max. 4 puffs twice daily,
reduced to 1 puff once daily if control maintained;
CHILD 12–17
years 1–2 puffs twice daily reduced to 1 puff once daily if control
maintained
Asthma, maintenance and reliever therapy, (but see p.
185) 2 puffs
daily in 1–2 divided doses, increased if necessary to 2 puffs twice
daily; for relief of symptoms, 1 puff as needed up to max. 6 puffs at
a time;
max.
8 puffs daily;
up to 12 puffs daily can be used for a
limited time but medical assessment should be considered; CHILD
12–18 years,
see
BNF for Children
Chronic obstructive pulmonary disease with forced expiratory
volume in 1 second <50 % of predicted,
2 puffs twice daily
Symbicort 400/12 Turbohaler
c
(= dry powder
inhaler),
budesonide 400 micrograms, formoterol
fumarate 12 micrograms/metered inhalation,
net
price 60-dose unit = £38.00.
Label:
8,
counselling,
administration;
also 10 and steroid card with high
doses
Dose
by inhalation of powder,
asthma maintenance therapy,
1
puff twice daily increased if necessary to max. 2 puffs twice daily,
reduced to 1 puff once daily if control maintained;
CHILD 12–17
years 1 puff twice daily reduced to 1 puff once daily if control
maintained
Chronic obstructive pulmonary disease with forced expiratory
volume in 1 second <50 % of predicted,
1 puff twice daily
CICLESONIDE
Indications
prophylaxis of asthma
Cautions
see notes above
Pregnancy
see p.
170
Breast-feeding
see p.
170
Side-effects
see notes above
Dose
. By aerosol inhalation,
160 micrograms daily as a
single dose reduced to 80 micrograms daily if control
maintained;
dose may be increased to max.
320 micrograms twice daily if necessary in severe
asthma [unlicensed];
CHILD
12–18 years,
160 micr-
ograms daily as a single dose reduced to 80 micr-
ograms daily if control maintained
Alvesco
c
(Nycomed) A
Aerosol inhalation
,
ciclesonide 80 micrograms/
metered inhalation, net price 120-dose unit = £32.83;
160 micrograms/metered inhalation,
60-dose unit =
£19.31, 120-dose unit = £38.62. Label: 8, counselling,
administration
FLUTICASONE PROPIONATE
Indications
prophylaxis of asthma (see also Manage-
ment of Chronic Asthma table,
p.
172)
Cautions
see notes above
Pregnancy
see p.
170
Breast-feeding
see p.
170
Side-effects
see notes above;
also
very rarely
dys-
pepsia,
hyperglycaemia,
and arthralgia
Dose
. See preparations below
Flixotide
c
(A&H) A
Accuhaler
c
(dry powder for inhalation),
disk con-
taining 60 blisters of fluticasone propionate 50 micr-
ograms/blister with
Accuhaler
c
device,
net price =
£6.38;
100 micrograms/blister with
Accuhaler
c
device = £8.93;
250 micrograms/blister with
Accuhaler
c
device = £21.26;
500 micrograms/blister
with
Accuhaler
c
device = £36.14.
Label:
8,
counsel-
ling,
administration;
also label 10 and steroid card
with high doses
Note
Flixotide Accuhaler
c
250 micrograms and 500 micrograms
are not indicated for children
Dose
by inhalation of powder, prophylaxis of asthma, ADULT and
CHILD over 16 years,
100–500 micrograms twice daily,
increased
according to severity of asthma;
max.
1 mg twice daily (doses
above 500 micrograms twice daily initiated by a specialist);
CHILD
5–16 years, 50–100 micrograms twice daily adjusted as necessary;
max.
200 micrograms twice daily
Evohaler
c
aerosol inhalation
, fluticasone propionate
50 micrograms/metered inhalation,
net price 120-
dose unit = £5.44;
125 micrograms/metered inhala-
tion,
120-dose unit = £21.26;
250 micrograms/
metered inhalation,
120-dose unit = £36.14.
Label:
8,
counselling,
administration; also label 10 and steroid
card with high doses
Note
Flixotide Evohaler
c
125 micrograms and 250 micrograms
not indicated for children
Dose
by aerosol inhalation,
prophylaxis of asthma,
ADULT and
CHILD over 16 years,
100–500 micrograms twice daily,
increased
according to severity of asthma;
max.
1 mg twice daily;
(doses
above 500 micrograms twice daily initiated by a specialist); CHILD
4–16 years, 50–100 micrograms twice daily adjusted as necessary;
max.
200 micrograms twice daily
Nebules
c
(= single-dose units for nebulisation),
fluticasone propionate 250 micrograms/mL, net price
10 2-mL (500-microgram) unit = £9.34;
1 mg/mL,
10 2-mL (2-mg) unit = £37.35. May be diluted with
sterile sodium chloride 0.9%.
Label:
8,
counselling,
administration,
10,
steroid card
Dose
by inhalation of nebulised suspension,
prophylaxis of
asthma,
ADULT and CHILD over 16 years, 0.5–2 mg twice daily;
CHILD 4–16 years, 1 mg twice daily
Note
Not suitable for use in ultrasonic nebulisers
188
3.2 Corticosteroids
BNF 61
3
Respiratory system