page210
SODIUM CROMOGLICATE
(Sodium Cromoglycate)
Indications
prophylaxis of asthma (see also Manage-
ment of Chronic Asthma table,
p.
172);
food allergy
(section 1.5.4);
allergic conjunctivitis (section 11.4.2);
allergic rhinitis (section 12.2.1)
Cautions
see notes above; also discontinue if eosino-
philic pneumonia occurs
Pregnancy
see p.
170
Breast-feeding
see p.
170
Side-effects
see notes above; also rhinitis;
very rarely
eosinophilic pneumonia
Dose
. By aerosol inhalation,
ADULT
and
CHILD
over 5 years,
10 mg (2 puffs) 4 times daily, increased if necessary to
6–8 times daily; or additional dose may also be taken
before exercise;
maintenance,
5 mg (1 puff) 4 times
daily
Intal
c
CFC-Free Inhaler
(Sanofi-Aventis) A
Aerosol inhalation
,
sodium cromoglicate 5 mg/
metered inhalation, net price 112-dose unit = £14.84.
Label:
8,
counselling,
administration
NEDOCROMIL SODIUM
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 nausea,
vomiting,
dyspepsia,
abdominal pain,
pharyngitis;
rarely
taste
disturbances
Dose
. By aerosol inhalation,
ADULT
and
CHILD
over 6 years
4 mg (2 puffs) 4 times daily,
when control achieved
may be possible to reduce to twice daily
Counselling
Regular use is necessary
Tilade
c
CFC-free Inhaler
(Sanofi-Aventis) T A
Aerosol inhalation
,
mint-flavoured, nedocromil sod-
ium 2 mg/metered inhalation, net price 112-dose unit
= £39.94.
Label:
8,
counselling,
administration
3.3.2
Leukotriene receptor
antagonists
The leukotriene receptor antagonists, montelukast and
zafirlukast, block the effects of cysteinyl leukotrienes in
the airways.
They are effective in asthma when used
alone or with an inhaled corticosteroid (see Manage-
ment of Chronic Asthma table p.
172).
Montelukast has not been shown to be more effective
than a standard dose of inhaled corticosteroid,
but the
two drugs appear to have an additive effect. The leuko-
triene receptor antagonists may be of
benefit in exer-
cise-induced asthma and in those with concomitant
rhinitis,
but they are less effective in those with severe
asthma who are also receiving high doses of other drugs.
Churg-Strauss syndrome has occurred very rarely in
association with the use of leukotriene receptor antago-
nists;
in many of
the reported cases the reaction fol-
lowed the reduction or withdrawal of oral corticosteroid
therapy. Prescribers should be alert to the development
of
eosinophilia,
vasculitic rash,
worsening pulmonary
symptoms,
cardiac complications,
or peripheral
neuro-
pathy.
Pregnancy
There is limited evidence for the safe use
of
leukotriene receptor antagonists during pregnancy;
however,
they can be taken as normal
in women who
have shown a significant
improvement
in asthma not
achievable with other drugs before becoming pregnant,
see also p.
170.
MONTELUKAST
Indications
prophylaxis of asthma,
see notes above
and Management of Chronic Asthma table,
p.
172;
symptomatic relief of seasonal allergic rhinitis in
patients with asthma
Cautions
interactions: Appendix 1 (leukotriene
receptor antagonists)
Pregnancy
manufacturer advises avoid unless essen-
tial,
see also notes above
Breast-feeding
manufacturer advises avoid unless
essential
Side-effects
abdominal pain,
thirst;
hyperkinesia (in
young children), headache;
very rarely
Churg-Strauss
syndrome (see notes above);
dry mouth,
diarrhoea,
dyspepsia,
nausea,
vomiting,
hepatic disorders,
pal-
pitation,
oedema,
increased bleeding,
epistaxis,
hypersensitivity reactions (including anaphylaxis,
angioedema,
and skin reactions),
respiratory infec-
tions,
depression,
suicidal thoughts and behaviour,
tremor,
asthenia,
dizziness,
hallucinations,
paraes-
thesia,
hypoaesthesia, sleep disturbances,
sleep-
walking,
abnormal dreams,
agitation, anxiety,
aggression,
seizures, pyrexia, arthralgia, and myalgia,
also reported
Dose
. Prophylaxis of asthma,
ADULT
and
CHILD
over 15 years,
10 mg once daily in the evening;
CHILD
6 months–6
years 4 mg once daily in the evening, 6–15 years 5 mg
once daily in the evening
. Seasonal allergic rhinitis,
ADULT
and
CHILD
over 15
years, 10 mg once daily in the evening
Singulair
c
(MSD) A
Chewable tablets
,
pink,
cherry-flavoured, montelu-
kast (as sodium salt) 4 mg,
net price 28-tab pack =
£25.69;
5 mg,
28-tab pack = £25.69.
Label:
23, 24
Excipients
include aspartame equivalent to phenylalanine 674 micr-
ograms/4-mg tablet and 842 micrograms/5-mg tablet (section 9.4.1)
Granules
,
montelukast (as sodium salt) 4 mg,
net
price 28-sachet pack = £25.69.
Counselling,
adminis-
tration
Counselling
Granules may be swallowed or mixed with cold
food (but not fluid) and taken immediately
Tablets
,
beige,
f/c,
montelukast (as sodium salt)
10 mg,
net price 28-tab pack = £26.97
Note
The
Scottish Medicines Consortium
has advised (June
2007) that
Singulair
c
chewable tablets and granules are
restricted for use as an alternative to low-dose inhaled
corticosteroids for children 2–14 years with mild persistent
asthma who have not recently had serious asthma attacks that
required oral corticosteroid use and who are not capable of
using inhaled corticosteroids;
Singulair
c
chewable tablets and
granules should be initiated by a specialist in paediatric asthma
190
3.3.2 Leukotriene receptor antagonists
BNF 61
3
Respiratory system