RESPIRATORY TRACT
Asthma/COPD 18A
;MONTELUKAST
SINGULAIR Merck
Leukotriene receptor antagonist. Montelukast (as
sodium) 10mg; tabs.
Also: Montelukast
SINGULAIR CHEWABLE
Montelukast (as sodium) 4mg, 5mg; tabs; cherry
flavor; contains phenylalanine.
Also: Montelukast
SINGULAIR ORAL GRANULES
Montelukast (as sodium) 4mg; per packet.
Indications: Prophylaxis and chronic treatment of
asthma (for patients ;
12 months old). Prevention
of exercise-induced bronchoconstriction (EIB) (for
patients ;15yrs old).
Adults and Children: Take granules by mouth
within 15 minutes of opening packet; may dissolve
in 5mL of cold or room temperature baby formula or
breast milk, or mix in spoonful of soft applesauce,
carrots, rice, or ice cream. ;12months: not
recommended. 12–23months: one 4mg granule
packet. 2–5yrs: one 4mg chew tab or granule packet.
6–14yrs: 5mg chew tab. ;15yrs: 10mg. For asthma:
take once daily in the PM. For EIB: Take at least 2
hours before exercise (max 1 dose/day).
Warnings/Precautions: Not for primary treatment
of acute attack. Caution when withdrawing from oral
steroids. Pregnancy (Cat.B). Nursing mothers.
Interactions: Monitor with potent CYP450 inducers
(eg, phenobarbital, rifampin). Caution with drugs
metabolized by CYP2C8 (eg, paclitaxel, rosiglitazone,
repaglinide).
Adverse reactions: Adults: headache, fatigue,
fever, GI upset. Children: also flu/cold symptoms, ear
or leg pain, thirst, urticaria.
How supplied: Tabs, chew tabs– 30, 90; Oral
granules– 30
;
;
;OMALIZUMAB
XOLAIR Genentech and Novartis
Antiasthmatic (IgE blocker). Omalizumab 150mg/vial;
pwd for SC inj after reconstitution; preservative-free.
Indications: Moderate to severe persistent asthma
in patients with a (;) skin test or in vitro reactivity
to a perennial aeroallergen and whose symptoms are
inadequately controlled by inhaled corticosteroids.
Adults: Base dose and frequency on baseline serum
total IgE level and body weight; see literature. Give
by SC inj over 5–10 seconds; max 150mg per inj
site. 150–375mg every 2 or 4 weeks. Reevaluate
periodically.
Children: Not recommended.
Warnings/Precautions: Not for treating acute
attacks. Have medications for treating anaphylaxis
available, monitor for at least 2 hours after inj; may have
delayed reaction. Elevated serum IgE levels may persist
for up to 1 year after stopping therapy. Patients at risk
of malignancy. Pregnancy (Cat.B). Nursing mothers.
Adverse reactions: Inj site reactions, viral
infections, upper respiratory tract infections (eg,
sinusitis, pharyngitis), headache; hypersensitivity
reactions (discontinue if severe), anaphylaxis (may be
fatal), antibody formation, malignancies.
How supplied: Single-use vial– 1
;ROFLUMILAST
DALIRESP Forest
Selective phosphodiesterase 4 (PDE4) inhibitor.
Roflumilast 500mcg; tablets.
Indications: To reduce risk of COPD exacerbations
in severe COPD patients with chronic bronchitis and
a history of exacerbations. Not for the relief of acute
bronchospasm.
Adults: 500mcg once daily.
Children: Not recommended.
Contraindications: Moderate-to-severe liver
impairment (Child-Pugh Class B or C).
Warnings/Precautions: Depression. Suicidal ideation.
Mild liver impairment (Child-Pugh Class A). Monitor
for insomnia, anxiety, depression, suicidal ideation,
other mood changes; reevaluate if occurs. Monitor
weight regularly; consider discontinuing if unexplained
or significant weight loss occurs. Pregnancy (Cat. C).
Labor & delivery, nursing mothers: not recommended.
Interactions: Concomitant strong CYP450 inducers
(eg, rifampicin, phenobarbital, carbamazepine,
phenytoin): not recommended. Potentiated by
CYP3A4 and CYP1A2 inhibitors (eg, erythromycin,
ketoconazole, fluvoxamine, enoxacin, cimetidine),
and by oral contraceptives containing gestodene ;
ethinyl estradiol (possible increased adverse effects).
Adverse reactions: GI upset, weight decrease,
headache, back pain, influenza, dizziness, decreased
appetite; psychiatric effects (eg, insomnia, anxiety,
depression).
How supplied: Tabs– 30
;SALMETEROL
SEREVENT DISKUS GlaxoSmithKline
Long-acting ;2-agonist. Salmeterol (as xinafoate)
50mcg/inh; dry pwd for inhalation; device with drug
in blisters.
Indications: As an adjunct (see literature): For the
maintenance treatment of asthma and in the prevention
of bronchospasm in reversible obstructive air way
disease (including nocturnal asthma). Maintenance
treatment of COPD-associated bronchospasm.
Prevention of exercise-induced bronchospasm (EIB).
Adults and Children: ;4yrs: not recommended.
;4yrs: 1 inh every 12 hours. EIB prevention: 1 inh at
least 30 minutes before exercise. Max 2 doses/day.
Contraindications: Not for treatment of acute
attacks, or when occasional use of short-acting drugs
suffices. Do not initiate in significantly worsening
or acutely deteriorating asthma. Salmeterol is not a
substitute for steroids. Do not exceed recommended
dose. Do not use additional doses for EIB if already
using regular dosing for asthma.
Warnings/Precautions: Not for use with
other long-acting ;2-agonists. Cardiovascular
disease (esp. coronary insufficiency, arrhythmias,
