Table 5:
Pharmacologic Agents for the Treatment of Asthma
Generic
Name
Brand Name
(Manufacturer)
Delivery Route/
Device
Suggested Dosage
(Adults)
Comment
Anticholinergics
Atropine
sulfate		 Many Solution
0.2% (1 mg/0.5 mL)
0.5% (2.5 mg/0.5 mL)
(1.25 mg)		 0.025 mg/kg diluted with 3-5 mL NS q 6-8 hr Minimal side effects with ipratropium;
Ipratropium
bromide		 Atrovent
(Boehringer)

MDI (18 g/puff)

Solution 0.02% (500-µ g unit dose vial)

 2-4 puffs qid; max = 12 puffs/day
500 µg/tid, qid		 Approved for COPD only
Tiotropium Spiriva (Boehringer) DPI 8 mg/puff 1 puff per day Approved for COPD only
β2-Adrenergic Agents
Albuterol sulfate Airet (Medeva)
Albuterol (various generic)
 
Proventil (Schering)

Solution (0.83%)
Solution (0.83%, 0.5%)
MDI (90 µg puff)

 

 



Solution for nebulizer

 

Tablets (2,4 mg)

2.5-10 mg q 6-8 hr
2.5-10 mg q 6-8 hr ml
(0.5 mL)
Acute: 2-4 puffs q 4-6 hr; max 16-20 puffs/day
Prophylaxis: 2 puffs 15 min before exercise

2.5-10 mg a 6-8 hr
(0.083%) (3 mL) or (0.5%) (0.5 mL)

2-4 mg q 6-8 hr; max: 32 mg/day
2-4 puffs q 4-6 hr
4 mg q 12 hr

 Inaled agents have fewer systemic side effects;
β-2 selective agents are albuterol, bitolterol, metaproterenol, pirbuterol, almeterol, terbutaline
Proventil-HFA (Schering) MDI (90 µg/puff)
Repetabs (sustained Release tablets), 4 mg		 2-4 puffs q 4-6 hr
4 mg q 12 hr
  Ventolin (Glaxo)

MDI (90 µg/puff)

Rotohaler (200 µg/
Rotacap)
Solution for nebulizer
(0.083% µg mL, 0.5% 20 mL)
Tablets (2,4 mg)

 Max: 16-30 puffs/day (200 puffs)
200-400 µg q 6-8 hr; max dose=2.4 mg/day
2.5-10 mg q 6-8 hr		  
Volmax (Muro) Sustained-release tablets (4, 8 mg) 4-8 mg q 12 hr
Bitolterol mesylate Tornalate (Sanofi Winthrop) MDI (370 µg/puff) 2 puffs q 6 hr
Epinephrine Medihaler-Epi (3M Pharm) Many

MDI (300 µg/puff)

 2 puffs qid
Adrenalin chloride
(Parke-Davis)		 SC inection 1:1000 (1 mg/mL) 0.2-0.5 mg SC (0.2-0.5 mL SC) q 20 min
Formoterol Foradil (Novartis)
(investigational in USA)		 MDI
DPI
Isoetharine HCl Bronkometer
(Sanofi Winthrop)
Many

MDI (340 µg/puff)

Solutions for inhalation

1-2 puffs q 4 hr

0.25-1 mL nebulized with NS
Isoproterenol HCL Medihaler-150 (3M Pharm)
Isuprel Mistometer
(Sanofi Winthrop)

MDI (800 µg/puff)

MDI (131 µg/puff)

Solution (0.5%, 1%, 5%)
Tablets (glossets 10, 15 mg)

1-2 puff qid

1-2 puffs qid
0.5 ml in 2.5 ml NS 1 3-4 hr
10-20 mg q 4 hr
Levalbuterol Xopenex (Sepracor) Solution for nebulizer (0.63 mg) 0.63 mg q 6-8 hr  
Metaproterenol Alupent (Boehringer)

MDI (650 µg/puff)


Solution (0.4%, 0.6%)


Tablets (10, 20 mg)

2-3 puffs q 3-4 hr max=12 puff/day

0.3 mL in 2.5 mL NS q 4-6 hr

10 mg q 6-8 hr, 10 mg up to 20 mg

  
Metaprel (Sandoz)

MDI (650 µg/puff)


Solution (0.5%)


Tablet (10, 20 mg)

2-3 puffs q 3-4 hr; max=12

0.3 mL in 2.5 mL NS q 4-6 hr

10 mg q 6-8 hr, up to 20 mg
Pirbuterol acetate Maxair (3M Pharm)

MDI (200 µg/puff)


AutoHaler

1-2 puffs q 4-6 hr; max=12 puffs/day

2 puffs q 6 hr
Salmeterol Serevent (Glaxo) MDI (46 µg/puff)
Diskus (DPI 50 µg/puff)		 2 puffs q 12 hr
Terbutaline sulfate Brethaire (Geigy)

MDI (200 µg/puff)
Solution for SC
injection or nebulizer (1 mg/mL)


Tablet (2.5, 5 mg)

1-2 puffs q 4-6 hr
0.25 mg SC q 15-30 min; max = 0.50 mg/4 hr, 0.75-2.5 mg nebulized with NS

2.5-5 mg tid; max=15 mg/24 hr
Bricanyl
(Marion Merrell Dow)		 MDI (200 µg/puff)
Tablets (2.5, 5 mg)		 1-2 puffs q 4-6 hr
2.4-5 mg tid max=15 mg/24 hr
Cromoglycates
Cromolyn sodium Intal (Fisons) Spinhaler (20 mg capsules)
MDI (800 µg/puffs)
Solution (20 mg/2 ml ampule)

20 mg qid
 
2 puffs qid
1 ampule qid

 Contraindication in acute asthma
Inhaled corticosteroids
Nedocromil sodium
Beclomethasone dipropionate		 Tilade (Aventis)
Beclovent (Allen & Hanburys)		 MDI (1.75 mg/puff)
MDI (42 µg/puff)		 2 puffs bid, tid, qid
2 puffs tid-qid: max=20 puffs/day		  
Need more than 400 µg/day to maintain off oral steroids, no adrenal suppression if <800-1200 µg/day

HFA-BDP
Qvar (3M)
Vanceril (Schering)

Vanceril DS

MDI (40 or 80 µg/puff)
 
MDI (42 µg/puff)
 
MDI (84 µg/puff)

 2-8 puffs bid
 
2 puffs tid-qid; max=20 puffs/day
2 puffs tid-qid; max=20 puffs/day
Budesonide

Pulmicort
(AstraZeneca)
 
Pulmicort Respules
(AstraZeneca)

Turbuhaler (200 µg/puff)
 
 
Solution (0.25 mg/2ml or 0.50 mg/2ml)

400-1600 µg in divided doses bid-qid
 
0.25 mg to 1 mg qd-bid

 Approved for 12 mos-8 yrs; only approved
Flunisolide AeroBid (Forest) MDI (250 µg/puff) 2 puffs bid; max=8 puffs/day
Fluticasone propionate Flovent (Glaxo) MDI (44, 110, 220, µg/puff)
Diskus powder inhaler
(50, 100, 250 µg/puff)		 100-800 µg/day

Mometasone furoate
(investigational in US)

Triamcinolone acetonide

Asthmanex
(Schering)

Azmacort (Rhone-Poulenc Rorter)

N/A
 

MDI (100 µg/puff)

N/A
 

2-4 puffs qid; max=16 puffs/day

Combination Products

Albuterol/
ipratropium

Salmeterol/flutcasone
 

Fomoterol/budesonide
(investigational)

Combivent
(Boehringer-Ingelheim)

Advair (Glaxo)


Symbicort
(AstraZeneca)

MDI (18 µg/ipratropium/
103 µg/albuterol per puff)

Diskus (DPI)


Turbuhaler

2 puffs qid
 

50/100, 50/250, 50/500
(1 puff bid)

N/A
Antileukotrienes

Montelukast
Zafirlukast

Zileuton

Singulair (Merck)
Accolate (Zeneca)

Zyflo (Abbott)

Tablet (5, 10 mg)
Tablets (20 mg)

Tablets (600 mg)

10 mg qd in the evening
20 mg bid

600 mg qid

Churg-Strauss
Take on empty stomach; drug interactions
Need to follow LFTs, drug interactions
Methylxanthines
Aminophylline Various IV Load: If not on theophylline at home, 5-6 mg/kg over 20 min; if on theophylline, level pending, 3 mg/kg over 20 min; a bolus of 0.5 mg/kg will increase level by 2 in the average adult. Maintenacne 0.5-0.9 mg/kg/hr; 200-400 mg bid Decreased clearance with cirrhosis, CHF, erythromycin, cimetidine, troleadomycin increased clearance with smoking, young age, and phenobarbital. Need to follow serum levels
Anti-IgE
Omalizumab Xolar
(Genentech/Novartis)		 Subcutaneous 0.016 mg X body wt (kg) X IgE level (IU/ml); also see nomogram See text for details; Urticaria 2%-3% anaphylaxis 0.01%-0.1%
HFA=hydrofluroalkaline-134a; DPI=dry powder inhaler; MDI=pressurized metered dose inhaler; BDP=beclomethasone dipropionate; SC=subcutaneous; LFT=liver function tests; CHF=congestive heart failure; N/A=not available.
Copyright 2004 The Cleveland Clinic Foundation

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