Asmanex Twistheiler
Instructions for use:
- 1. Release form and composition
- 2. Indications for use
- 3. Contraindications
- 4. Method of application and dosage
- 5. Side effects
- 6. Special instructions
- 7. Drug interactions
- 8. Terms and conditions of storage
Asmanex Twistheiler is an inhaled glucocorticosteroid (GCS) with a local anti-inflammatory effect.
Release form and composition
Dosage form - metered powder for inhalation: powdery agglomerates of almost white or white color without visible foreign inclusions [240 mg (30 doses) in metered dose inhalers "Twisthailer", in a cardboard box 1 inhaler, packed in aluminum foil and polymer laminated film].
Active ingredient: mometasone furoate, in 1 dose - 200 or 400 mcg.
Anhydrous lactose is used as an excipient.
Indications for use
- bronchial asthma of any severity, including in patients who have previously received other inhaled or systemic corticosteroids, as well as in the case of insufficient effectiveness of previous therapy without corticosteroids (basic therapy);
- chronic obstructive pulmonary disease of any degree.
Contraindications
- children under 12 years old;
- hypersensitivity to any component of the drug.
Carefully:
- herpes eye damage (herpes simplex virus);
- active or latent pulmonary tuberculosis;
- systemic viral, bacterial, or fungal infections;
- the period of pregnancy and lactation.
Method of administration and dosage
Asmanex Twistheiler is used in the form of inhalation.
The recommended initial dose for mild to moderate bronchial asthma in the case of its stable course is 400 mcg 1 time per day in the evening.
In some cases (for example, in patients who previously received high-dose GCS inhalations), more adequate disease control can be achieved if the daily dose is divided into 2 inhalations. For some patients, during maintenance therapy, a dose of 200 mcg 1 time per day is sufficient, also in the evening. Such patients should use Asmanex Twistheiler with an active ingredient content of 200 mcg in 1 dose.
Further, the doctor selects the dose individually, until the minimum dose is reached, allowing adequate control over the disease.
In severe bronchial asthma, at the beginning of treatment, 400 mcg is prescribed 2 times a day. After a stable effect is achieved, the dose is gradually reduced to the minimum effective.
When a patient is transferred to Asmanex Twistheiler from oral GCS at the beginning of treatment, both drugs are used simultaneously. Further, the oral corticosteroid begins to be gradually canceled: after about a week, its daily dose is reduced or 1 dose is missed, after another 1-2 weeks, the next dose reduction is carried out. The dose should not be reduced by more than 2.5 mg of prednisolone or its equivalent per day. During the period of cancellation of oral corticosteroids, it is necessary to carefully monitor the patient's condition, including monitoring his respiratory function (in order to prevent the worsening of the course of the disease) and adrenal function (to exclude insufficient function of the adrenal cortex).
In chronic obstructive pulmonary disease, Asmanex Twistheiler is prescribed in a daily dose of 800 mcg. For most patients, it is enough to receive the entire dose once a day - in the evening, in some cases, therapy is more effective if the daily dose is divided into 2 doses.
Rules for using the Twistheiler inhaler
- Make sure that the dose counter on the lid is aligned with the pointer.
- Open the inhaler by sliding the white cap counterclockwise while holding the base in a fixed position. The meter will then indicate the use of one dose.
- Place the inhaler in the mouth, clasp the mouthpiece with your lips, inhale deeply while pressing the inhaler.
- Remove the mouthpiece and hold your breath for at least 10 seconds. Do not exhale through Twisthaler.
- Put the cover back in place, turn it clockwise, gently pressing it down until you hear a click and the cover is completely closed. In this case, the pointer will be combined with the dose counter, a new dose will be loaded for the next inhalation.
- Rinse out the mouth (to reduce the risk of developing oral candidiasis).
When the last dose is loaded into the inhaler, the display will show “00” (instead of “01”), and the lid will be locked, as a result of which inhalation will become impossible. After that, the Twisthaler should be thrown away.
The inhaler must be kept clean and dry. Do not wash Twistheiler with water. The outside of the mouthpiece can be cleaned with a dry cloth or gauze.
Side effects
- most often: headache, pharyngitis, oral candidiasis, dysphonia;
- in rare cases: dry mouth and throat, palpitations, weight gain, dyspepsia;
- from the respiratory system: an increase in the number of wheezing in the lungs and the development of bronchospasm immediately after inhalation;
- systemic effects (especially with long-term treatment at high doses): increased intraocular pressure, glaucoma, cataracts, inhibition of adrenal cortex function, bone demineralization, growth retardation in children and adolescents.
In the course of post-marketing studies, it was found that in isolated cases, hypersensitivity reactions are possible: itching, rash, urticaria, erythema, anaphylactic reaction, angioedema (swelling of the eyes, face, lips and throat).
It was reported about cases of worsening of the course of bronchial asthma, manifested by wheezing, shortness of breath, cough, bronchospasm.
special instructions
Asmanex Twistheiler is not intended for rapid relief of bronchospasm. When prescribing it, patients should be warned that for this purpose it is necessary to use fast-acting inhaled bronchodilators.
Also, patients should be informed about the need to immediately contact their doctor if, during treatment with this drug, it is not possible to stop bronchospasm with the help of bronchodilators. In this case, an increase in the dose of mometasone furoate and / or the appointment of systemic corticosteroids may be required.
In order to avoid a worsening of the course of the disease, Asmanex Twistheiler should be used constantly, even in the absence of symptoms of the disease.
In connection with the risk of developing adrenal insufficiency, special care should be taken when transferring a patient to Asmanex Twistheiler inhalation from systemic GCS, after their cancellation, it takes several months to restore the function of the hypothalamic-pituitary-adrenal system.
When switching to Asmanex Twistheiler with GCS for systemic use, the development of concomitant allergic diseases is possible, the manifestations of which were previously suppressed by systemic corticosteroids. In some patients during this period, signs of cancellation of systemic corticosteroids appear, including pain in muscles and / or joints, feeling of fatigue, depression. At the same time, lung function indicators remain stable or even improve. For this reason, patients are recommended to continue therapy with Asmanex Twistheiler, but their condition is carefully monitored for the development of adrenal cortex insufficiency. When signs of insufficiency appear, it is necessary to temporarily increase the dose of the systemic corticosteroid, and in the future to carry out its cancellation more smoothly.
During stressful situations (including a severe attack of bronchial asthma, infectious diseases, trauma or surgery), patients who have previously received systemic corticosteroids are advised to prescribe an additional short course of glucocorticosteroids for systemic use. In the future, as the symptoms subside, they are gradually canceled.
Such patients should carry a small amount of oral corticosteroids with them along with a warning card, which should indicate the recommended doses in stressful situations. In this category of patients, it is necessary to control the function of the adrenal glands (in particular, the morning content of cortisol in the blood plasma).
In case of development of paradoxical bronchospasm, it is necessary to immediately apply a fast-acting inhalation bronchodilator, after which Asmanex Twistheiler should be canceled and alternative therapy prescribed.
During treatment with GCS or other immunosuppressive drugs, patients are advised to avoid contact with patients with certain infectious diseases, including measles and chickenpox. If such contact does occur, you should definitely consult a doctor, especially for adolescents over 12 years old.
To avoid suppression of the hypothalamic-pituitary-adrenal system, the dose prescribed by the doctor should not be exceeded. For each patient, the dose of mometasone furoate must be titrated to achieve the minimum effective dose. In this case, the attending physician should take into account that the effect of the drug on the production of cortisol may differ from person to person.
If candidiasis develops, it is necessary to prescribe an appropriate antifungal therapy, in some cases, the cancellation of Asmanex Twistheiler is required.
In adolescents who receive long-term inhalation of GCS, it is necessary to regularly monitor growth. If it slows down, the dose of the drug should be reduced to the minimum, with the help of which it will be possible to effectively control the symptoms of bronchial asthma.
Newborns whose mothers received mometasone furoate during pregnancy should be monitored so that signs of adrenal cortex dysfunction can be detected in time if they develop.
Drug interactions
The CYP3A4 enzyme inhibitor ketoconazole, when used simultaneously, increases the concentration of mometasone furoate, but it is unlikely that these changes are of clinical significance.
Terms and conditions of storage
Store at a temperature of 8-30 ° C out of the reach of children.
Shelf life - 2 years, after opening the aluminum foil package - 3 months.
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
