Flunisolide Dosage

Applies to the following strengths: 80 mcg/inh; 250 mcg/inh

Usual Adult Dose for Asthma - Maintenance

Initial dose: 160 mcg via oral inhalation twice a day
Maximum dose: 320 mcg twice a day

Comments:

Not indicated for the relief of acute bronchospasm.
Contains a built-in spacer; do not use with any external spacer or holding chamber.
Onset and degree of symptom relief varies with individual; if adequate response is not realized after 3 to 4 weeks of therapy, higher doses may provide additional benefit.
Once asthma stability has been achieved, patients should be titrated to the lowest effective dose.
For patients receiving oral corticosteroids, gradually taper oral corticosteroids on a weekly basis beginning after the first week of inhaled therapy (e.g., no more than prednisone 2.5 mg/day once a week); patients should be carefully monitored for asthma instability during transition; once oral corticosteroid taper is complete, inhalation dose should be reduced to the lowest effective dose.

Uses: For the maintenance treatment of asthma as prophylactic therapy; may also be used for patients with asthma requiring oral corticosteroids when use may reduce or eliminate the need for oral corticosteroids.

Usual Pediatric Dose for Asthma - Maintenance

Age: 6 to 11 years:
Initial dose: 80 mcg via oral inhalation twice a day
Maximum dose: 160 mcg twice a day

Age: 12 years or older:
Initial dose: 160 mcg via oral inhalation twice a day
Maximum dose: 320 mcg twice a day

Comments:

Not indicated for the relief of acute bronchospasm.
Contains a built-in spacer; do not use with any external spacer or holding chamber.
Onset and degree of symptom relief varies with individual; if adequate response is not realized after 3 to 4 weeks of therapy, higher doses may provide additional benefit.
Once asthma stability has been achieved, patients should be titrated to the lowest effective dose.
For patients receiving oral corticosteroids, gradually taper oral corticosteroids on a weekly basis beginning after the first week of inhaled therapy (e.g., no more than prednisone 2.5 mg/day once a week); patients should be carefully monitored for asthma instability during transition; once oral corticosteroid taper is complete, inhalation dose should be reduced to the lowest effective dose.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

No adjustment recommended

Dose Adjustments

Abrupt discontinuation after prolonged use is not recommended

Inhalation doses should be reduced to the lowest effective dose once asthma stability has been achieved

Oral Corticosteroids:

Allow at least 7 days before initiating a taper with oral corticosteroid
Oral steroid should be reduced gradually on a weekly basis (e.g. prednisone 2.5 mg/day once a week)
Monitor for signs of asthma instability including serial objective measure of airflow
Monitor for signs of adrenal insufficiency

Precautions

Safety and efficacy have not been established in patients younger than 4 years.
Efficacy has not been established in patients 4 or 5 years of age.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

For oral inhalation only
Inhaler includes a built-in spacer; do not use with external spacers or holding chambers
Patients should rinse mouth with water (without swallowing) after each use
Patients should receive instruction on proper use; pediatric patients should use inhaler under adult supervision

Storage requirements:

Store at room temperature; contents under pressure: do not puncture; do not store or use near heat or open flame; or throw canister into fire or incinerator.

Preparation techniques: The manufacturer product information should be consulted for complete instructions.

The inhaler contains a built-in spacer
Prepare inhaler by pulling the built-in purple actuator out from the gray spacer and snapping into an "L" shape
Prime inhaler prior to first use and if not used for more than 2 weeks: Shake inhaler; press down on the metal canister 2 times for 1 second each to release 2 test sprays

General:

This drug is not intended for acute asthma exacerbations; patients should treat acute asthma symptoms with an inhaled, short-acting bronchodilator.
Use with caution, if at all, in patients with active or quiescent tuberculosis infection, untreated fungal, bacterial, systemic viral or parasitic infections, or ocular herpes simplex.
Patients switching from oral corticosteroid treatment should do so gradually while monitoring HPA axis functions regularly; oral corticosteroid supplementation may be needed during periods of stress.

Monitoring:

Monitor asthma signs and symptoms including serial objective measures of airflow
Monitor bone mineral content in patients at high risk of decreased bone mineral density
Monitor growth regularly in pediatric patients
Regular eye examinations should be considered, especially in patients with a history of ocular changes or those experiencing visual changes
Periodically assess oral cavity for signs and symptoms of Candida albicans infection
Monitor for signs and symptoms of adrenal insufficiency
Monitor adrenocortical function in patients transferring from corticosteroids with higher systemic effects.

Patient advice:

Patients should understand that this drug is a corticosteroid; they should know the signs and symptoms of hypercorticism and adrenal suppression.
Patients should understand that during times of stress, such as surgery or infection, additional oral supplementation may be necessary; they should discuss with their healthcare professional whether they need to carry a medical identification card identifying their corticosteroid use.
Patients on immunosuppressant doses of corticosteroids should understand that a greater risk of infection exists; they should avoid exposure to chickenpox or measles and if exposed, they should consult their healthcare professional promptly.
Patients should be instructed on proper inhaler technique and the importance of regular use; patients will need to keep track of the number of sprays they have used by using the check-off chart that is supplied with the inhaler.
Patients should understand this drug is not intended to relieve acute asthma symptoms and a short acting bronchodilator should be used for that; if asthma symptoms do not respond to a short acting bronchodilator, or require higher or more frequent dosing, they should contact their healthcare professional for reevaluation of therapy.
Patients should be instructed to rinse and spit after oral inhalation use to avoid infection; if infection develops, they should contact their healthcare professional.