Pronunciation:
moe-met-a-sone
Trade Name(s)
Ther. Class.
anti-inflammatories (steroidal)
Pharm. Class.
(inhalation)
Maintenance treatment of asthma as prophylactic therapy.
Potent, locally acting anti-inflammatory and immune modifier.
Therapeutic Effect(s):
Absorption: <1%; action is primarily local after inhalation.
Distribution: 10–25% is deposited in airways if a spacer device is not used. All cross the placenta and enter breast milk in small amounts.
Metabolism and Excretion: Primarily metabolized by the liver via the CYP3A4 isoenzyme after absorption from lungs; 75% excreted in feces.
Half-life: 5 hr.
TIME/ACTION PROFILE (improvement in symptoms)
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
Inhalation | within 24 hr | 1–4 wk† | unknown |
Contraindicated in:
Use Cautiously in:
EENT: dysphonia, hoarseness, cataracts, glaucoma, nasal congestion, oropharyngeal candidiasis, pharyngitis, sinusitis
Endo: ↓ bone mineral density, adrenal suppression (↑ dose, long-term therapy only), ↓ growth (children)
GI: diarrhea, dry mouth, dyspepsia, nausea, taste disturbances
MS: back pain
Neuro: headache, agitation, depression, dizziness, fatigue, insomnia, restlessness
Resp: bronchospasm, cough, wheezing
Misc: CHURG-STRAUSS SYNDROME, HYPERSENSITIVITY REACTIONS (including anaphylaxis, laryngeal edema, urticaria, and bronchospasm),
* CAPITALS indicate life-threatening.
Underline indicate most frequent.
Drug-Drug
Strong CYP3A4 inhibitors, including, atazanavir, clarithromycin, cobicistat, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir may ↓ metabolism and ↑ levels; use with caution.
Asmanex HFA
Inhaln (Adults and Children ≥12 yr): Not on inhaled corticosteroids: Two 100–mcg inhalations twice daily; not to exceed 800 mcg/day; Currently on chronic oral corticosteroids: Two 200–mcg inhalations twice daily; not to exceed 800 mcg/day.
Inhaln (Children 5–11 yr): Two 50–mcg inhalations twice daily; not to exceed 200 mcg/day).
Asmanex Twisthaler
Inhaln (Adults and Children ≥12 yr): Previously on bronchodilators or other inhaled corticosteroids: 220 mcg (1 inhalation) once daily, up to 440 mcg/day as a single dose or 2 divided doses; Previously on oral corticosteroids: 440 mcg (2 inhalations) twice daily (not to exceed 880 mcg/day).
Inhaln (Children 4–11 yr): 110 mcg once daily in evening (not to exceed 110 mcg/day).
Inhalation aerosol (Asmanex HFA): 50 mcg/metered inhalation in 13-g canisters (120 metered inhalations), 100 mcg/metered inhalation in 13-g canisters (120 metered inhalations), 200 mcg/metered inhalation in 13-g canisters (120 metered inhalations)
Powder for inhalation (Asmanex Twisthaler): 110 mcg (delivers 100 mcg/metered inhalation; in packages of 7 and 30 inhalation units), 220 mcg (delivers 200 mcg/metered inhalation; in packages of 14, 30, 60, and 120 inhalation units)
In Combination with: formoterol (Dulera). See combination drugs.
Monitor for signs and symptoms of hypersensitivity reactions (rash, pruritus, swelling of face and neck, dyspnea) periodically during therapy.
Lab Test Considerations:
Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression.
Advise patient to stop using medication and notify health care professional immediately if signs and symptoms of hypersensitivity reactions occur.