BNF for Children 2011-2012

BNFC 2011–2012 3.3 Cromoglicate and related therapy 151price 120-dose unit = £35.00. Label: 8, counselling,administration, 10, steroid cardDoseProphylaxis of asthma. By aerosol inhalationChild 12–18 years 2 puffs twice dailySeretide 250 Evohaler c (aerosol inhalation), fluticasonepropionate 250 micrograms, salmeterol (asxinafoate) 25 micrograms/metered inhalation, netprice 120-dose unit = £59.48. Label: 8, counselling,administration, 10, steroid cardDoseProphylaxis of asthma. By aerosol inhalationChild 12–18 years 2 puffs twice dailyMOMETASONE FUROATECautions see notes abovePregnancy see p. 133Breast-feeding see p. 133Side-effects see notes above; also pharyngitis, headache;less commonly palpitationIndication and doseProphylaxis of asthma see also Management ofChronic Asthma table, p. 135. By inhalation of powderChild 12–18 years 200–400 micrograms as asingle dose in the evening or in 2 divided doses;dose increased to 400 micrograms twice daily ifnecessaryAsmanex c (MSD) TATwisthaler (= dry powder inhaler), mometasone furoate200 micrograms/metered inhalation, net price30-dose unit = £15.70, 60-dose unit = £23.54;400 micrograms/metered inhalation, 30-dose unit =£21.78, 60-dose unit = £36.05. Label: 8, counselling,administration, 10, steroid cardNote The Scottish Medicines Consortium has advised(November 2003) that Asmanex c is restricted for usefollowing failure of first-line inhaled corticosteroidschildren is contentious. Prophylaxis with cromoglicateor nedocromil is less effective than with inhaled corticosteroids(see Management of Chronic Asthma table).Withdrawal of sodium cromoglicate or nedocromilshould be done gradually over a period of one week—symptoms of asthma may recur.Nedocromil may be of some benefit in the prophylaxisof exercise-induced asthma.For the use of sodium cromoglicate and nedocromil inallergic conjunctivitis see section 11.4.2; sodium cromoglicateis used also in allergic rhinitis (section 12.2.1)and allergy-related diarrhoea (section 1.5.4).Paradoxical bronchospasm If paradoxical bronchospasmoccurs, a short-acting beta 2 agonist such as salbutamolor terbutaline (section 3.1.1.1) should be usedto control symptoms; treatment with sodium cromoglicateor nedocromil should be discontinued.Side-effects Side-effects associated with inhalation ofsodium cromoglicate and nedocromil include throatirritation, cough, bronchospasm (including paradoxicalbronchospasm—see above), and headache.SODIUM CROMOGLICATE(Sodium Cromoglycate)Cautions see notes above; also discontinue if eosinophilicpneumonia occursPregnancy see p. 133Breast-feeding see p. 133Side-effects see notes above; rhinitis and eosinophilicpneumonia also reportedIndication and doseProphylaxis of asthma (see also Management ofChronic Asthma, p. 135). By aerosol inhalationChild 5–18 years 10 mg (2 puffs) 4 times daily,increased if necessary to 6–8 times daily; anadditional dose may also be taken before exercise;maintenance, 5 mg (1 puff) 4 times dailyFood allergy section 1.5.43 Respiratory system3.3 Cromoglicate and relatedtherapy and leukotrienereceptor antagonists3.3.1 Cromoglicate and related therapy3.3.2 Leukotriene receptor antagonistsAllergic conjunctivitis section 11.4.2Allergic rhinitis section 12.2.1Intal c CFC-free inhaler (Sanofi-Aventis) AAerosol inhalation, sodium cromoglicate 5 mg/metered inhalation, net price 112-dose unit = £14.84.Label: 8, counselling, administration3.3.1 Cromoglicate and relatedtherapyThe mode of action of sodium cromoglicate and nedocromilis not completely understood; they may be ofvalue as prophylaxis in asthma with an allergic basis,but the evidence for benefit of sodium cromoglicate inNEDOCROMIL SODIUMCautions see notes abovePregnancy see p. 133Breast-feeding see p. 133Side-effects see notes above; also nausea, vomiting,dyspepsia, abdominal pain, pharyngitis; rarely tastedisturbancesLicensed use not licensed for use in children under 6years