concomitant therapy, or both. Long-term use is justified if the drug significantly reduces the severity of asthma symptoms; permits a significant reduction in, or elimination of, steroid dosage; or improves management of those who have intolerable side effects to sympathomimetic agents or methylxan-thines. For cromolyn to be effective, it must be administered at least 30 minutes prior to antigen challenge and administered at regular intervals (see dosing information that follows). When inhaled, the powder does produce irritation in some patients. Also, overuse of cromolyn can result in tolerance.
Dosage forms: Oral concentrate (100 mg/5 mL), nasal solution (40 mg/mL), solution for inhalation (20 mg/2 mL), aerosol (800 mg), ophthalmic solution (4%) Usual adult dose:
• Inhalation solution (adults and children at least 2 years of age): 20 mg (one ampule per vial) bynebulization 4 times/day at regular intervals
• Aerosol (asthma in adults and children at least 5 years of age): 2 metered sprays inhaled 4 times per day at regular intervals
• Nasal solution (adults and children): one spray in each nostril 3 to 6 times daily at regular intervals every 4 to 6 hours
• Oral: two ampules 4 times per day 30 minutes before meals and at bedtime
• Ophthalmic: 1 drop of a 2% to 4% solution 4 to 6 times daily; Oral: two ampules 4 times a day 30 minutes before meals and at bedtime
Nedocromil Sodium. Nedocromil sodium, disodium 9-ethyl-6, 9-dihydro-4,6-dioxo-10-propyl-4H-pyrano[3, 2-g]quinoline-2,8-dicarboxylate (Tilade), is structurally re lated to cromolyn and displays similar, but broader, pharmacological actions.52 It was available as an aerosol in a metered-dose inhaler for asthma treatment, and currently remains available as ophthalmic solution for the treatment of itching associated with allergic conjunctivitis. The inhalation formulation was marketed for maintenance therapy in the management of patients with mild-to-moderate bronchial asthma, but since has been withdrawn.
Dosage forms: Ophthalmic solution (2% or 20 mg/mL) Usual adult dose: 1 or 2 drops in each eye twice a day at regular intervals
Lodoxamide Tromethamine. Lodoxamide tromethamine, N, n'-(2-chloro-5-cyano-m-phenylene)diox-amic acid (Alomide), is a white crystalline, water-soluble powder. The only significant structural similarity between lodoxamide and cromolyn and nedocromil is the presence of two acidic groups. Lodoxamide is indicated in the treatment of the ocular disorders including vernal keratoconjunctivitis, vernal conjunctivitis, and vernal keratitis.55 Lodoxamide is available as a 0.1% solution, with each milliliter containing 1.78 mg of lodoxamide tromethamine equivalent to 1 mg of lodoxamide. The solution contains the preservative benzal-konium chloride (0.007%) as well as mannitol, hydroxy-propyl methylcellulose, sodium citrate, citric acid, edetate disodium, tyloxapol, hydrochloric acid and/or sodium hydroxide (to adjust pH), and purified water.
The dose for adults and children older than 2 years of age is 1 to 2 drops in each affected eye 4 times daily for up to 3 months. The most frequently reported ocular adverse experiences were transient burning, stinging, or discomfort on instillation.
Pemirolast Potassium Ophthalmic Solution.
Pemirolast potassium, 9-methyl-3-(1H-tetrazol-5-yl)-4H-pyrido[1, 2-a]pyrimidin-4-one potassium (Alamast), is a yellow, water-soluble powder. It can be considered an analog of one portion of the cromolyn structure in which the carboxyl group has been replaced with an isosteric tetra-zole moiety. Pemirolast is indicated for the prevention of itching of the eye caused by allergic conjunctivitis. The commercial preparation is available as a 0.1% sterile ophthalmic solution for topical administration to the eyes. Each milliliter of this solution contains 1 mg of pemirolast potassium, as well as the preservative lauralkonium chloride (0.005%), and glycerin, phosphate buffers, and sodium hydroxide to maintain a solution pH of 8.0. The solution has an osmolality of 240 mOsm/L. The recommended dose is 1 to 2 drops instilled into each affected eye 4 times a day. This drug product is for ocular administration only and not for injection or oral use and should be used with caution during pregnancy or while nursing.56
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