Symbicort (Budesonide / Formoterol)

Synonyms: Bidien, Budeson, Cortivent, Desowen, Entocort, Foracort, Micronyl, Preferid, Pulmicort, Rhinocort

Symbicort (Budesonide / Formoterol) is used for:

Long-term treatment of asthma and chronic obstructive pulmonary disease (COPD) in certain patients. It may also be used for other conditions as determined by your doctor.

Symbicort (Budesonide / Formoterol) is a combination of a synthetic corticosteroid and a long-acting beta-agonist bronchodilator. It works by decreasing irritation and inflammation in the lungs; it widens the airways in the lungs, which helps you breathe more easily.

Do NOT use Symbicort (Budesonide / Formoterol) if:

•you are allergic to any ingredient in Symbicort (Budesonide / Formoterol)

•you are using another medicine that has a long-acting beta-agonist (eg, salmeterol) in it

•you are having an asthma attack (eg, sudden, severe onset or worsening of asthma or COPD symptoms such as wheezing, cough, chest tightness, shortness of breath)

•you are taking mifepristone

Before using Symbicort (Budesonide / Formoterol):

Some medical conditions may interact with Symbicort (Budesonide / Formoterol). Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

•if you are pregnant, planning to become pregnant, or are breast-feeding

•if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

•if you have allergies to medicines, foods, or other substances

•if you have a history of diabetes, heart problems (eg, fast or irregular heartbeat, heart blood vessel problems), high blood pressure, low blood potassium levels, seizures, tuberculosis, a weakened immune system, liver problems, or thyroid problems

•if you have weakened bones (eg, osteoporosis), a family history of weakened bones, or have other risk factors for weak bones (eg, smoking, poor nutrition)

•if you have a history of eye problems (eg, glaucoma, cataracts, increased eye pressure)

•if you have a fungal, bacterial, or parasitic infection; a viral infection (eg, chickenpox, measles); herpes infection of the eye; or a lung infection (eg, pneumonia)

•if you have recently been to an emergency room for asthma, have a history of frequent hospitalizations for asthma, or have ever had a life-threatening asthma attack

•if you have had an unusual reaction to a sympathomimetic medicine (eg, albuterol, pseudoephedrine), such as fast or irregular heartbeat, overexcitement, or severe trouble sleeping

•if you are taking a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) or a tricyclic antidepressant (eg, amitriptyline), or if you have taken either of these medicines within the last 14 days

Some MEDICINES MAY INTERACT with Symbicort (Budesonide / Formoterol). Tell your health care provider if you are taking any other medicines, especially any of the following:

•Beta agonists (eg, albuterol), corticosteroids (eg, prednisone), diuretics (eg, furosemide, hydrochlorothiazide), or xanthines (eg, theophylline) because the risk of low blood potassium or irregular heartbeat may be increased

•Ritodrine because the risk of maternal lung edema may be increased

•Catechol-o-methyltransferase (COMT) inhibitors (eg, entacapone), clarithromycin, HIV protease inhibitors (eg, atazanavir, ritonavir), itraconazole, ketoconazole, long-acting beta-agonists (eg, salmeterol), MAOIs (eg, phenelzine), nefazodone, telithromycin, or tricyclic antidepressants (eg, amitriptyline) because they may increase the risk of Symbicort (Budesonide / Formoterol)'s side effects

•Barbiturates (eg, phenobarbital), beta-blockers (eg, propranolol), carbamazepine, hydantoins (eg, phenytoin), oral contraceptives, or rifampin because they may decrease Symbicort (Budesonide / Formoterol)'s effectiveness or worsen your condition

•Mifepristone because the risk of its side effects may be increased by Symbicort (Budesonide / Formoterol)

This may not be a complete list of all interactions that may occur. Ask your health care provider if Symbicort (Budesonide / Formoterol) may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Symbicort (Budesonide / Formoterol):

Use Symbicort (Budesonide / Formoterol) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

•Symbicort (Budesonide / Formoterol) comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Symbicort (Budesonide / Formoterol) refilled.

•Store Symbicort (Budesonide / Formoterol) in the foil package until right before use.

•You will need to prime the inhaler before using it for the first time. To prime the inhaler, shake it for 5 seconds, then release a test spray into the air away from your face. Shake well again for 5 seconds and release a second test spray into the air.

•To use Symbicort (Budesonide / Formoterol), remove the inhaler from the foil pouch. Write the date that you open the foil pouch on the dose tracker card that comes with Symbicort (Budesonide / Formoterol).

•Be sure that the canister is properly placed in the inhaler unit. Shake well. Remove the mouthpiece cover. Check the mouthpiece for foreign objects. Breathe out slowly and completely. Place the mouthpiece between your lips and try to rest your tongue flat, unless your doctor has told you otherwise. Your doctor may have told you to hold the inhaler 1 or 2 inches (2 or 3 centimeters) away from the open mouth or to use a special spacing device. As you start to take a slow, deep breath, press the canister and mouthpiece together at exactly the same time. This will release a dose of Symbicort (Budesonide / Formoterol). Continue breathing in slowly and deeply and hold for as long as comfortable, then breathe out slowly through pursed lips or your nose. If more than 1 inhalation is to be used, wait a few minutes and repeat the above steps. Keep the spray away from your eyes. Close the mouthpiece cover after each use.

•If the inhaler is not used for more than 7 days or if it is dropped, it will need to be reprimed again before you use it.

•Wipe the mouthpiece clean with a dry cloth at least once a week.

•Rinse your mouth with water after you finish using the medicine (do not swallow). This will help remove excess medicine and decrease your risk of developing an oral fungal infection.

•Use the enclosed dose tracker card to keep track of the number of puffs you have used. Throw the inhaler away after you have used the labeled number of puffs or after it has been removed from the foil pouch for longer than 3 months, even if the container does not feel empty.

•Use the new inhaler that comes with each refill. Do not reuse an old inhaler. Do not use Symbicort (Budesonide / Formoterol) with a different kind of inhaler.

•Never wash the mouthpiece or any other part of the inhaler with water. Keep it dry and always store in a dry place. Do NOT try to take the inhaler apart.

•Continue to use Symbicort (Budesonide / Formoterol) even if you feel well. Do not miss any doses.

•If you miss a dose of Symbicort (Budesonide / Formoterol), skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Symbicort (Budesonide / Formoterol).

Important safety information:

•Symbicort (Budesonide / Formoterol) may cause dizziness. This effect may be worse if you use it with alcohol or certain medicines. Use Symbicort (Budesonide / Formoterol) with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.

•Some patients may have trouble using Symbicort (Budesonide / Formoterol) correctly. Some may also get mouth sores or a bad taste in the mouth after using it. If you have any of these problems, ask your health care provider if a spacing device may help.

•The risk of serious heart problems (eg, irregular heartbeat) may be greater if you use Symbicort (Budesonide / Formoterol) in high doses. Do NOT use more than the recommended dose or use for longer than prescribed without checking with your doctor.

•Use caution if you switch from an oral steroid (eg, prednisone) to Symbicort (Budesonide / Formoterol). It may take several months for your body to make enough natural steroids to handle events that cause physical stress. Such events may include injury, surgery, infection, loss of blood electrolytes, or a sudden asthma attack. These may be severe and sometimes fatal. Contact your doctor right away if any of these events occur. You may need to take an oral steroid (eg, prednisone) again. Carry a card at all times that says you may need an oral steroid (eg, prednisone) if any of these events occur.

•Symbicort (Budesonide / Formoterol) may lower the ability of your body to fight infection. Avoid contact with people who have colds or infections. Tell your doctor if you notice signs of infection like fever, sore throat, rash, or chills.

•If you have not had chickenpox, shingles, or measles, avoid contact with anyone who does. Tell your doctor right away if you are exposed to anyone who has these infections.

•Do not receive a live vaccine (eg, measles, mumps) while you are taking Symbicort (Budesonide / Formoterol). Talk with your doctor before you receive any vaccine.

•Symbicort (Budesonide / Formoterol) will not stop an asthma attack once it has already started. Be sure to carry a short-acting bronchodilator inhaler with you at all times to treat any breathing problems that may occur between doses of Symbicort (Budesonide / Formoterol) (eg, severe or sudden onset of wheezing or shortness of breath). If you have any questions about which medicines stop asthma attacks, check with your doctor or pharmacist.

•If you have been regularly using a short-acting bronchodilator inhaler (eg, albuterol), talk with your doctor about how to use it with Symbicort (Budesonide / Formoterol). Short-acting bronchodilators are normally only used with Symbicort (Budesonide / Formoterol) to treat breathing problems that may occur between doses.

•If your symptoms do not get better within 1 to 2 weeks of starting Symbicort (Budesonide / Formoterol) or if they get worse, contact your doctor right away.

•Tell your doctor at once if you notice that your short-acting bronchodilator inhaler does not work as well, if you need to use it often (eg, 4 or more times a day for more than 2 days in a row, more than 1 canister in 8 weeks), or if you have a decrease in your peak flow meter results.

•Contact your doctor or seek medical care right away if you have breathing problems that worsen quickly, or if you use your short-acting bronchodilator and do not get relief.

•Talk with your doctor or pharmacist about all of your asthma medicines and how to use them. Do not start, stop, or change the dose of any asthma medicine unless your doctor tells you to.

•The medicine may sometimes cause breathing problems right after you use a dose. If this happens, use your short-acting bronchodilator. Contact your doctor or seek other medical care at once.

•Lab tests, including lung function tests, blood pressure, and eye exams, may be performed while you use Symbicort (Budesonide / Formoterol). These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

•Use Symbicort (Budesonide / Formoterol) with caution in the ELDERLY; they may be more sensitive to its effects, especially weakened bones.

•Corticosteroids may affect the growth rate in CHILDREN and teenagers in some cases. They may need regular growth checks while they use Symbicort (Budesonide / Formoterol).

•Symbicort (Budesonide / Formoterol) should be used with extreme caution in CHILDREN younger than 12 years old; safety and effectiveness in these children have not been confirmed.

•pregnancy and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Symbicort (Budesonide / Formoterol) while you are pregnant. Symbicort (Budesonide / Formoterol) is found in breast milk. Do not breast-feed while taking Symbicort (Budesonide / Formoterol).

Possible side effects of Symbicort (Budesonide / Formoterol):

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

•Dizziness; dry mouth; headache; nausea; nervousness; stomach pain or upset; stuffy nose; throat irritation; tiredness; tremor; trouble sleeping; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

•Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, tongue, or throat; unusual hoarseness); back pain; bone pain; chest pain; fast or irregular heartbeat; fever, chills, or persistent sore throat; increased mucus production or change in color of mucus; new or worsening asthma or COPD symptoms (eg, coughing, increased chest tightness, shortness of breath, wheezing); seizures; severe or persistent dizziness, headache, nervousness, or tremor; severe or persistent muscle pain or cramps; trouble speaking; vision changes; white patches in your mouth or throat.

This is not a complete list of all side effects that may occur. Call your doctor for medical advice about side effects.

If OVERDOSE is suspected:

Symptoms may include chest pain; fast or irregular heartbeat; fatigue; headache; increased thirst or urination; muscle pain or cramps; nausea; nervousness; seizures; severe or persistent dizziness; tremors; trouble sleeping; vomiting.

Proper storage of Symbicort (Budesonide / Formoterol):

Store Symbicort (Budesonide / Formoterol) at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and direct sunlight. Do not store in the bathroom. Do not puncture, break, or burn the canister even if it appears to be empty. Store Symbicort (Budesonide / Formoterol) with the mouthpiece down. Keep Symbicort (Budesonide / Formoterol) out of the reach of children and away from pets.

General information:

•If you have any questions about Symbicort (Budesonide / Formoterol), please talk with your doctor, pharmacist, or other health care provider.

•Symbicort (Budesonide / Formoterol) is to be used only by the patient for whom it is prescribed. Do not share it with other people.

•If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Symbicort (Budesonide / Formoterol). If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

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Singulair (Montelukast)

Synonyms: Montair, Romilast

What is the most important information I should know about Singulair?

•Singulair will not stop an asthma attack that has already begun. It is used to prevent asthmatic attacks.

•Use Singulair on a regular basis for best results. It may take several weeks to get the maximum effect of this medication.

•Seek medical attention if you notice that you require more than your usual or more than the maximum amount of any asthma medication in a 24-hour period. An increased need for medication could be an early sign of a serious asthma attack.

What is Singulair?

•Singulair is a leukotriene (loo-koe-try-een) inhibitor. Leukotrienes are substances in the body that are associated with the inflammation and constriction of airway muscles and the accumulation of fluid in the lungs, all of which occur during an asthma attack.

•Singulair is used to prevent asthma attacks. Singulair is also used in the treatment of allergies.

•Singulair may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking Singulair?

•Before taking Singulair, tell your doctor if you have liver disease. You may not be able to take Singulair, or you may require a dosage adjustment or special monitoring during treatment if you have liver disease.

•The 4 mg chewable Singulair tablets contain 0.674 mg phenylalanine and the 5 mg chewable Singulair tablets contain 0.842 mg phenylalanine. Individuals with phenylketonuria (PKU) may need to monitor their intake of this additive.

•Singulair is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby. Do not, however, take this medication without first talking to your doctor if you are pregnant.

•It is not known whether Singulair passes into breast milk. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.

How should I take Singulair?

•Take Singulair exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

•Singulair is usually taken in the evening. Follow your doctor's instructions.

•Swallow the regular tablets with a glass of water.

•Chew the chewable tablets thoroughly before swallowing.

•The granules can be given either directly into the mouth or mixed with a spoonful of cold or room temperature applesauce, mashed carrots, rice, or ice cream. The packet should not be opened until ready to use. After opening the packet, the full dose must be administered within 15 minutes. Never store any mixed or unmixed granules for use after 15 minutes. The granules are not intended to be dissolved in liquid however, liquids may be taken after administration of the medication.

•Singulair can be taken with or without food.

•Do not stop taking Singulair without first talking to your doctor. It may be some time before you begin to notice effects from this medication.

•Continue taking any other asthma medications, as directed by your doctor.

•Singulair will not stop an asthma attack that has already begun. Keep another medication on hand to treat attacks.

•Seek medical attention if you notice that you require more than your usual or more than the maximum amount of any asthma medication in a 24-hour period. An increased need for medication could be an early sign of a serious asthma attack.

•Store Singulair at room temperature away from moisture and heat.

What happens if I miss a dose?

•Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take the next regularly scheduled dose as directed. Do not take a double dose of this medication.

What happens if I overdose?

•Seek emergency medical attention.

•The symptoms of an overdose of Singulair are unknown.

What should I avoid while taking Singulair?

•Avoid items or activities that may trigger an asthma attack.

What are the possible side effects of Singulair?

•If you experience any of the following serious side effects, stop taking Singulair and seek emergency medical attention or notify your doctor immediately:

◦an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);

◦numbness, tingling, or pain;

◦a rash or unexplained open sores or bruising;

◦a flu-like illness;

◦severe inflammation (pain and swelling) of the sinuses; or

◦worsening respiratory symptoms.

•Other, less serious side effects may be more likely to occur. Continue to take Singulair and talk to your doctor if you experience

◦upset stomach, stomach pain, or heartburn;

◦dizziness or headache;

◦tiredness;

◦sore throat or cough, or

◦nasal irritation.

•Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Singulair?

•Before taking Singulair, tell your doctor if you are taking rifampin (Rimactane, Rifadin) or phenobarbital (Luminal, Solfoton). You may not be able to take Singulair, or you may require a dosage adjustment or special monitoring during your treatment.

•Drugs other than those listed here may also interact with Singulair. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.

 

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Serevent (Salmeterol)

Synonyms: Serobid, Seroflo, Aeromax, Arial, Astmerole, Fujimycin, Salmetedur

What is the most important information I should know about Serevent?

•Data from a large study of people using Serevent has shown a small but significant increased risk of asthma-related deaths. Discuss with your doctor the risks and benefits of using Serevent before starting treatment.

•Do not use Serevent more often than is prescribed by your doctor. Doing so could seriously affect the heart and could even lead to death. Generally, Serevent should not be used more often than every 12 hours.

•Seek medical attention if you notice that you require more than your usual or more than the maximum amount of any asthma medication in a 24-hour period. An increased need for medication could be an early sign of a serious asthma attack.

•Serevent is a long-acting medication used to treat chronic asthma. It does not treat acute asthma attacks.

•Do not substitute Serevent for any of your other asthma medications, especially if you are having an acute asthma attack.

•It is very important to use the Serevent inhaler properly, so that the medicine gets into the lungs. Your doctor may want you to use a spacer with the inhaler. (A spacer should not be used with the Serevent Diskus inhaler.) Talk to your doctor about proper inhaler use.

What is Serevent?

•Serevent is a bronchodilator. It works by relaxing muscles in the airways to improve breathing.

•Serevent is used to treat asthma. It is used only to prevent asthma attacks, not to treat an attack already in progress. It will not work fast enough to give relief during an attack. Serevent is also used in the treatment of chronic obstructive pulmonary disease (COPD) including emphysema and chronic bronchitis.

•Serevent may also be used for conditions other than those listed in this medication guide.

What should I discuss with my healthcare provider before using Serevent?

•Data from a large study of people using Serevent has shown a small but significant increased risk of asthma-related deaths. Discuss with your doctor the risks and benefits of using Serevent before starting treatment.

•Before using this medication, tell your doctor if you have

◦heart disease or high blood pressure;

◦irregular heartbeats;

◦epilepsy or another seizure disorder;

◦diabetes;

◦an overactive thyroid (hyperthyroidism);

◦liver disease; or

◦kidney disease.

•You may require a dosage adjustment or special monitoring during therapy if you have any of the conditions listed above.

•Serevent is in the FDA pregnancy category C. This means that it is not known whether Serevent will be harmful to an unborn baby. Do not use this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment.

•It is not known whether Serevent passes into breast milk. Do not use Serevent without first talking to your doctor if you are breast-feeding a baby.

•Serevent inhalation aerosol is approved for use by children 12 years of age and older. Serevent Diskus is approved for use by children 4 years of age and older.

How should I use Serevent?

•Use Serevent exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

•If you are using Serevent to prevent exercise-induced asthma, take a dose 30 to 60 minutes before exercising, or as directed by your doctor. Another dose should not be taken for at least 12 hours.

•To use the inhaler:

◦Shake the inhaler several times and uncap the mouthpiece. Breathe out fully. For best results, hold the inhaler 1 to 2 inches in front of your open mouth or attach a spacer to the inhaler and place the spacer in your mouth, above your tongue and past your teeth. Take a deep, slow breath as you push down on the canister. Hold your breath for 10 seconds, then exhale slowly. If you place your inhaler directly into your mouth, you may not receive the correct amount of medicine because it will be propelled onto the back of your tongue and/ or throat. If you do use your inhaler directly in your mouth, be sure that it is above your tongue and past your teeth.

◦If your doses consist of more than one puff each, wait for at least 1 full minute after each puff, then repeat the procedure.

◦Keep your inhaler clean and dry. Keep the mouthpiece capped to avoid getting dirt inside it. Clean your inhaler once a day by removing the canister and immersing the mouthpiece in warm water. Allow the parts to dry, then reassemble the inhaler.

•To use the Serevent Diskus inhaler:

◦Snap the mouthpiece into position. Hold the Diskus level and away from your mouth, breathe out fully away from the mouthpiece. (Do not breathe out into the Diskus mouthpiece.) Put the mouthpiece to your lips. Take a steady, deep breath in through your mouth. Remove the mouthpiece from your mouth. Hold your breath for about 10 seconds. Breathe out slowly away from the mouthpiece. Close the Diskus. The Diskus is now ready for your next scheduled dose.

◦Never wash the mouthpiece or any part of the Diskus device. Keep it dry at all times.

•It is very important to use the Serevent inhaler properly, so that the medicine gets into the lungs. Your doctor may want you to use a spacer with the inhaler. (A spacer should not be used with the Serevent Diskus inhaler.) Talk to your doctor about proper inhaler use.

•In most cases, you should be able to taste or feel a dose of Serevent being delivered. If the delivery of a dose is not detected, do not use another dose. Contact your healthcare provider if you have questions.

•Do not use Serevent more often than is prescribed by your doctor. Doing so could seriously affect the heart and could even lead to death. Generally, Serevent should not be used more often than every 12 hours.

•Do not use Serevent to treat an asthma attack that has already begun. It will not work fast enough to reverse your symptoms. Have another, faster-acting inhalation — such as albuterol (Ventolin, Proventil) — on hand to relieve asthma attacks.

•Seek medical attention if you notice that you require more than your usual or more than the maximum amount of any asthma medication in a 24-hour period. An increased need for medication could be an early sign of a serious asthma attack.

•Serevent is not a substitute for steroid medications taken orally or by inhalation. Do not stop taking a steroid medication without first talking to your doctor.

•It is important to use Serevent regularly to get the most benefit. Do not stop using Serevent without first talking to your doctor.

•Your doctor may want you to have lung function tests or other medical evaluations during treatment with Serevent to monitor progress and side effects.

•Store Serevent at room temperature. Refill the medication before you run out and before going on vacation.

What happens if I miss a dose?

•If it is almost time for the next regularly scheduled dose, skip the missed dose and use the next one as directed. Alternatively, you can use the missed dose as soon as you remember, then wait at least 12 hours before using another dose of Serevent. Do not use a double dose of this medication.

What happens if I overdose?

•Seek emergency medical attention if an overdose is suspected.

•Symptoms of a Serevent overdose include angina or chest pain, irregular heartbeats or a fluttering heart, seizures, tremor, weakness, headache, nausea, and vomiting.

What should I avoid while using Serevent?

•Avoid situations that may trigger an asthma attack such as exercising in cold, dry air; smoking; breathing in dust; and exposure to allergens such as pet hair.

What are the possible side effects of Serevent?

•Stop using Serevent and seek emergency medical attention if you experience any of the following serious side effects:

◦an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

◦increased difficulty breathing; or

◦chest pain or irregular heartbeats.

•Other, less serious side effects may be more likely to occur. Continue to use Serevent and talk to your doctor if you experience

◦headache, dizziness, lightheadedness, or insomnia;

◦tremor or nervousness;

◦sweating;

◦nausea, vomiting, or diarrhea; or

◦dry mouth.

•Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Serevent?

•Before using this medication, tell your doctor if you are taking any of the following medicines:

◦a beta-blocker such as atenolol (Tenormin), metoprolol (Lopressor), propranolol (Inderal), acebutolol (Sectral), bisoprolol (Zebeta), carteolol (Cartrol), carvedilol (Coreg), labetalol (Normodyne, Trandate), nadolol (Corgard), or pindolol (Visken);

◦a tricyclic antidepressant such as amitriptyline (Elavil), doxepin (Sinequan), nortriptyline (Pamelor), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), or protriptyline (Vivactil);

◦a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate); or

◦caffeine, a diet medicine, or a decongestant.

•You may not be able to use Serevent, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.

•Drugs other than those listed here may also interact with Serevent, or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

 

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Pulmicort (Budesonide)

Synonyms: Budez, Plumicort, Bidien, Cortivent, Desonide, Desowen, Entocort, Micronyl, Preferid, Rhinocort

What is the most important information I should know about Pulmicort?

•Pulmicort will not stop an asthma attack that has already started. It is used to prevent attacks.

•Avoid exposing yourself to known sources of infection. Stay away from people with chicken pox, measles, or any other type of infection. Your immune system may not be strong enough to fight off an infection while you are taking Pulmicort.

•Do not use more of this medication than is prescribed for you. Too much may cause serious side effects.

•Use Pulmicort on a regular basis for best results. It may take several weeks to get the maximum effect of this medication.

•It is very important that you use your Pulmicort inhaler or nebulizer properly, so that the medicine gets into your lungs. Talk to your doctor about proper inhaler or nebulizer use.

•Seek medical attention if you notice that you require more than your usual or more than the maximum amount of any asthma medication in a 24-hour period. An increased need for medication could be an early sign of a serious asthma attack.

What is Pulmicort?

•Pulmicort is a steroid. It prevents the release of substances in the body that cause inflammation.

•Pulmicort is used to prevent asthma attacks.

•Pulmicort may also be used for purposes other than those listed in this medication guide.

Who should not use Pulmicort?

•Before using Pulmicort, tell your doctor if you have a viral, bacterial, or fungal infection of any kind. The absorption of this drug into your system can inhibit your body's ability to fight off infections. You may not be able to use Pulmicort if you have an infection.

•Pulmicort will not stop an asthma attack that has already started. It is used to prevent attacks. Do not use Pulmicort to treat an asthma attack. If you are having an asthma attack that is not responding to any treatment, seek emergency medical attention.

•Pulmicort is in the FDA pregnancy B. This means that it is not expected to harm an unborn baby. Do not use this medication without first talking to your doctor if you are pregnant.

•It is not known whether Pulmicort passes into breast milk. Do not use Pulmicort without first talking to your doctor if you are breast-feeding a baby.

How should I use Pulmicort?

•Use Pulmicort exactly as directed by your doctor. Read the information insert included with your inhaler. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

•If you are also using a bronchodilator such as albuterol (Proventil, Ventolin), pirbuterol (Maxair), or bitolterol (Tornalate), your doctor may want you to use the bronchodilator first, then use your Pulmicort inhaler. Using the medications in this order will allow more Pulmicort to reach your lungs.

•The Pulmicort Turbuhaler must be primed the first time it is used. Turn the cover and lift it off while holding the unit upright. Turn the grip all the way to the right then all the way to the left until it clicks. Repeat this procedure. The unit is now primed. You will not have to prime it again, even if you do not use it for an extended period of time.

•To inhale a dose, hold the unit upright, turn the cover and lift it off. While still holding the unit upright, twist the grip all the way to the right and all the way to the left until it clicks. Do not blow or exhale into the unit, and do not shake it. Turn your head away and breathe out fully. Place your lips around the mouthpiece while holding the unit upright or horizontally. Take a deep, slow breath. You may not taste, smell, or feel any medicine when you inhale, however you are receiving a dose. Hold your breath for several seconds, then exhale slowly. If more than one dose is required, repeat this process. Replace the cover on the unit and twist it firmly into place after each use.

•The Pulmicort Respules are intended for administration with a jet nebulizer (not an ultrasonic nebulizer). The Pulmicort Respules should not be mixed with any other nebulizable medications in the nebulizer. Gently shake the Respule using a circular motion before use.

•To reduce the chance of developing a yeast infection in your mouth, rinse your mouth with water after a dose of Pulmicort but do not swallow. Also, if you are using a nebulizer with a face mask, wash the area of your face covered by the mask.

•It is very important that you use your Pulmicort inhaler or nebulizer properly, so that the medicine gets into your lungs. Talk to your doctor about proper inhaler or nebulizer use.

•Do not use more of this medication than is prescribed for you, but use it consistently, as directed, even when you are feeling better. It may be several weeks before you see effects from Pulmicort. Talk to your doctor if your symptoms do not improve or if they get worse.

•Pulmicort will not stop an attack after it has started. It is used to prevent attacks from occurring. Keep another medicine on hand to treat attacks.

•Seek medical attention if you notice that you require more than your usual or more than the maximum amount of any asthma medication in a 24-hour period. An increased need for medication could be an early sign of a serious asthma attack.

•If you are switching from an oral steroid (pills or liquid) to Pulmicort, carry or wear identification that will let others know that you may require a systemic steroid during a severe asthma attack or during another traumatic situation. Discuss with your doctor the precautions necessary when discontinuing an oral steroid.

•There are 200 doses in each Pulmicort Turbuhaler. A red mark will appear in the top of the dose indicator window when there are 20 doses of medicine remaining. You should get your next inhaler at this time. When the red mark reaches the bottom of the indicator window, the inhaler is empty and should be thrown away.

•Store this medication at room temperature away from moisture and heat. Keep the inhaler clean and dry at all times. Do not refrigerate or freeze the Pulmicort Respules. After opening an aluminum foil envelope, any unused Pulmicort Respules should be returned to the envelope to protect them from light. Any individually opened Respules should be used promptly. The Pulmicort Respules are good for up to 2 weeks at room temperature, when protected from light after the envelope has been opened. Record the date the envelope was opened on the back of the envelope in the space provided.

What happens if I miss a dose?

•Use the missed dose as soon as you remember. However, if it is almost time for your next regularly scheduled dose, skip the missed dose and use the next one as directed. Do not use a double dose of this medication.

What happens if I overdose?

•An overdose of this medication is not likely to occur. If you do think an overdose has occurred, call an emergency room or poison control left.

What should I avoid while taking Pulmicort?

•Avoid items or activities that you know are allergens for you if they make your symptoms worse. Clean areas where dust or pet fur may aggravate your condition.

•Avoid exposing yourself to known sources of infection. Stay away from people with chicken pox, measles, or any other type of infection. Your immune system may not be strong enough to fight off an infection while you are taking Pulmicort.

What are the possible side effects of Pulmicort?

•Serious side effects from Pulmicort are not likely to occur. If you experience any of the following serious side effects, stop using Pulmicort and seek emergency medical attention or notify your doctor immediately:

◦an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

◦numbness, tingling, or pain;

◦a rash or unexplained open sores or bruising; or

◦worsening respiratory symptoms.

•Other, less serious side effects may be more likely to occur. Continue to take Pulmicort and talk to your doctor if you experience

◦dry mouth, nose, or throat after use;

◦yeast (or another) infection in the mouth or throat (white patches);

◦hoarseness or deepening of the voice, cough, or sore throat;

◦headache;

◦weakness or fatigue;

◦weight loss;

◦increased tanning of the skin;

◦lightheadedness or dizziness;

◦unpleasant (or loss of) taste or smell;

◦nausea or abdominal pain;

◦decreased growth in children taking large doses;

◦increased pressure in the eyes, glaucoma, or tearing of the eyes;

◦cataracts, which may develop after long-term use; or

◦mood changes such as depression, aggression, irritability, or anxiety (these effects are very rare).

•Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Pulmicort?

•Before using this medication, tell your doctor and pharmacist about any other drugs you are taking. The use of other oral, nasal, or inhaled steroids may increase the chance of side effects or overdose.

•The effects of Pulmicort may be increased by the antifungal medicine ketoconazole (Nizoral). If you are using this or another antifungal medication, talk to your doctor.

•Drugs other than those listed here may also interact with Pulmicort or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

 

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