lSIDE-EFFECTS
▶Common or very commonAbdominal pain.arthralgia.back
pain.bone fracture.cough.dysphonia.fever.muscle
spasms.oropharyngeal pain
▶UncommonVision blurred
▶Rare or very rareAngioedema.anxiety
lPREGNANCYManufacturer advises use only if potential
benefit outweighs risk.
lBREAST FEEDINGManufacturer advises avoid—no
information available.
lHEPATIC IMPAIRMENTManufacturer advises use with
caution.
RELVAR ELLIPTA®
184 MICROGRAMS/22 MICROGRAMSAvoid in moderate to
severe impairment.
lPATIENT AND CARER ADVICEPatients or carers should be
given advice on how to administerfluticasone with
vilanterol powder for inhalation.
A steroid card should be provided.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Inhalation powder
CAUTIONARY AND ADVISORY LABELS8, 10
▶Relvar Ellipta(GlaxoSmithKline UK Ltd)A
Vilanterol 22 microgram per 1 dose, Fluticasone furoate
92 microgram per 1 doseRelvar Ellipta 92 micrograms/dose /
22 micrograms/dose dry powder inhaler| 30 doseP£ 22. 00 DT =
£ 22. 00
Vilanterol 22 microgram per 1 dose, Fluticasone furoate
184 microgram per 1 doseRelvar Ellipta 184 micrograms/dose /
22 micrograms/dose dry powder inhaler| 30 doseP£ 29. 50 DT =
£ 29. 50
eiiiiF 159Mometasone furoate 21-Dec-2017
lINDICATIONS AND DOSE
Prophylaxis of asthma
▶BY INHALATION OF POWDER
▶Child 12–17 years:Initially 400 micrograms daily in
1 – 2 divided doses, single dose to be inhaled in the
evening, reduced to 200 micrograms once daily, if
control maintained
Prophylaxis of severe asthma
▶BY INHALATION OF POWDER
▶Child 12–17 years:Increased if necessary up to
400 micrograms twice dailylINTERACTIONS→Appendix 1 : corticosteroids
lPATIENT AND CARER ADVICEPatients or carers should be
given advice on how to administer mometasone by inhaler.
With high doses, a steroid card should be supplied.
Medicines for Children leaflet: Mometasone furoate inhaler for
asthma prevention (prophylaxis)www.medicinesforchildren.org.
uk/mometasone-furoate-inhaler-for-asthma-prevention-
prophylaxis
lNATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) Decisions
TheScottish Medicines Consortiumhas advised (November
2003 ) thatAsmanex®is restricted for use following failure
offirst-line inhaled corticosteroids.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Inhalation powder
CAUTIONARY AND ADVISORY LABELS8, 10
▶Asmanex Twisthaler(Merck Sharp & Dohme Ltd)
Mometasone furoate 200 microgram per 1 doseAsmanex
200 micrograms/dose Twisthaler| 30 doseP£ 15. 70 DT = £ 15. 70
| 60 doseP£ 23. 54 DT = £ 23. 54
Mometasone furoate 400 microgram per 1 doseAsmanex
400 micrograms/dose Twisthaler| 30 doseP£ 21. 78 DT = £ 21. 78
| 60 doseP£ 36. 05 DT = £ 36. 05IMMUNOSUPPRESSANTS›MONOCLONAL
ANTIBODIESOmalizumab
lINDICATIONS AND DOSE
Prophylaxis of severe persistent allergic asthma
▶BY SUBCUTANEOUS INJECTION
▶Child 6–17 years:Dose according to immunoglobulin E
concentration and body-weight (consult product
literature)
Add-on therapy for chronic spontaneous urticaria in
patients who have had an inadequate response to H 1
antihistamine treatment
▶BY SUBCUTANEOUS INJECTION
▶Child 12–17 years: 300 mg every 4 weekslCAUTIONSAutoimmune disease.susceptibility to
helminth infection—discontinue if infection does not
respond to anthelmintic
lSIDE-EFFECTS
▶Common or very commonFever.headache.skin reactions
▶UncommonCough.diarrhoea.dizziness.drowsiness.
fatigue.flushing.gastrointestinal discomfort.increased
risk of infection.influenza like illness.limb swelling.
nausea.paraesthesia.photosensitivity reaction.postural
hypotension.respiratory disorders.syncope.weight
increased
▶Rare or very rareAngioedema.hypersensitivity.systemic
lupus erythematosus (SLE)
▶Frequency not knownAlopecia.eosinophilic
granulomatosis with polyangiitis.immune
thrombocytopenic purpura.joint disorders.
lymphadenopathy.myalgia
SIDE-EFFECTS, FURTHER INFORMATION
Eosinophilic granulomatosis with polyangiitis (Churg-
Strauss syndrome)Churg-Strauss syndrome has
occurred rarely in patients given omalizumab; the reaction
is usually associated with the reduction of oral
corticosteroid therapy. Churg-Strauss syndrome can
present as eosinophilia, vasculitic rash, cardiac
complications, worsening pulmonary symptoms, or
peripheral neuropathy.
Hypersensitivity reactionsHypersensitivity reactions
can also occur immediately following treatment with
omalizumab or sometimes more than 24 hours after the
first injection.
lPREGNANCYManufacturer advises avoid unless
essential—crosses the placenta.
lBREAST FEEDINGManufacturer advises avoid—present in
milk inanimalstudies.
lHEPATIC IMPAIRMENTManufacturer advises caution—no
information available.
lRENAL IMPAIRMENTManufacturer advises caution—no
information available.164 Airways disease, obstructive BNFC 2018 – 2019
Respiratory system3