INHALED CORTICOSTEROIDS (ICS)

PRICING INFO
References:
Inhaled corticosteroid (ICS) use and linear growth in children

Conclusions:
ASTHMA STUDIES


COPD STUDIES

Drug Dosage form Dosage Generic/Price Other Mechanism of Action Indications
(FDA-approved)
Side Effects Drug Interactions Precautions/
Contraindications
Beclomethasone

(Qvar®)
Qvar® 40 inhaler
  • Delivers 40 mcg of beclomethasone per actuation
  • Available as 100 (7.3g) or 120 actuations (8.7g) per inhaler

Qvar® 80 inhaler
  • Delivers 80 mcg of beclomethasone per actuation
  • Available as 100 (7.3g) or 120 actuations (8.7g) per inhaler
Asthma
  • 5 - 11 years
    • Starting: 40 mcg twice a day
    • Max: 80 mcg twice a day
    • For patients who do not respond to 40 mcg after 2 weeks, the dose may be increased to 80 mcg
  • 12 years and older
    • Starting: 40 - 80 mcg twice a day
    • Max: 320 mcg twice a day
    • Patients who are already using an inhaled corticosteroid may require higher starting doses

  • See NHLBI ICS dosing chart for more detailed recommendations
NO/$$$-$$$$
  • A spacer may help prevent thrush

  • Rinsing mouth after use may help prevent thrush
  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators
Asthma
  • Patients 5 years of age and older
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm
All ICS
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm

From the Qvar® PI
P = % of patients on placebo who reported side effect
  • Upper respiratory infection - 11%, P - 11%
  • Headache- 8%, P - 9%
  • Pharyngitis - 5%, P - 4%
  • Oral symptoms - 3%, P - 2%
  • Sinusitis - 3%, P - 2%
  • Nausea - 1%, P - 0%
  • CYP3A4 strong inhibitors - beclomethasone is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to beclomethasone
  • - long-term ICS use in children may inhibit linear growth
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - has not been studied extensively
  • Kidney disease - has not been studied extensively
Drug Dosage form Dosage Generic/Price Other Mechanism of Action Indications
(FDA-approved)
Side Effects Drug Interactions Precautions/
Contraindications
Budesonide

(Pulmicort®)
Pulmicort Flexhaler™
  • Pulmicort Flexhaler® 90 - contains 90 mcg of budesonide inhalation powder (60 actuations)
  • Pulmicort Flexhaler® 180 - contains 180 mcg of budesonide inhalation powder (120 actuations)

Pulmicort Respules® - nebulizer
  • 0.25 mg/2ml
  • 0.5 mg/2ml
  • 1 mg/2ml
  • 30 respules in a carton
Flexhaler
  • Asthma (6 - 17 years)
    • Starting: 180 mcg twice a day
    • Max: 360 mcg twice a day

  • Asthma (≥ 18 years)
    • Starting: 360 mcg twice a day
    • Max: 720 mcg twice a day

  • See NHLBI ICS dosing chart for more detailed recommendations

Respules
  • Asthma (1 - 8 years old)
    • Starting: 0.5 mg once daily or 0.25 mg twice a day
    • Max: 1 mg once daily or 0.5 mg twice a day

  • See NHLBI ICS dosing chart for more detailed recommendations
Inhaler
NO/$$$-$$$$

Respules
YES/$$$$
Pulmicort Flexhaler™
  • Rinsing mouth after use may help prevent thrush

Pulmicort Respules®
  • Protect from sunlight

  • When an envelope has been opened, the shelf life of the unused ampules is 2 weeks when protected

  • Rinsing mouth after use may help prevent thrush

  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators
Asthma
  • Flexhaler™ - 6 years of age and older
  • Respules® - 12 months - 8 years of age
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm
All ICS
  • Thrush- up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm

From the Flexhaler® PI
P = % of patients on placebo who reported side effect
  • Nasopharyngitis - 9.3%, P - 8.3%
  • Nasal congestion - 2.7%, P - 0.4%
  • Pharyngitis- 2.7%, P - 1.7%
  • Allergic rhinitis - 2.2%, P - 1.3%
  • Viral upper respiratory infection - 2.2%, P - 1.3%
  • Nausea - 1.8%, P - 0.9%
  • CYP3A4 strong inhibitors - budesonide is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to budesonide
  • Severe milk allergy - (Flexhaler® only) - DO NOT USE - contains small amount of lactose
  • - long-term ICS use in children may inhibit linear growth
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - has not been studied extensively
  • Kidney disease - has not been studied extensively
Drug Dosage form Dosage Generic/Price Other Mechanism of Action Indications
(FDA-approved)
Side Effects
Drug Interactions Precautions/
Contraindications
Ciclesonide

(Alvesco®)
Alvesco® inhaler
  • Alvesco® 80 - delivers 80 mcg of ciclesonide per actuation
  • Alvesco® 160 - delivers 160 mcg of ciclesonide per actuation
  • Inhalers come with 60 actuations
Asthma (12 years and older)
  • Starting: 80 mcg twice a day
  • Max: 320 mcg twice a day
  • Patients taking oral corticosteroids may require higher starting doses

See NHLBI ICS dosing chart for more detailed recommendations
NO/$$$$
  • Rinsing mouth after use may help prevent thrush

  • Prime inhaler before first dose by releasing 3 puffs into the air

  • Prime inhaler if not used for more than 10 days
  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators
Asthma
  • Patients 12 years of age and older
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm
All ICS
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm

From the Alvesco® PI
P = % of patients on placebo who reported side effect
  • Headache- 11%, P - 7.3%
  • Nasopharyngitis - 8.7%, P - 7.5%
  • Upper respiratory infection - 8.7%, P - 6.5%
  • Sinusitis - 5.5%, P - 3%
  • Nasal congestion - 5.5%, P - 1.6%
  • CYP3A4 strong inhibitors - ciclesonide is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to ciclesonide
  • - long-term ICS use in children may inhibit linear growth
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - no dose adjustment necessary
  • Kidney disease - has not been studied extensively
Drug Dosage form Dosage Generic/Price Other Mechanism of Action Indications
(FDA-approved)
Side Effects Drug Interactions Precautions/
Contraindications
Flunisolide

(Aerospan™)
Aerospan™ HFA
  • delivers 80 mcg of flunisolide per actuation
  • Inhaler comes with 120 actuations
  • Inhaler comes with built-in spacer
Asthma
  • 6 - 11 years
    • Starting: 80 mcg twice a day
    • Max: 160 mcg twice a day

  • 12 years and older
    • Starting: 160 mcg twice a day
    • Max: 320 mcg twice a day

  • See NHLBI ICS dosing chart for more detailed recommendations
  • NO/$$$$
  • Aerospan™ comes with a built-in spacer

  • Rinsing mouth after use may help prevent thrush

  • Prime before using for the first time by releasing 2 test sprays into the air

  • Re-prime inhaler if not used for more than 2 weeks
  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators
Asthma
  • Patients 6 years of age and older
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm
All ICS
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm

From the Aerospan™ PI
P = % of patients on placebo who reported side effect
  • Pharyngitis- 16.8%, P - 13.2%
  • Sinusitis- 8.8%, P - 5.5%
  • Allergic reaction - 4.4%, P - 2.3%
  • Upset stomach- 3.5%, P - 1.4%
  • CYP3A4 strong inhibitors - flunisolide is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to flunisolide
  • - long-term ICS use in children may inhibit linear growth
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - has not been studied extensively
  • Kidney disease - has not been studied extensively
Drug Dosage form Dosage Generic/Price Other Mechanism of Action Indications
(FDA-approved)
Side Effects Drug Interactions Precautions/
Contraindications
Fluticasone
propionate

(ArmonAir RespiClick®)
ArmonAir RespiClick®
powder inhaler

  • ArmonAir RespiClick® 55 - delivers 55 mcg of fluticasone propionate per inhalation
  • ArmonAir RespiClick® 113 - delivers 113 mcg of fluticasone propionate per inhalation
  • ArmonAir RespiClick® 232 - delivers 232 mcg of fluticasone propionate per inhalation
  • Each inhaler contains 60 actuations
Asthma (12 years and older)
  • Starting: 55 mcg twice daily
  • Maintenance: 55 - 232 mcg twice daily
  • Max: 232 mcg twice daily
  • Increase dose at intervals of 2 weeks
  • Inhale at the same time each day
  • Patients switching from other inhaled corticosteroids may require higher starting doses
NO/$$$$
  • Inhaler does not require priming
  • Never wash or put any part of the inhaler in water
  • Do not use with a spacer or volume holding chamber
  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators
Asthma
  • Patients ≥ 12 years of age
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm
All ICS
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm

From the ArmonAir RespiClick® PI
P = % of patients on placebo who reported side effect. Information is for 232 mcg dose.

  • Nasopharyngitis - 4.8%, P - 4.4%
  • Upper respiratory infection - 5.5%, P - 4.8%
  • Oral candidiasis - 4.8%, P - 0.7%
  • Headache - 4.8%, P - 4.4%
  • Cough - 3.4%, P - 2.6%
  • CYP3A4 strong inhibitors - fluticasone is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to fluticasone
  • Severe milk allergy - DO NOT USE - contains small amount of lactose
  • - long-term ICS use in children may inhibit linear growth
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections and serious infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.) and/or serious systemic infections
  • Hypersensitivity reactions - serious hypersensitivity reactions including anaphylaxis have occurred with ICS
  • Paradoxical bronchospasm - paradoxical bronchospasm may occur after dosing
  • Eosinophilic Conditions and Churg-Strauss Syndrome - In rare cases, ICS use has been associated with eosinophilic conditions and Churg-Strauss Syndrome. Symptoms include eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy.
  • Liver disease - systemic exposure is likely increased. Use with caution.
  • Kidney disease - has not been studied
Drug Dosage form Dosage Generic/Price Other Mechanism of Action Indications
(FDA-approved)
Side Effects Drug Interactions Precautions/
Contraindications
Fluticasone
furoate

(Arnuity Ellipta®)
Arnuity Ellipta®
inhalation powder

  • Arnuity™ Ellipta® 100 - delivers 100 mcg of fluticasone furoate per inhalation
  • Arnuity™ Ellipta® 200 - delivers 200 mcg of fluticasone furoate per inhalation
  • Inhaler contains 30 doses
Asthma (12 years and older)
  • Starting: 100 mcg once daily
  • Maintenance: 100 - 200 mcg once daily
  • Max: 200 mcg once daily
  • Increase dose at intervals of 2 weeks
  • Inhale at the same time every day
NO/$$$$
  • Rinsing mouth after use may help prevent thrush

  • Protect from direct heat and sunlight

  • Discard Arnuity™ Ellipta® inhaler 6 weeks after opening foil tray
  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators
Asthma
  • Patients ≥ 12 years of age
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm
All ICS
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm

From the Arnuity™ Ellipta® PI
P = % of patients on placebo who reported side effect
  • Nasopharyngitis - 8%, P - 5%
  • Bronchitis - 7%, P - 6%
  • Headache - 6%, P - 4%
  • Upper respiratory infection - 6%, P - 5%
  • Pharyngitis - 4%, P - 3%
  • Sinusitis - 4%, P - < 1%
  • Oropharyngeal pain - 3%, P - 0%
  • CYP3A4 strong inhibitors - fluticasone is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to fluticasone
  • Severe milk allergy - DO NOT USE - contains small amount of lactose
  • - long-term ICS use in children may inhibit linear growth
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - systemic exposure is increased; use with caution in moderate-to-severe liver disease
  • Kidney disease - no dose adjustment necessary
Drug Dosage form Dosage Generic/Price Other Mechanism of Action Indications/
Recent studies
Side Effects Drug Interactions Precautions/
Contraindications
Fluticasone

(Flovent®)
Flovent® HFA inhaler
  • Flovent® 44 - 44 mcg per actuation
  • Flovent® 110 - 110 mcg per actuation
  • Flovent® 220 - 220 mcg per actuation
  • HFAs have 120 actuations

Flovent® Diskus - inhalation powder
  • Flovent® Diskus 50 - 50 mcg per actuation
  • Flovent® Diskus 100 - 100 mcg per actuation
  • Flovent® Diskus 250 - 250 mcg per actuation
  • Diskus have 60 actuations
Flovent HFA
  • Asthma (4 - 11 years)
    • Dosing: 88 mcg twice a day
  • Asthma (12 years and older)
    • Starting: 88 mcg twice a day
    • Max: 880 mcg twice a day
    • Maximum benefit seen after 2 weeks
  • See NHLBI ICS dosing chart for more detailed recommendations

Flovent Diskus
  • Asthma (4 - 11 years)
    • Starting: 50 mcg twice a day
    • Max: 100 mcg twice a day
    • Maximum benefit seen after 2 weeks
  • Asthma (12 years and older)
    • Starting: 100 mcg twice a day
    • Max: 1000 mcg twice a day
    • Maximum benefit seen after 2 weeks
  • See NHLBI ICS dosing chart for more detailed recommendations
NO/$$$-$$$$ Flovent® HFA
  • Shake well before using
  • Rinsing mouth after use may help prevent thrush
  • Prime before using for the first time by releasing 4 test sprays into the air
  • Re-prime inhaler with 1 test spray if not used for more than 7 days or if dropped

Flovent® Diskus
  • Protect from light
  • Rinsing mouth after use may help prevent thrush
  • Diskus should be discarded 6 weeks (50 mcg strength) or 2 months (100 and 250 mcg strengths) after removal from the moisture-protective foil pouch
  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators
Indications

  • Asthma
    • Patients 4 years of age and older
    • ICS are indicated for maintenance and prophylactic therapy
    • NOTE: ICS are NOT indicated for the relief of acute bronchospasm

Recent studies

All ICS
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm

From the Flovent® HFA PI
P = % of patients on placebo who reported side effect
  • Upper respiratory infection - 16%, P - 14%
  • Throat irritation - 8%, P - 5%
  • Sinusitis - 7%, P - 3%
  • Headache - 7%, P - 6%
  • Upper respiratory infection - 16%, P - 14%
  • CYP3A4 strong inhibitors - fluticasone is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to fluticasone
  • Severe milk allergy - (Flovent Diskus® only) - DO NOT USE - contains small amount of lactose
  • - long-term ICS use in children may inhibit linear growth
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - has not been studied extensively
  • Kidney disease - has not been studied extensively
Drug Dosage form Dosage Generic/Price Other Mechanism of Action Indications
(FDA-approved)
Side Effects Drug Interactions Precautions/
Contraindications
Mometasone

(Asmanex®)
Asmanex Twisthaler® - inhalation powder
  • Asmanex® 110 - 100 mcg per actuation
  • Asmanex® 220 - 200 mcg per actuation
  • Asmanex® 110 - 30 actuation inhaler
  • Asmanex® 220 - 30, 60, and 120 actuation inhalers
Asthma (12 years and older)
  • Starting: 200 mcg twice a day
  • Max: 400 mcg twice a day
  • Titrate dose at intervals of 2 weeks

See NHLBI ICS dosing chart for more detailed recommendations
NO/$$$$
  • Rinsing mouth after use may help prevent thrush

  • Discard the inhaler 45 days after opening the foil pouch
  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators
Asthma
  • Patients 4 years of age and older
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm
All ICS
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm

From the Asmanex® PI
P = % of patients on placebo who reported side effect
  • Headache - 17%, P - 20%
  • Allergic rhinitis - 11%, P - 13%
  • Pharyngitis - 8%, P - 7%
  • Upper respiratory infection - 8%, P - 7%
  • Sinusitis - 6%, P - 5%
  • CYP3A4 strong inhibitors - mometasone is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to mometasone
  • Severe milk allergy - DO NOT USE - contains small amount of lactose
  • - long-term ICS use in children may inhibit linear growth
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - has not been studied extensively
  • Kidney disease - has not been studied extensively
Drug Dosage form Dosage Generic/Price Other Indications
(FDA-approved)
Symbicort®

formoterol + budesonide
Symbicort® Inhaler (budesonide/formoterol)
  • Symbicort® 80/4.5 - 80 mcg/4.5 mcg per actuation
  • Symbicort® 160/4.5 - 160 mcg/4.5 mcg per actuation
  • Comes in inhaler with 120 actuations
Asthma
  • 6 to 11 years old
    • Dose: Symbicort 80/4.5 two inhalations twice daily

  • 12 years of age and older
    • Dose: two inhalations twice daily
    • Starting - may start with 80/4.5 or 160/4.5, depending on severity
    • Max: Symbicort 160/4.5 two inhalations twice daily
    • Maximum benefit seen after 2 weeks

COPD
  • For patients with COPD, the recommended dose is Symbicort 160/4.5 two inhalations twice daily
NO/$$$$
  • Shake well for 5 seconds before use

  • Inhaler is good for 3 months after removal from foil pouch

  • If you do not use your inhaler for more than 7 days or if you drop it, you will need to prime again

  • See patient instructions for details
  • Maintenance treatment of Asthma
  • Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)
  • NOT for relief of acute bronchospasm

Drug Dosage form Dosage Generic/Price Other Indications
(FDA-approved)
Dulera®

formoterol + mometasone
Dulera® Inhaler (mometasone/formoterol)
  • Dulera® 100/5 - 100 mcg/5 mcg per actuation
  • Dulera® 200/5 - 200 mcg/5 mcg per actuation
  • Comes in inhaler with 120 actuations
Asthma (≥ 12 years old)
  • Dose: 2 inhalations twice daily
  • Medium dose corticosteroids: Dulera® 100 mcg/5 mcg, two inhalations twice daily
  • High dose corticosteroids: Dulera® 200 mcg/5 mcg, two inhalations twice daily
  • Maximum benefit seen after 2 weeks

NO/$$$$
  • Shake well before use

  • Prime inhaler by releasing 4 test sprays

  • Re-prime if not used for ≥ 5 days
  • Maintenance treatment of Asthma
  • NOT for relief of acute bronchospasm

Drug Dosage form Dosage Generic/Price Other Indications/
Recent studies
Advair®

Salmeterol + fluticasone
Advair® Diskus (fluticasone/salmeterol)
  • Advair® 100/50 - 100/50 mcg per inhalation
  • Advair® 250/50 - 250/50 mcg per inhalation
  • Advair® 500/50 - 500/50 mcg per inhalation
  • Inhalation powder packaged in diskus with 60 doses

Advair® HFA (fluticasone/salmeterol)
  • Advair HFA® 45/21 - 45/21 mcg per actuation
  • Advair HFA® 115/21 - 115/21 mcg per actuation
  • Advair HFA® 230/21 - 230/21 mcg per actuation
  • Inhaler with 120 actuations per inhaler
Advair® Diskus
  • Asthma
    • 4 - 11 years old
      • One inhalation of 100/50 twice daily
    • 12 years of age and older
      • Dose: one inhalation twice daily
      • Starting: strength will depend on asthma severity
      • Max dose: 500/50, one inhalation twice daily
      • Maximum benefit seen after 2 weeks
  • COPD
    • 1 inhalation of 250/50 twice daily

Advair® HFA
  • Asthma in children ≥ 12 years and adults
    • Dose: two inhalations twice daily
    • Starting: strength will depend on asthma severity
    • Max dose: 230/21, two inhalations twice daily
    • Maximum benefit seen after 2 weeks

HFA and diskus
NO/$$$$
Advair® HFA
  • Shake well for 5 seconds before use
  • Prime before using for the first time by releasing 4 test sprays
  • In cases where the inhaler has not been used for more than 4 weeks or when it has been dropped, prime the inhaler again by releasing 2 test sprays
  • Rinse mouth after use

Advair® Diskus
  • The device should be discarded 1 month after removal from the moisture-protective foil overwrap pouch
  • Rinse mouth after use
Indications

    Advair® Diskus
    • Asthma in children ≥ 4 years and adults
    • Chronic Obstructive Pulmonary Disease (COPD)
    • NOT for relief of acute bronchospasm

    Advair® HFA
    • Asthma in children ≥ 12 years and adults
    • NOT for relief of acute bronchospasm

Recent studies

Drug Dosage form Dosage Generic/Price Other Indications
AirDuo RespiClick®

salmeterol + fluticasone
AirDuo RespiClick® powder inhaler (fluticasone/salmeterol)
  • AirDuo RespiClick® 55/14 - 55/14 mcg per inhalation
  • AirDuo RespiClick® 113/14 - 113/14 mcg per inhalation
  • AirDuo RespiClick® 232/14 - 232/14 mcg per inhalation
  • Each inhaler contains 60 actuations
Asthma (≥ 12 years old)
  • Starting: 55/14 mcg twice daily
  • Maintenance: 55/14 - 232/14 mcg twice daily
  • Max dose: 232/14 mcg twice daily
  • Increase dose at intervals of 2 weeks
  • Inhale at the same time each day
  • Patients switching from other inhaled corticosteroids may require higher starting doses
YES/$$
  • Inhaler does not require priming
  • Never wash or put any part of the inhaler in water
  • Do not use with a spacer or volume holding chamber
  • Asthma in children ≥ 12 years and adults
  • NOT for relief of acute bronchospasm
Drug Dosage form Dosage Generic/Price Other Indications
(FDA-approved)
Breo Ellipta®

vilanterol + fluticasone
Breo Ellipta® inhaler
  • Inhaler delivers 100 mcg of fluticasone powder and 25 mcg of vilanterol powder per inhalation
  • Inhaler comes with 30 inhalations
COPD
  • One inhalation once daily

Asthma (≥ 18 years old)
  • One inhalation once daily
NO/$$$$
  • See Breo Ellipta® PI for complete prescribing information

  • Discard inhaler 6 weeks after opening the foil tray

  • DO NOT USE in patients with severe milk allergy

  • Vilanterol is a CYP3A4 substrate. Use caution with strong CYP3A4 inhibitors.
  • Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)
  • Asthma in patients ≥ 18 years old that is not well-controlled with other medications
  • NOT for relief of acute bronchospasm