15
treatment, and varies with individual patients. The time to improvement in asthma
control was not evaluated in clinical studies with AEROSPAN Inhalation Aerosol. For
patients who do not respond adequately to the starting dose after 3-4 weeks of therapy,
higher doses may provide additional asthma control.
The safety and efficacy of
AEROSPAN Inhalation Aerosol when administered in excess of recommended doses
have not been established.
Note: In all patients it is desirable to titrate to the lowest effective dose once asthma
stability is achieved.
Adults (age 12 and older):
The recommended starting dose is 160 mcg twice daily. The
maximum dose should not exceed 320 mcg twice daily. Higher doses have not been
studied.
Children (age 6 to 11):
The recommended starting dose is 80 mcg twice daily. The
maximum dose should not exceed 160 mcg twice daily. Higher doses have not been
studied.
Pediatric patients should administer this product under adult supervision.
The recommended dosage of AEROSPAN Inhalation Aerosol relative to flunisolide CFC
inhalation aerosol is lower due to differences in delivery
characteristics between the
products. Recognizing that a definitive comparative therapeutic ratio between
AEROSPAN Inhalation Aerosol and flunisolide CFC inhalation aerosol has not been
demonstrated, any patient who is switched from flunisolide CFC inhalation aerosol to
AEROSPAN Inhalation Aerosol should be dosed appropriately, taking into account the
dosing
recommendations above, and should be monitored to ensure that the dose of
AEROSPAN Inhalation Aerosol selected is safe and efficacious. As with any inhaled
corticosteroid, physicians are advised to select the dose of AEROSPAN Inhalation
Aerosol that would be appropriate based upon the patient’s disease severity and titrate the
dose of AEROSPAN Inhalation Aerosol downward over time to the lowest level that
maintains proper asthma control.
Clinical studies with AEROSPAN Inhalation Aerosol did not
evaluate patients on oral
corticosteroids. However, clinical studies with therapeutic doses of flunisolide CFC
inhalation aerosol did show efficacy in the management of asthmatics dependent or
maintained on systemic corticosteroids.
If a patient is already on a systemic corticosteroid for asthma control, AEROSPAN
Inhalation Aerosol should be used concurrently with the patient’s usual maintenance dose
of oral corticosteroid before an attempt is made to withdraw systemic corticosteroid. The
patient’s asthma should be reasonably stable before withdrawal of
oral corticosteroid is
initiated. After approximately one week, gradual withdrawal of the systemic
corticosteroid may be started by reducing the daily or alternate daily dose. The next
reduction may be made after an interval of one or two weeks, depending on the response
of the patients.
In general, these decrements should not exceed 2.5 mg of prednisone or
its equivalent. A slow rate of withdrawal is strongly recommended. During reduction of
oral corticosteroids, patients should be carefully monitored for asthma instability,
16
including objective measures of airway function, and for adrenal insufficiency (see
WARNINGS). During their withdrawal
from a systemic corticosteroid, some patients
may experience symptoms of systemic corticosteroid withdrawal, e.g., joint and/or
musculoskeletal pain, lassitude and depression, despite maintenance or even
improvements in pulmonary function. Such patients should be encouraged to continue
with AEROSPAN Inhalation Aerosol and should be monitored
for objective signs of
adrenal insufficiency. If evidence of adrenal insufficiency occurs, the systemic
corticosteroid doses should be increased temporarily and thereafter withdrawal should
continue more slowly. During periods of stress or a severe asthma attack, patients being
transferred may require supplementary treatment with a systemic corticosteroid.
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